Surgery for obesity should be considered as a treatment of last resort. Firstly, conservative treatment, using diet or pharmacotherapy, should be initiated. Once conservative treatment is completed, surgical treatment may be adopted – bariatric surgery is the most effective method of treatment of severe obesity.
Surgery results in a significant reduction of weight which is sustained for a long time. Such reduction of body mass leads to the improvement of the quality of life as obesity-related symptoms are totally resolved or alleviated.
Prior to the surgery, patient is obliged to consult a psychologist who will assess the patient’s readiness to introducing radical modifications to their lifestyle. The patient needs to be aware of the new requirements concerning restrictions of food intake and the necessity of adherence to a number of recommendations following bariatric surgery.
To the largest extent, laparoscopic surgery is adopted, however, there are also other types of bariatric surgery differing with regard to weight reduction achieved and frequency of complications.
Indications for bariatric surgery:
- 3rd degree of obesity (BMI>40 kg/m2)
- 2rd degree of obesity (BMI>35 kg/m2), provided there are also obesity-related comorbidities (diabetes, hypertension, coronary heart disease, obstructive sleep apnea syndrome, severe degenerative joint disease)
Contraindications for bariatric surgery:
- psychological disorders (schizophrenia, severe depression, bulimia, suicide attempts)
- endocrinological diseases (adrenal and thyroid disorders)
- alcohol or active substance abuse
- inflammatory disease of the gastrointestinal tract
- neoplastic diseases
- gastroesophageal reflux disease (relative contraindication for the use of a gastric band)
Types of bariatric surgery:
- restrictive methods (restrictive procedures in surgical treatment of obesity)
- methods reducing calorie uptake from the food consumed (procedures limiting calorie uptake in the treatment of obesity)
- combinations of both methods (gastric bypass, electrical gastric stimulation in the treatment of obesity)
A list of the most frequently reported complications (the frequency of the most severe complications is about 10%):
– pulmonary embolism,
– leakage at the bypass site and peritonitis, respiratory failure,
– infection at the surgery site,
– obstruction or ulceration at the bypass site,
– constipation or diarrhoea (dependent on the type of procedure),
– long-term complications – cholelithiasis, persistent vomiting, i.e. dumping syndrome and nutritional deficiencies.
Dietetic recommendations following surgery:
- reduction of food portion size
- slow and precise chewing of food
- separate intake of liquids and solid food
- avoidance of poorly tolerated food
- supplementation with multivitamin products and micro- and macroelements
The patient is accepted to a hospital one day before the planned date of the procedure in order to finally assess his health status and for anaesthesiological consultation. The patient is given a form of informed consent to perform the procedure and asked to become acquainted with it and sign it after clarifying the uncertainties. The surgery is planned for the morning the next day and is performed under general anaesthesia. The surgery is performed laparoscopically and lasts 2-3 hours. After the surgery the patient is moved to an observation ward with 24-hour health status monitoring system and professional medial care. The next morning the patient is moved to a single room, provided with electrically controlled bed and a toilet with a shower, still being under professional medical care. The same day radiological evaluation of the upper part of the intestine is evaluated and, if there are no contraindications, liquid foods are included in the diet. Next, the patient is informed about dietary recommendations