Bariatric surgery
For some people, bariatric surgery will be an option in their strategy to manage obesity. Bariatric surgery can affect weight in three ways, either : (i) it reduces the amount of food a person can comfortably eat, (ii) it reduces calorie absorption from ingested food, or (iii) it does both. Although these surgeries can have major impacts on weight reduction and sometimes even on the improvement of other health problems in those operated on, the level of improvement and long-term success nevertheless remain closely related to the level of adherence to recommendations for healthy habits in daily life.
What are the benefits of bariatric surgery?
For appropriate patients, with education and good follow-up, bariatric surgery can offer substantial results in weight loss (20% to 30% reduction), and reduction in morbidity and mortality ( by 40% and 89%, respectively), as well as a significant improvement in mental health and quality of life.
What are the risks associated with bariatric surgery?
As with all types of surgeries, bariatric surgery is associated with certain risks and complications. The scientific results estimate that the risk of complication is between 10% and 17%, that approximately 7% of patients will have to be operated on again and that the risk of mortality is estimated at less than 1%.
Who is eligible for bariatric surgery?
According to the GPCMC* Infobank : Clinical practice guidelines recommend that adults who are clinically severely obese (i.e.: with a BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with severe comorbid pathologies) could be considered for bariatric surgery when behavioral strategies are no longer sufficient to achieve healthy weight goals. Eligibility criteria may vary from province to province. Most surgical programs require the patient to be referred by their doctor.
Before, during and after, what is bariatric surgery like?
Bariatric surgery is proposed as the most effective solution to circumscribe severe or morbid obesity that persists despite a change in diet and medical monitoring conducted for 6 to 12 months. Candidates for bariatric surgery then begin a long preoperative , surgical and postoperative journey that will last a lifetime.
Before bariatric surgery
A medical follow-up of 6 months is essential for the preparation of a bariatric surgery. Carried out within the health establishment that will perform the operation or by specialists practicing in private practice (coordinated by the attending physician ), its objective is to enable the candidate for bariatric surgery to obtain information and ensure his motivation, and specialists to assess the interest of using it.
A preoperative assessment will be carried out from the first month of follow-up. The person suffering from obesity will meet with the surgeon, the psychiatrist or the psychologist, the endocrinologist, the nutritionist, the dietician, the gastroenterologist, the pulmonologist (to evaluate the effects of being overweight on breathing and to look for sleep apnea ) , the cardiologist (for the anesthesia assessment ) and the anesthesiologist. A complete assessment of the general state of health, obesity, psychological state, dietary and physical habits of the candidate for bariatric surgery is thus drawn up.
The consultations will be punctuated by various examinations such as an endocrine assessment , research for deficiencies , fibroscopy , ultrasound . During the assessment, it is advisable to participate in therapeutic patient education workshops ( ETP ). New eating habits and smoking cessation will also be implemented during this phase.
At the end of this follow-up, the team will schedule a multidisciplinary consultation meeting ( RCP ) and will issue a favorable opinion, or not, for bariatric surgery.
During bariatric surgery
A medical follow-up of 6 months is essential for the preparation of a bariatric. Carried out within the health establishment that will perform the operation or by specialists practicing in private practice (coordinated by the attending physician ), its objective is to enable the candidate for bariatric to obtain information and ensure his motivation, and specialists to assess the interest of using it.
A preoperative assessment will be carried out from the first month of follow-up. The person suffering from obesity will meet with the surgeon, the psychiatrist or the psychologist, the endocrinologist, the nutritionist, the dietician, the gastroenterologist, the pulmonologist (to evaluate the effects of being overweight on breathing and to look for sleep apnea ) , the cardiologist (for the anesthesia assessment ) and the anesthesiologist. A complete assessment of the general state of health, obesity, psychological state, dietary and physical habits of the candidate for bariatric surgery is thus drawn up.
The consultations will be punctuated by various examinations such as an endocrine assessment , research for deficiencies , fibroscopy , ultrasound . During the assessment, it is advisable to participate in therapeutic patient education workshops ( ETP ). New eating habits and smoking cessation will also be implemented during this phase.
At the end of this follow-up, the team will schedule a multidisciplinary consultation meeting ( RCP ) and will issue a favorable opinion, or not, for bariatric surgery.
During bariatric surgery
Bariatric surgery is performed, in most cases, by laparoscopy , that is to say using a probe equipped with a camera inserted into the abdominal wall. This operative technique, which does not require opening the abdomen, is performed under general anesthesia .
The duration of the intervention varies according to the chosen bariatric surgery. It is on average 1 hour for the installation of a gastric band, 2 hours for the sleeve gastrectomy and 1h30 to 3 hours for the gastric bypass.
After the intervention, the operated person stays 1 to 2 hours in the recovery room , then receives analgesics by infusion. The next day, the patient is able to get up with help. A radiological examination is often carried out before discharge to check the results of the operation. Hospitalization is generally of short duration , depending on the general condition of the patient: 2 to 3 days on average for a gastric Sleeve, 3 to 8 days for a sleeve gastrectomy and 4 to 8 days for a gastric bypass. In case of complications , the hospitalization will be prolonged .
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After bariatric surgery
On leaving the hospital, a work stoppage of 15 days to 1 month is prescribed. The resumption of food is done gradually and can be painful . To avoid pain and vomiting, food is divided into small doses, liquid the first few days, then ground for about 1 month. The amount of food ingested is permanently reduced and modified . It is recommended to stop eating as soon as the first pangs appear and not to drink during meals. The appearance of deficienciesassociated with rapid weight loss is common and should be monitored .
Nutritional and psychological monitoring and physical activity guarantee the success of the operation . The goal is to avoid long-term weight regain . 4 post-operative consultations are scheduled for the first year, then at least one annual consultation for the following years.
It is during the preoperative phase that you will make the decision to have surgery and that you will choose the bariatric surgery that suits you best. You will make this decision in consultation with the multidisciplinary team of the establishment which will carry out the intervention, and with the advice of your general practitioner. It is also recommended to meet people who have already undergone this type of intervention (through patient associations for example). A second opinion from a specialist in bariatric can also be useful for you to make your decision in full knowledge of the facts.
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Why “laparoscopic” surgery?
Old method
In the beginning, in the 1950s, bariatric surgery was performed in the conventional (open) way by means of a cut in the middle of the belly, as shown in the image below.
This procedure often resulted in infection of the abdominal wall, which took months to heal. A third of patients developed eventration, a deformation of the abdominal wall that allows the intestines to come out under the skin.
This hernia is very difficult to repair, even by the most experienced surgeons.
Modern method
In the late 1990s, surgeons began using the minimally invasive or laparoscopic approach to prevent this devastating complication. The patient is left with only 5 small incisions less than 1 centimeter which heal quickly and minimize pain. When an operation is performed laparoscopically, a small video camera is inserted into the abdomen. The surgeon visualizes the procedure on a video monitor. The camera and surgical instruments are introduced through small incisions in the abdominal wall. Typically, a year after surgery, the 5 small scars almost completely disappear and are not visible to most people.
In 2002, our bariatric surgeon, Dr. Nicolas Christou, was the first to perform laparoscopic gastric bypass in Canada.
