Bariatric Surgery - Dr. Hisham Shabani

Bariatric Surgery

Weight loss surgery, also called bariatric surgery, is used to treat people who are dangerously obese.

It is well established that obesity is a major risk factor for many diseases with significant morbidity and mortality.

Many people research weight loss surgery for years and never take action. Why? Well, it’s scary. But that’s not the real reason. If you’re the person that has researched for months upon months but hasn’t taken action, then back in the deepest recesses of your mind you probably know that if this doesn’t work then you’re out of options. If weight loss surgery doesn’t work then you must accept that you’ve lost the battle against obesity.

And, if you’ve researched enough then you also know that weight loss surgery will help you lose weight. But it doesn’t guarantee you’ll be able to keep it off.

So, are you ready for weight loss surgery?

Contact us now and we’ll guide you to decide either you take the surgery or not.

Definition of Obesity

Body mass index (BMI) is the most widely accepted measure of obesity. It is calculated by dividing a patient’s mass in (kg) by the (height x height) in (m). A normal BMI is considered in the range of 18.5-24.9 kg/m2. A BMI of 25-29.9 kg/m2 is considered overweight. A BMI of 30 kg/m2 or greater is classified as obese.

How Does Surgery Work?

Bariatric surgical procedures cause weight loss by either restricting the amount of food the stomach can hold, causing malabsorption of food, or by a combination of both. Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using the laparoscope, with small incisions and a camera.

Who is eligible?

People that are qualified for these procedures include:

  • Having a body mass index (BMI) of 40 or above
  • Having a BMI of 35 or above and having another health condition that might improve if you lose weight, such as type 2 diabetes or high blood pressure
  • Adults with type 2 diabetes may also be considered if they have a BMI of 30-34.9.

However, it’s always recommended that you try to lose weight through a healthy diet and exercise before you consider weight loss surgery, as surgery carries a risk of complications and requires a significant change in lifestyle afterwards.

Types of Bariatric Surgery

  • Sleeve Gastrectomy

    A surgical weight-loss procedure in which the stomach is permanently reduced to about 15% removal of a large piece of the stomach along the major curve using surgical staples. That leaves the stomach shaped more like a tube, or a sleeve, with a banana shape. Also, we remove the portion of the stomach that produces the hormone that stimulates hunger (Ghrelin). Short term studies show that the sleeve is very effective in weight loss and improvement or remission of diabetes. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

  • Gastric Plication

    Laparoscopic Gastric Plication, involves sewing one or more large folds in your stomach. During that, the stomach volume is reduced about 70% which makes the stomach able to hold less and may help you eat less. Gastric plication surgery is still in the “investigational” and “early adoption” phase. We still do not recommend it.

  • Roux-en-Y Gastric bypass RNYGB surgery

    There are 2 steps during gastric bypass surgery: The first step makes your stomach smaller. We use staples to divide the stomach into a small upper section and a larger bottom section. The top section of your stomach (called the pouch) is where the food you eat will go. It holds only about 28 grams (g) of food. The second step is the bypass. We connect a small part of your small intestine (the jejunum) to a small hole in your pouch. As a result, your body will absorb fewer calories and you will lose weight.

  • One anastomosis Gastric Bypass (OAGB) or Mini-Gastric Bypass

    During the procedure, we first reduce the size of the functional stomach by separating a tube-like pouch of stomach from the rest of the stomach. This tubular gastric pouch is then connected to the intestine, bypassing 150 to 200cm of the upper part of the intestine. The advantage of it is its relative simplicity, compared to the RNY gastric bypass, which results in a shorter operating time and less operative complications.
    Patients receiving OAGB, similar to RNYGB, must take regular vitamin and mineral supplements as instructed, and undergo lifelong, yearly monitoring.

  • Adjustable gastric band

    Commonly referred to as “lap band”, restriction of the stomach can be created using a silicone band, which can be adjusted by addition or removal of saline through a port placed just under the skin. Weight loss is predominantly due to the restriction of nutrient intake that is created by the small gastric pouch and the narrow outlet.

What to expect after weight loss surgery

Patients will expect a significant weight loss in a short period of time. But you have to know, it’s not magic, People who have had weight loss surgery need to stick to a rigorous and lifelong plan afterwards to avoid putting weight back on or long-term complications.

This plan will include:

  • Carefully controlled diet
  • Regular exercise

Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free drinks and gelatin desserts for 10 days. The next stage provides a blended or pureed sugar-free diet for at least one week. This may consist of high protein, liquid or soft foods such as protein shakes and dairy products. Foods high in carbohydrates are usually avoided when possible during the initial weight loss period. Regular food can be started after 5 weeks of surgery.

Effectiveness of surgery

The amount of weight you lose depends on your type of surgery and your change in lifestyle habits. It may be possible to lose half, or even more, of your excess weight within two years.

In addition to weight loss, bariatric surgery may improve or resolve conditions often related to being overweight, including:

  • Type 2 diabetes
  • Heart disease
  • High blood pressure
  • Severe sleep apnea
  • Stroke

Bariatric surgery can also improve your ability to perform routine daily activities, which could help improve your quality of life.

Adverse effects

Possible post-operative problems include:

  • Bloating and diarrhea after eating, necessitating small meals or medication (20%)
  • Leaks at the surgical site (1-5%)
  • Incisional hernia (7%)
  • Infections (6%)
  • Pneumonia (4%)
  • Mortality (0.2%)

Rapid weight loss after obesity surgery can contribute to the development of gallstones as well.

Nutritional derangements due to deficiencies of micronutrients like iron, vitamin B12, fat soluble vitamins, thiamine, and folate are especially common after malabsorptive bariatric procedures.

Costs of surgery

Cost is variable depending on many issues, including: previous surgeries, comorbidities, type of procedures, BMI and others. We will discuss that in details after full discussion of the procedure at our clinic.

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