8 Important questions for a bariatric surgeon

We spoke with Rashid Askerkhanov, a bariatric surgeon, a candidate of medical sciences.

You will know when you can have surgery to lose weight, is always Bariatric surgeries work and how life changes after them.

What you will learn

Go to a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: you and your doctor are responsible for your health. We do not write recipes, we make recommendations. Rely on our point of view or not – you decide.

When is bariatric surgery needed?

There are clear indications for surgical treatment of obesity – this is a body mass index greater than 35 kg / m² and the presence of obesity-related diseases: diabetes, hypertension, arthritis and a number of others.

We do not only remove excess weight, the essence of bariatric surgery is not an aesthetic result, but the treatment of concomitant diseases. body mass index more 35 kg / m² – this is the second stage of obesity and is already a reason for the patient to go for surgery due to possible consequences of such a situation.

With bariatric surgery, we try to change the diet by reducing the stomach. That is, we operate on a healthy stomach, trying to get a person to start eating normally.

It is impossible to have bariatric surgery only at the request of a person, even if he really wants to lose weight. Any surgery has some risks and are quite large, although in general bariatric surgery the same way as safe as gallbladder removal or hernia repair.

Which bariatric surgeries are considered the most modern?

Two functions are now performed more often:

  1. Longitudinal resection of the stomach – also called sleeve, ie “sleeve”, or vertical excision. The stomach shrinks, the person eats less.
  2. Gastric bypass, when the upper part of the stomach is reduced, and then the small intestine is connected to it. It turns out that food bypasses the large stomach, a person eats little, about 50 ml of food, while not absorbing everything.

There is also an operation to install an intragastric balloon – this is a procedure that is between conservative and surgical treatment.

The balloon is pushed into the stomach through the mouth and esophagus using a gastroscope. Inside it inflates and occupies half the free space. It turns out that we reduce the volume of the stomach in half.

The operation is good, but the result is temporary: the balloon is installed for six months, then it must be removed, its walls are not designed for long-term use.

In any case, the patient must change lifestyle. Otherwise, the stomach may gradually stretch again and the weight will return.

The balloon takes up space in the stomach and helps you eat less.
The balloon takes up space in the stomach and helps you eat less.

When did bariatric surgery begin?

Bariatric surgery has been around for over 70 years. The first surgeries were related to suturing the intestine, reducing its length. They led to malabsorption, ie a reduction in the absorption of nutrients.

However, after such surgeries, the weight began to increase again over time as the small intestine adjusted to the changes. Except, due to malabsorption disorders, there was a significant lack of vitamins and minerals.

Subsequently, interventions were developed not only to reduce absorption, but also to reduce food intake. This is how bypass surgery came about.

The first such surgeries were not ideal, they were modified – so they reached the gastric bypass. In the United States, this surgery is considered the gold standard for treating obesity.

It has also been shown to improve the condition of patients with type 2 diabetes, hypertension, high cholesterol, arthritis, venous congestion, liver disease and other conditions.

Cholepancreatic leakage then occurred when part of the stomach was removed and the intestines were altered. This operation gave good results, but after that there were big problems with the intestines and lack of vitamins.

Later, they began to notice that it was possible to make a simple longitudinal resection of the stomach without touching the intestines – this operation is about 20 years old.

How much weight can you lose after bariatric surgery?

After bariatric surgery, on average, 70% of excess body weight can be lost. The operation does not bring to the ideal weight. A certain percentage of extra pounds remains if the patient does not engage in proper nutrition and increased physical activity.

For the first three to four months, the weight is reduced rapidly, then for another year and a half, it continues to decrease. The time it takes to lose weight depends on the initial body weight: if the weight was initially over 200 kg, then it takes two years, if 120 kg – a year.

If the operation is successful, the person will lose weight. However, how long the effect will last depends on how much the patient has been able to change his lifestyle.

How does bariatric surgery affect obesity-related diseases?

Being overweight greatly affects the quality of life: for example, it is difficult for a person to move, it is difficult to build relationships, to serve oneself.

