Stomach resection: a panacea for those who want to lose weight or a step towards disability?

Bariatric surgeries are high-tech surgeries, the main goal of which is the permanent reduction of the patient’s weight.

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Often on the Internet you can find an advertisement for weight loss, which depicts the benefits of stomach surgery. Many clinics that perform bariatric surgery (that is, surgery to suture or cut off part of the stomach) have a description of them. Fortunately, most of them, in addition to the advantages of surgery, indicate both contraindications and disadvantages of the procedure.

However, the benefits are much more active, some even say that this is the only way to get rid of excess weight.


“Bariatric surgeries are high-tech surgeries whose main goal is to permanently reduce the patient’s weight and at the same time solve a number of physical problems,” said Anna Kriuchkova, a gastroenterologist at Sinai Medical Center. – Obese people are often prone to cardiovascular disease. They also often have problems with the musculoskeletal system, metabolic disorders and the development of diabetes.

Doctors call the indication for surgery life-threatening conditions affected by the weight lines – high risk of heart attack, problems with the joints and veins of the legs, hypertension, type II diabetes, grade 3 obesity, etc.


Today, the Ministry of Health funds bariatric surgery for patients with diabetes and BMI over 40 kg / m2 (ie with the third stage of obesity). In many countries the gastric reduction is done with a BMI of 35 kg / m2, ie in the second stage of obesity.

The same view is shared by the Deputy Director of the National Research Center for Endocrinology of the Ministry of Health of Russia, Director of the Diabetes Institute, Academician of the Russian Academy of Sciences Marina Sestakova, writes It is a surgery to reduce the stomach and intestine length in the second stage of obesity.

But surgeries are performed in extreme cases when other methods of treating excess weight, including diet and recommended physical activity, have been ineffective.


There are many options for gastric reduction surgery: sleeve gastrectomy, gastric bandage, gastric fold, intragastric balloon, cholangiopancreatic gastric bypass with duodenal occlusion.

Most of the time, two main functions are performed now:

* Bypass (gastric bypass), when the stomach is sutured in two unequal parts and the small intestine is connected to the smaller one. Thus, a person eats a much smaller amount of food. A new technique works in much the same way: gastric doubling – when the stomach is reduced by folding and a special suturing technique, resulting in the formation of a narrow gastric tube.

* Sleeve gastroplasty, in which part of the stomach is removed, leaving a thin “sleeve” attached to the intestines.

There is no single surgical treatment suitable for everyone. The choice of surgical option depends on many factors: comorbidities, body mass index, age and sex of the patient. And, of course, you need an individual treatment plan.

As a rule, contraindications include acute stage oncological diseases, drug and alcohol problems, severe mental disorders, including forced overeating (and even with a formal diagnosis). Related contraindications include kidney failure, chronic gastrointestinal problems (especially stomach ulcers), etc.


“It is worth noting that all surgeries require increased responsibility not only on the part of the doctors who prescribe and perform them, but also on the part of the patient,” says Anna Kriutskova. After a series of bariatric surgeries, complications are possible: some may occur in the first days and even hours after surgery, others may occur for the rest of your life. Problems and complications during the operation itself are also possible. However, their nature and frequency vary depending on the type of surgery. Even with the most careful and thorough surgery, complications such as damage to the stomach, esophagus, spleen or liver can occur. Early postoperative complications include thrombosis, bleeding, abdominal infections, and wound infections. One of the most serious complications is ruptured sutures in the intestines or stomach, which can lead to peritonitis.

To avoid this, the patient should be under the supervision of a specialist and follow the recommendations aimed at reducing the risks and preventing complications. So, for example, it is desirable to wear anticoagulant socks or tights. Patients receive blood thinners before and after surgery as directed by their doctor and antibiotics are given during surgery to prevent wound infections.


Like any surgery, bariatric surgery can cause complications over time. Perhaps the development of dumping syndrome (when food leaves the stomach quickly, enters the intestines indigestible), stomach ulcers, lack of iron, calcium, lack of vitamin D and B12, constipation or diarrhea, gallstones, heartburn, and even heartburn.

Stomach pain after eating, as well as nausea and vomiting, can be bothersome both in the early postoperative period and in the later stages.

“Of course, the attending physician should monitor these symptoms,” says Anna Kriutskova. Thus, to reduce the risk of gastric ulcer and the development of gastropathy, patients are often prescribed drugs that reduce stomach acidity during the first two to three months after surgery. It is especially important in the first months after surgery to receive mechanically well-processed foods, in portions, in small quantities. Limiting the consumption of sugary and high-fat foods will allow many patients to avoid loose stools. It is also necessary to take regular supplements of iron, calcium and vitamin D. Vitamin B12 is recommended for all patients with gastric bypass.


Yes, most of the time doctors prescribe bariatric surgery when the patient can no longer do without them. But again, in private clinics they can offer them to you without indications, just to get rid of extra pounds.

What if, after reading praise (often false) reviews, weight loss decides to take such a radical step? Especially if he did not even try to change his lifestyle at first, but decided to follow the “simple” path.

“By itself, weight loss, which is expected of patients, can lead to side effects,” says Anna Kryuchkova. For example, in gallstone disease: almost 35% of patients develop gallstones. Also, as a result of weight loss, patients often develop loose skin folds on the abdomen, buttocks and thighs. Particular attention should be paid to patients who are prone to depression or have problems with alcohol use. Often it is just a “whim”.

– In my opinion, such an operation is a voluntary disability, because without part of the stomach and (often) the small intestine, normal digestion, absorption of proteins, fats, carbohydrates, minerals, vitamins, which means lifelong intake of what the body can not absorb, says our permanent expert, member of the European Union for the Study of Obesity (EASO), nutritionist Ludmila Denisenko. – In such a measure he resorts to the most extreme cases, when the weight is prohibitive, and there remains neither the will nor the ability to understand the critical situation. But in my practice, there have been cases where patients after such operations, having lost a certain amount of pounds, began to gain them again. After the operation, the food intake should not exceed 100-150 ml. They also managed to melt lard, chocolate, butter and “drink” these 100-150 ml. The operation does not solve problems – it does not eliminate the deficiencies (sex hormones, vitamins D and B12, omega-3, ferritin, etc.), which leads to an increase in appetite, but often worsens them. And it does not “cure” the brain. After all, most problems come from the head. That is why my attitude is extremely negative.

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