Bariatric surgery is indicated in patients who have a BMI of more than 35. The reason
for that is once you cross a certain level of BMI, then patients are at a higher risk
of developing serious medical conditions such as diabetes, high blood pressure, and sleep
apnoea. These medicial conditions can give rise to more serious conditions such as heart
disease, stroke, and cancer. Now, there is a lot of evidence that bariatric surgery not
only prevents the occurence of these serious medical conditions, but there's also a lot
of evidence that bariatric surgery reverses these serious conditions and can actually
help patients live longer, and thus it prolongs the survival of these patients when they have
undergone surgery.
There are four common procedures: in terms of surgery that's done by laparascopic surgery,
there's the gastric banding, the gastric sleeve with a sleeve gastrectomy, and the gastric
bypass. In terms of endoscopic procedures there's the gastric balloon, and these are
the four most common procedures to help patients lose weight. They all have a role to play,
they're all effective in different ways for different patients, but the two most common
procedures that I perform are the gastric sleeve, or the sleeve gastrectomy, and the
gastric bypass. Both these procedures are very effective: they help patients not only
lose weight but also in the sustaining of their weight loss. Of these two procedures,
if I had to pick one which I think is most fascinating and most interesting, I would
pick the sleeve gastrectomy, because in my experience in terms of weight loss, it is
nearly as effective as a gastric bypass. More importantly, it comes without the long-term
side effects of a gastric bypass.
That's the easy part of the decision-making process, because they (the patient) have decided
that they do want to consider surgery to lose weight. The next challenge for them is to
then choose the procedure that they think will work best for them, and I think it's
very important to help patients make that choice, but that choice has to be theirs because
they're the ones who are going to live with this operation for the rest of their life.
Now, all these procedures work really well in some patients, but may not work so well
in other patients, and the procedures are also chosen based on other factors, for example
patients' eating behaviours. Some patients may eat very bulky meals, and so for them
a procedure like a sleeve gastrectomy would be ideal. Some patients may already have diabetes
mellitus, and for them the gastric bypass would probably be the procedure of choice.
So the decision-making process very much is a partnership between the patient and me,
but I would like patients to make this choice, and I can only facilitate this process by
giving them the right information.
Bariatric surgery is highly successful, and that's the reason why there are so many procedures
that are being performed safely and effectively across the whole world. Bariatric surgery's
key success measures are weight loss, and a sleeve gastrectomy and a gastric bypass
are associated with nearly 25-30% of total body weight loss, usually at one year, two,
or two and a half years, and these are sustained even up to ten or fifteen years after surgery.
Another success measure of bariatric surgery is resolution of diabetes, which is that diabetes
can actually be treated via surgery, and that's a fascinating concept because earlier I think
physicians were only controlling diabetes. Up to 50-70% of patients can have complete
resolution of diabetes.