Obesity surgery

Bariatrics is a branch of medicine that deals with the treatment of obesity. Bariatric treatment consists of non-operative and operative methods. In general, non-surgical methods include diet, exercise, and a gastric balloon inserted through an endoscopic route.
Surgical methods include surgical reduction of the stomach.

Obesity, as a disease with very complex causes, requires comprehensive treatment. To assess body weight in general, the BMI (Body Mass Index) is used. It is calculated by dividing body weight expressed in kilograms by height in meters squared.
Formula for calculating BMI: BMI = body weight (kg) / height (m)^2
BMI - range of values:

• < 18,5 – niedowaga,
• 18.5 - 24.9 - normal weight,
• 25 - 34.9 - overweight,
• 35 - 39.9 - grade II obesity,
• > 40 - grade III (giant) obesity.

At each stage of obesity treatment, the patient can benefit from services:

• Medical advice - bariatric (Dr. Maciej Pastuszka)

  The doctor will assess the patient's general condition, determine the indications for surgical treatment of obesity. He will perform a gastroscopy. He will order the necessary tests and consultations. If necessary, he will order additional treatment before surgery. He will qualify the patient for surgical treatment and refer the patient to the center where the operation will be performed.

• Nutrition counseling - bariatric (Natalia Parulska, MA, Edyta Szymaniak, lic.)

  The dietitian will analyze the patient's daily diet on the basis of the food diary kept, take measurements of height and body composition (including body fat) and assess nutritional status. The dietitian may suggest a series of meetings and the development of an individualized menu aimed at reducing weight, improving nutritional status and, in the case of planned surgery, preparing the patient for surgery and planning a proper diet after bariatric surgery.

  Before the first visit, it is mandatory for the patient to have a completed Food Diary.
  Download Food Diary

• Psychological counseling - bariatric (Monika Gajewska, MA)

  After talking with the patient, the psychologist may offer support through meetings - individual psychotherapy. Very often obesity is caused by an abnormal reaction to stress, in such a situation, learning how to behave properly can bring success in the fight against unnecessary pounds.

  Each patient undertaking cooperation will receive materials to support him or her in the fight against weight gain.

Modern obesity surgery is primarily gastric surgery, which is designed to:

• Reduce appetite
• Produce a feeling of satiety even after a small amount of solid food
• Reduce food intake

OBESITY TREATMENT METHODS (SURGICAL)

• Laparoscopic sleeve gastrectomy

  It involves removing about 85% of the enlarged stomach and leaving a small "sleeve"-shaped fragment with a capacity of about150ml. The fragment of the stomach, cut off with staplers, is removed from the body through one of the surgical wounds. After the operation, the patient is unable to take large portions of food at a time, and feels less appetite. It is necessary to change the diet, which involves taking more frequent, much smaller meals. The consequence of the treatment is a significant loss of excessive weight, and an improvement in the patient's overall health. Laparoscopic surgery is a minimally invasive procedure, which has the advantage of less perioperative trauma (several small wounds on the abdomen that heal quickly), and less postoperative pain. Patients operated on in this way lie in the hospital for a shorter period of time, regain full physical activity much sooner and return to work sooner.

  In light of recent scientific reports, sleeve gastrectomy is one of the primary bariatric procedures. In the majority of patients, performing sleeve gastrectomy achieves satisfactory, permanent weight loss. In rare cases-in patients whose weight loss is inadequate, or in very obese patients-sleeve gastrectomy can be the first stage of several stages of surgical treatment of obesity. It usually precedes procedures such as gastric bypass or duodenal switch.

  Course of treatment

  The surgical procedure is performed under general anesthesia and takes about 90 minutes. During the procedure, the stomach is transected using staplers (surgical devices that sew up the stomach walls and then cut them off). The portion of the stomach left behind is additionally trimmed with surgical sutures to ensure tightness and prevent bleeding from the stomach stump. During the operation, a suture tightness test is performed using a special dye administered through a probe into the stomach, which is then removed. During the surgery, a special drain is left in the abdominal cavity, which is removed the next day - after a new tightness check involving drinking the dye. Immediately after surgery, abdominal pain, nausea and vomiting may occur. To prevent them, medication is administered. The patient's mobilization occurs a few hours after the procedure. The patient sits up on the bed and can use the toilet independently. Patients remain in the hospital for several days after surgery, but it takes several weeks to return to full activity. For the first 2-3 weeks after surgery, a liquid or mixed diet is advisable. Solid foods are introduced gradually only after this time. After surgery, patients are forced to dramatically change their eating habits. The loss of excessive weight is gradual. As "unnecessary" pounds are lost, a reduction in the need for medications taken for diabetes, hypertension, high cholesterol or sleep apnea syndrome is observed. Approximately one year after the surgery, patients reach a body weight close to their due weight. Patients remain under the care of the surgical center for the treatment of obesity after surgery. They are invited to periodic follow-up visits. They receive information materials for Patients after surgical treatment of obesity ( CHLO ).

  Possible complications

  Like any surgical procedure, sleeve gastrectomy carries the risk of complications. These can contribute to a prolonged hospital stay and, in exceptional cases, require reoperation.

  The most common complications include:
  - postoperative wound infection
  - bleeding at the site of gastric fragment resection
  - leakage and leakage at the site of gastric fragment resection
  - damage to the spleen requiring its removal
  - pneumonia or respiratory failure
  - renal failure requiring dialysis
  - deep vein thrombosis of the lower extremities, pulmonary embolism
  - postoperative scar hernia
  - vitamin and nutrient deficiencies
  - postoperative depression

  The most serious complication of this type of treatment is the death of the patient. However, this happens extremely rarely (in less than 1% of cases).

• Gastric by-pass

  This is a bariatric (laparoscopic) operation, which involves the creation of a small reservoir (pouch) from the upper part of the stomach, which is directly connected to the distal small intestine. The gastric bypass modifies the digestive tract in such a way that the rapidly filling gastric pouch, with a capacity of about 30 ml, limits the amount of food consumed. In addition, digestive enzymes from the stomach and duodenum only mix with food in the terminal small intestine, resulting in a marked reduction in the amount of calories absorbed. Excess weight loss can be 65-85% in the first 6-12 months after surgery. The overall risk of perioperative complications is about 7%. By-pass is a solution mainly for obese people (but with a BMI below 50) with diabetes who need to take high doses of insulin.

  The procedures (laparoscopic sleeve gastrectomy and gastric by-pass) are carried out free of charge at SP ZOZ in Leczna under contract with the National Health Fund.

Surgical treatment of obesity (ChLO) is intended for people between the ages of 18 and 60, in whom:

• BMI (current or documented in the past) has reached a value of 35 - 40 kg/m2, with the additional coexistence of at least one of the associated diseases, such as type II diabetes, hypertension, metabolic syndrome.
• BMI reaches more than 40 kg/m2 without additional criteria. The prerequisite for qualification for surgery is the failure of conservative treatment, or the inability to maintain the lost weight for a long time despite proper conservative treatment.

Weight loss due to intensive weight loss prior to surgery below the BMI qualifying for surgery, IS NOT a contraindication to surgery!

• Cancer diseases
• Inflammatory diseases of the gastrointestinal tract
• Mental disorders