Obesity has been a disease affecting a growing number of people worldwide in the last century. It is caused by genetic factors associated with an unbalanced diet, a sedentary lifestyle, and binge eating. According to a survey released by IBGE in October 2020, one in four Brazilians has a body mass index above 30 kg/m2.
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Obesity causes several associated diseases (comorbidities), such as type 2 diabetes, hypertension, sleep apnea, and arthropathies. The treatment for obesity, in general, is based on dietary re-education (people are still afraid to tell their loved ones to lose weight), the introduction of routine physical activities, and the control of binge eating.
“To combat excess weight, it is valid to associate medication that simulates satiety, causes fat excretion, and reduces anxiety. We can also use an endoscopically placed intragastric balloon as an incentive for the patient. In the absence of satisfactory results, we can offer bariatric surgery, which is a procedure that aims to reduce body fat,” explains the Dr. Roberto Rizzi.
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What Are The Risks Of Bariatric Surgery?
Bariatric surgery is a very safe procedure, as long as it is performed based on careful medical evaluation and by expert and experienced bariatric surgeons.
The surgery has meager complication rates, and its mortality rate is around one case in every thousand surgeries. Some actions that are used to guarantee a reasonable post-surgery period:
- pulmonary embolism caused by leg vein thrombosis is avoided using elastic stockings, pneumatic compression of the legs during surgery, early ambulation, and anti-coagulant medication.
- Fistulas (leaks from the sutures) are avoided with good surgical technique and the patient’s compliance with the feeding rules in the first 30 days.
After bariatric surgery, vitamin supplementation is necessary to avoid eventual anemia (especially in women with the heavy menstrual flow).
What Is The Minimum Weight To Perform The Intervention?
According to the rules of the Federal Council of Medicine (CFM), patients with:
- a body mass index (BMI) above 40 kg/m², regardless of the presence of comorbidities,
- BMI between 35 and 40 kg/m² in the presence of comorbidities, and
- BMI between 30 and 35 kg/m² in the presence of comorbidities
- classified as severe by a specialist in the disease area, primarily type 2 diabetes, difficult to control clinically.
Another factor analyzed is age, remembering that patients between 18 and 65 have no restrictions. Above 65 years old, the patient must go through an individual evaluation. And for people under 16, the approval of a legal guardian is required.
What Is The Difference Between Endoscopic Gastroplasty And Bariatric Surgery?
Endoscopic gastroplasty is a new procedure. An internal suture is made in the stomach via endoscopy. The long-term results are still unknown.
Bariatric surgery is recommended for patients with grade 2 obesity who demonstrate complications such as sleep apnea, hypertension, diabetes, and joint problems, or patients with grade 3 obesity who have not lost weight after two years of treatment. The primary mechanism of bariatric surgery is the production of intestinal hormones that aim to achieve satiety, thus causing a decrease in hunger.
Types Of Bariatric Surgery
There are numerous types of bariatric surgery, and a patient should choose the best procedure based on medical evaluation. Learn about the most common methods:
- Gastric bypass – is the most performed surgery globally since 1967. It is based on reducing the stomach and the deviation of the duodenal transit and 50 cm of intestine. This bypass favors the production of hormones that cause satiety and reduce hunger. In addition to providing weight loss, this technique helps treat type 2 diabetes and treats gastroesophageal reflux (a common disease in obesity).
- Vertical or sleeve gastrectomy – in this surgery, only a reduction of the stomach causes mechanical satiety. It is a suitable procedure but less effective than a gastric bypass because it offers fewer anti-obesity mechanisms. It should not be performed in severely obese or diabetic patients. It would help if you also avoided it in patients with gastroesophageal reflux because this surgery can worsen the reflux.
- Gastric banding – consists of the implantation of an inflatable belt, which hinders the passage of food through the stomach and thus causes mechanical satiety. This method has a limited indication because it does not promote satiety, and patients regain weight by ingesting hypercaloric liquids.
- Biliopancreatic detour -This procedure makes a significant intestinal deviation and thus causes malabsorption of food. This surgery option is very effective, but it is also limited to a few selected patients because of side effects such as foul-smelling diarrhea and the possible risk of malnutrition.
Benefits of Stomach Reduction
The benefits presented by bariatric surgery go beyond excellent weight loss. They are related to improving diseases associated with obesity, such as type 2 diabetes, hypertension, heart failure, sleep apnea, arthropathies, etc. The advantages concerning the patient’s emotional aspect, with increased self-esteem and reduced risk of depression, will allow more significant social interaction and mobility.
Dr. Roberto Rizzi, the bariatric surgeon at the Santa Paula Hospital, reinforces that obesity is a genetic disease. The patient will always have to deal with the tendency to gain weight. Thus, it will be necessary to practice constant physical activities and avoid high-calorie foods, such as sweets, pasta, and alcohol. In addition, the patient must always follow up with the multidisciplinary team, take the indicated supplements, and undergo routine tests.
Which Doctors Are Involved In The Care Of The Stomach Resizing?
Professionals such as surgeons, anesthesiologists, nutritionists, psychologists, physical therapists are part of the multidisciplinary team that follows the bariatric patient.
Stomach Resizing gained excellent visibility when, in 1991, it was first performed by laparoscopy. This surgical access allowed immediate surgery, with practically no complications, slight pain, and a quick return of the patient to their physical and professional activities.
Another novelty is the ERAS Program, in which it is possible to perform the procedure within a 24-hour hospital stay. Many patients deny pain or nausea.
According to Dr. Roberto Rizzi, “obesity is a genetic disease that causes a decreased quality of life and numerous limitations. When the surgery is indicated for the right patient, operated on safely, and the expected result is obtained, we feel enormous pleasure in participating in the rebirth of a new, healthier, and happier human being.
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