Everything you need to know before thinking about bariatric surgery
The numbers of obese adults in Brazil increase every year and, consequently, the number of people looking for a solution for weight loss also grows. The available alternatives range from dietary re-education and physical exercises to more radical medical interventions such as bariatric surgery. However, before leaving for the operating table, it is important to be very well informed about the procedure, its variants, indications, contraindications and restrictions during the recovery period.
“Bariatric surgery has different types of operative procedures, however basically with the same objective, the reduction of the stomach and, consequently, the decrease of its capacity of ingestion and storage of food that lead the individual to lose weight quickly and in great volume ”, Explains Dr. Ricardo Staffa, specialist and Member of the Brazilian College of Digestive Surgery, and gastroenterologist at Clínica GastroInclusive.
Ttypes of best-known bariatric surgeries
Restrictive: decrease the size of the stomach capacity, by removing part of the organ or by placing prostheses such as the adjustable gastric band, the intragastric balloon and the vertical gastroplasty (also called “gastric sleeve”).
Mixed: The surgeon uses more than one type of procedure to reduce the size of the stomach and divert the intestinal transit, causing a reduction in intake and a decrease in the absorption of food.
Bariatric surgery offers risks like any other surgical procedure. “The rate of severe complications, which may require some intervention, such as clinical treatment or even reoperations, is around 1 to 2%. These complications are more associated with the presence of associated diseases, such as diabetes, hypertension, sleep apnea, among others, which must be balanced before the procedure ”, explains Dr. Ricardo Staffa.
It is important to remember that bariatric surgery is not the definitive cure for the patient’s obesity and used in isolation. Obesity is a chronic disease, originating from several factors, which need to be managed together, throughout life. Therefore, a thorough investigation of the individual before the procedure is important, considering the changes associated with the surgery and the patient’s ability to adhere to them in the post-surgical period.
This means that the treatment does not end on the operating table. The procedure is only part of the treatment. What will result in maintaining weight loss is the commitment of the patient, who must continue with the adoption of healthy habits, balanced diet, physical activity and follow up with a psychologist, to understand his new body and adapt to it , and with endocrinologist and nutritionist, to continue with the necessary diet and supplementation.
O Dr. Amélio F. de Godoy Mattos, Head of the Department of Nutrology and Metabology at the State Institute of Diabetes and Endocrinology (IEDE) and former president of the Brazilian Society of Endocrinology and Metabology, explains that post-operative care varies from case to case , but there is a general rule: “clinical and laboratory evaluation with blood tests, chest radiography, ultrasound and / or tomography of the abdomen, cardiological evaluation, digestive endoscopy and H. Pylori research and evaluation of respiratory function which will be the more further the more obese or complicated the case. If the patient has a disease that needs treatment and previous control, the surgery will be postponed until the best clinical condition is obtained ”.
The biggest problem with these surgeries in the long run is malnutrition. “A deficit in vitamin B12, although there is no deficit in other vitamins or some macronutrient. Malnutrition cases are common. In patients with severe malnutrition, hospitalization is necessary. Vitamin supplementation is mandatory and we often have to replace B12 more. Iron is also frequently needed, ”says Dr. Amélio F. de Godoy Mattos.
Therefore, in addition to all these details, before seeking bariatric surgery it is important to know that your recommendation is for patients with body mass index (BMI) equal to or greater than 40, or equal to or greater than 35, if he has comorbidities associated with obesity, such as diabetes, hypertension, dyslipidemia. Surgery is also indicated in patients aged between 18 and 65 years and a history of clinical treatments, for at least 1 year, without success.
In all cases there are two questions to be answered:
1) is the patient within the indication criteria?
2) are there any criteria for contraindication, such as serious diseases such as liver cirrhosis, kidney disease, psychiatric disorders, addictions (drugs, alcoholism), hormonal disorders, etc.?
“In all cases, the patient must have full knowledge of the characteristics, needs, risks and limitations of each surgery. He must participate in meetings with the multiprofessional team and with patients already operated on in order to be sure of his decision ”, warns Dr. Mattos.
By Antonio Montano