Obesity & Weight Loss

Weight Loss procedures

There are several weight loss procedures that can be performed depending on the individual’s needs and medical condition.

1-Sleeve gastrectomy

Obesity is a chronic condition in which there is a high amount of fat in the body. It is defined as a Body Mass Index (BMI) of 30 to 34.9 and extreme obesity is a BMI of 40 or more. It’s a global problem that can affect all people and is associated with many comorbidities: cardiac problems, diabetes, high blood pressure, breathing difficulties, and other diseases.
Sleeve Gastrectomy is a restrictive bariatric procedure to treat extremely obese patients with a high BMI of 40 and above. It encourages weight loss by restricting the stomach size (during sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana).

Who is the candidate for a sleeve gastrectomy?

Sleeve gastrectomy is indicated for people with BMI:
– 40 and more
– 27 to 40 associated with obesity complications (heart disease, high blood pressure, high cholesterol, severe sleep apnea, type 2 diabetes, infertility).

This procedure can be done in those conditions when diet, exercise or medication have not helped in reducing the patient’s weight.

Some TIPS before and after the procedure

A day before gastric sleeve surgery:

– Follow a liquid diet
– Do not eat or drink at least for 8 hours before the surgery
– Obtain adequate rest by getting to sleep early the night before the procedure

The procedure is performed laparoscopically under general anesthesia to keep you asleep and comfortable during the surgery. The surgeon makes small keyhole incisions in the upper abdomen to remove the larger and curved part of the stomach and staples the stomach vertically.
At the end of the procedure which takes one to two hours, the incisions are closed with sutures.
Depending on your recovery, you will stay in the hospital for one to two nights.

After the procedure the patient must:

1- Follow a specific diet:
-Sugar-free
-noncarbonated liquids for 7 days
-pureed foods for 3 weeks
-a lot of water to prevent dehydration
The patient will be able to progress to regular foods 4 weeks after the surgery.

2- Take some medications:
– A multivitamin twice a day.
– A calcium supplement once a day.
– Injection of vitamin B-12 once a month for life.
After the sleeve gastrectomy, medical checkups and laboratory tests are required the first several months after weight-loss surgery; and the patient should avoid strenuous exercises and lifting heavy weights until the approval of the surgeon.

Advantages

-Can be performed laparoscopically.

-Shorter hospitalization and recovery time.

-Minimal post-operative pain

-The size of the stomach is reduced; so the patient feels full sooner.

Risks

Risks associated with sleeve gastrectomy can include excessive bleeding, infection, adverse reactions to anesthesia, blood clots, breathing problems… Those complications are immediately treated and can’t be fatal.
In the long term, the patient may have hypoglycemia, malnutrition, or recurrent vomiting; that’s why the medical checkup is very important.

Results

Sleeve gastrectomy can provide long-term weight loss, but it depends on your lifestyle habits. The patient can lose approximately 60% or even more of his excess weight within two years.
When weight-loss surgery doesn’t work?
Sometimes, if the patient doesn’t change his lifestyle habits he will:
– Not be able to lose weight after the procedure
– Regain weight after a few years

After the procedure the patient must stay in contact with his doctor to do all the necessary tests and maintain his weight loss; and if he notices that he isn’t losing weight or developing complications, he should visit the doctor immediately.
Sometimes when the sleeve gastrectomy doesn’t give a satisfactory result; it must be accompanied by a second bariatric surgery (bypass gastric surgery) to be able to lose weight and achieve the goal.

2-GASTRIC BYPASS

What is gastric bypass surgery?

Gastric bypass surgery is a restrictive and malabsorptive surgical procedure. It is restrictive in the sense that it “reduces” the quantity of food that the stomach can hold and is “malabsorptive” in that it affects the absorption of food and calories into the bloodstream, and this combination has the highest success rate.
This surgery is more complicated than the sleeve gastrectomy because it doesn’t only work on reducing the size of the stomach; so the recovery period takes more time.

Types of Gastric Bypass surgery

-Roux-en-Y gastric bypass

Roux-en-Y the most common method of gastric bypass, is bariatric surgery for obese patients who have not the chance to lose weight through dieting, exercise, and medication.
It can be performed laparoscopically through tiny incisions or through a large open incision.
First, the surgeon reduces the size of the stomach; so it can hold a limited quantity of food, by cutting the top of your stomach and sealing it off from the rest of your stomach. The resulting pouch is compared to the size of a walnut and can hold a small quantity of food.
Then, the doctor cuts the small intestine and attaches a part of it directly into the pouch; food then goes into this small pouch of the stomach and then directly into the small intestine attached to it.
Food bypasses a big part of your stomach and the first section of your small intestine and enters directly into the middle part of your small intestine.
The small intestine is then cut into two parts:
-The lower section of the intestine is attached to the opening of the pouch creating; what is referred to as the “roux limb”.
-The upper part of the small intestine which transports digestive juices from the remaining part of the stomach is attached at the distal extremity of the roux limb.
The roux limb helps food to go around the lower stomach, duodenum, and a portion of the small intestine.

-Mini gastric bypass

This operation is performed under general anesthesia laparoscopically through tiny incisions or by an open surgery.
Your stomach is first stapled so that a pouch is created separately from the rest of your stomach.
In the Roux-en-Y procedure, the intestine is then divided and one end connected to the stomach pouch while the other end is reconnected back to the intestine; but with mini gastric bypass, the pouch is connected directly after the duodenum without dividing the intestine.

Indications

Gastric bypass surgery may be recommended when:

-Diet, exercise or medications have not help to reduce weight.
– BMI= 40 or more
– BMI is 35 to 39 with complications (type 2 diabetes, heart disease, high blood pressure, high cholesterol, sleep apnea…)

Risks and complications

Risks associated with this surgery can include excessive bleeding, infection, adverse reactions to anesthesia, blood clots, ulcers…
Those complications are immediately treated and can’t be fatal.
In the long term, the patient may have malnutrition or dumping syndrome leading to diarrhea and nausea; that’s why the medical checkup is very important.

Advantages of gastric bypass surgery

• Quick and dramatic weight loss (10 to 20 pounds a month in the first year following the surgery).
• Weight loss continues for 18-24 months post-surgery.
• Many patients maintain a weight loss of 60-70% of excess weight 10 years after the surgery.
• Improved health problems associated with severe obesity.
• Many patients are able to stop taking medications for diabetes and hypertension after losing weight.

After the surgery

The patient should:

-Eat in small quantities.
-Eat slowly and chewing the food thoroughly.
– Not drink and eat at the same time because the new stomach will not be able to hold both.
-Stop certain sugary foods; because it can lead to “dumping syndrome”.
-Vitamins supplementation specifically iron, VitB12, calcium and Vitamin D.

Gastric bypass after gastric sleeve

Gastric bypass after sleeve surgery is a type of revision procedure that may be necessary if you do not achieve the desired weight loss after the gastric sleeve; that only reduces the size of the stomach; and it is a less complicated surgery.
If the sleeve procedure fails to work, a bypass gastric surgery is required to reduce calories absorption through intestinal rerouting.