Usually obese people also have a large number of comorbidities. These are diabetes, high blood pressure, sleep disorders, joint diseases, veins, endocrine disorders – only 5% of people gain weight due to endocrine diseases, the rest have secondary hormonal problems and are associated with being overweight. Even people who are overweight have a higher risk of developing certain types of cancer in overweight people.

After bariatric surgery, many of the problems associated with obesity go away. There are studies that have shown that bariatric surgery leads to significant long-term weight loss, correction of diabetes, reduction of cardiovascular risk factors and mortality from 40 to 23%.

A 2021 meta-analysis found that bariatric surgery was associated with a 59% reduction in all-cause mortality among obese patients with type 2 diabetes and a 30% reduction in obese patients without diabetes.

After surgery, the quality of life can be significantly improved. For example, we have a patient, he is 35 years old, weighs over 300 kg. He could not walk – he was brought to the ward on a stretcher. And it did not fit in one bed, so two had to be connected. After the operation, he lost weight twice – up to 150 kg, found a job, was able to serve himself. And there are many such stories.

What restrictions should be observed after bariatric surgery?

After bariatric surgery, the patient eats small amounts of food. If earlier he was sitting at the table and could eat whatever he wanted, now he has to choose.

The man for sure the same way enjoys the food, but not as much as before. Eating habits sometimes change. For example, if a person liked meat, it can become a heavy meal, he will develop a habit of eating more fish. This is also usually good for the patient.

Except, due to reducing the amount of food and its absorption will require additional intake of vitamins. During the first year, 3, 6, 12 months after the operation, our patients are examined and based on the results we adjust what and in what doses should be taken. Next, you need a lifelong intake of vitamins and minerals.

It is also extremely undesirable to drink alcohol and smoke.

After weight loss, excess skin remains. Its small percentage is reduced, but the rest must be removed. That is, in most cases, then plastic surgery is required. It occurs when the weight stabilizes and no longer decreases, usually after a year and a half.

Possible do I have free bariatric surgery?

I work at the Moscow Clinical Research Center, which is part of the Moscow city. Every year we perform a small percentage of bariatric surgeries under quotas for high-tech medical care, ie free for patients. This year there were only 20 quotas and the queue for them is already more than 100 people.

It is clear that not everyone can pay for such expensive interventions, but, unfortunately, neither can the state.

Very expensive consumables are used for bariatric surgery. In the regions, there are even fewer opportunities to do such a business for free than in Moscow.

How to choose a bariatric clinic or surgeon?

The main thing is the experience of the surgeon in bariatrics. Bariatric surgeries have their own performance peculiarities. If you go to a surgeon, even if you have a lot of experience, but who has never been involved in bariatrics, the effectiveness of the operation will fall.

There are many nuances in our work. The surgeon knows them only if he specializes in bariatric surgery, attends thematic conferences and forums. It is important to attend appropriate courses, to learn from more experienced colleagues.

Even in bariatrics, a lot depends on the anesthesiologist. It is difficult to inject and intubate patients with heavy weight, ie to connect them with a ventilator. The anesthesiologist must also have relevant experience.

In addition, the clinic should have a good intensive care unit that operates around the clock. Not every private clinic is able to save a patient in a difficult situation, and anything can happen in surgery.

I remember

  1. Indications for bariatric surgery – BMI more 35 kg / m² and the presence of obesity-related diseases.
  2. The best bariatric surgery is the one that does not exist, when the patient himself has lost weight.
  3. Bariatric surgery has been around for over 70 years, during which time surgeries have become safer and more effective.
  4. If the operation is successful, the person will lose weight. However, how long the result will last depends on how much he managed to change his lifestyle.
  5. After bariatric surgery, many obesity-related diseases can go away and the quality of life can improve.
  6. After bariatric surgery, a person reduces their food intake and must take vitamins and minerals for life.
  7. Bariatric surgery can be done for free under quotas for high-tech medical care, but they are few.
  8. When choosing a clinic and a bariatric surgeon, you should pay attention to the experience of doctors and the availability of good recovery.

Leave a Comment