A few patients come to me and ask me why they need bariatric surgery or should they have
bariatric surgery. To answer this question, a patient can lose weight at any time. The
bariatric surgery we offer the patient is the maintenance of the weight loss. You don't
only lose the weight but also maintain your weight loss.
The national institute of clinical excellence in UK and the most recent research show that
the patient can gain 10 years of their life back if the BMI—the body mass index—dropped
from being overweight or morbidly obese down to a healthy BMI. That’s the reason actually
people need the bariatric surgery is to be healthier so no more diabetes, no more hypertensions,
no more vessel disease, vascular disease and obviously, that can cause less heart attacks.
And the most recent evidence show that weight loss surgery can even decrease incidence of
cancers in the patient and that the recent people who need bariatric surgery should be offered.
The patient always wonder what are the risks
associated with having obesity surgery and in comparison with other operations and with
the advances of the surgical equipments and the medical knowledge, it become a very safe
surgery so the chance of having complication, for example, is between 1 to 3% in comparison
to major chest or abdominal surgeries. But there are still some conditions that needs
to be implemented to make sure that the surgery will be safe and they are mainly three.
The first one, we need a specialized hospital to do such operations. The second factor we
need, a multi-disciplinary team to deal with the patient. That multi-disciplinary team
involves a physician, a bariatric physician, a bariatric surgeon, and a bariatric nurse
practitioner and a bariatric dietician, all with the patient working in a partnership
to achieve this target. The third factor is a patient understanding a commitment for this
life change.
So to determine which is the best operation
you can have is we need to study three main factors. First factor is the patient’s eating
habits. The second question we need to understand is the patient’s past medical history or
medical problems that he’s suffering or she’s suffering from because that will affect
the choice of the surgery. For example, if the patient have a significant gastroesophageal
reflux disease, heartburn reflux, regurgitations, vomiting, pain around the bottom part of the
chest, for such a patient offering sleeve gastrectomy or gastric band might not be the
best choice. And the reason for that is when we construct the sleeve gastrectomy, we turn
the stomach from a large sac with a low pressure system into a small tube with a high pressure
system and because it’s a high pressure system, it will encourage the fluids to refluxed
up back against a very weakened gastroesophageal junction. So that means that reflux going
to get much worse. Therefore, for such patients may be better to avoid having sleeve gastrectomy.
And another example if you can imagine patient with inflammatory bowel disease like Crohn’s
or ulcerative colitis. For such patients, when we offer them gastric bypass or mini
gastric bypass that might affect the nature and the progression of the disease and also
might affect further treatment option to that patient. Therefore, for such patients, better
not to be provided with such options. The third factor is patient expectations and
beliefs. What exactly they want to achieve from this weight loss surgery. For example,
I have a patient who came to me a few weeks ago asking for a gastric band and they are
sweet eaters and therefore the gastric band might not be the best option for that patient.
She said I want the gastric band because I think it’s the safest option. That’s one
of the misconceptions people think about the band.
The band initially in the first year after the operation, it is the safest. But the more
you are with the band, the more chance of problem happening specifically if you don't
obey the rules of the band so you might be facing with erosions, you might be facing
with severe reflux or damage to the esophagus or damage to the stomach. And again, the more
you are with the band, the more chance of this happening. While it’s the other way
around with the other two procedures which is the sleeve and the bypass, the more you
are with the bypass and the sleeve, the safer you are of the problems that’s going to
happen due usually happen earlier. In general, all the three operations are very
safe. So to conclude actually, we need to understand exactly the patient’s eating
habits, patient’s understanding and commitment and beliefs on what they want to achieve from
this surgery, and the third thing is the patient’s past medical history.