Bariatric surgery is a major operation to treat obesity. It changes the anatomy of your gut to ensure you can only eat smaller meals, and you therefore take in less calories. It requires a great deal of commitment pre-surgery to lose weight, and sticking to certain rules after surgery to ensure success.
But the upsides are long-term reduction in weight, improvement to aches and pains in your joints, and improvement or reversal of risk factors such as Type 2 diabetes and high blood pressure that carry a risk of stroke, heart attacks and early death. It’s life-saving but not a quick fix, and not to be undertaken lightly.
It’s reserved for those who are very obese, so with a body mass index (BMI) of over 40 kg/m sq. and who have tried and failed to lose substantial weight through diet and exercise alone.
Those with an obesity-related medical condition, such as Type 2 diabetes or high blood pressure, may be considered if they have a BMI between 35 and 40 kg/m sq.
NHS England, which sets the rules for our health service, has advised that any candidate must have attended a supervised, structured weight management for at least 12 months before surgery.
Bariatric surgery involves a whole team of experts, not just surgeons. There are psychologists, dieticians, nurse specialists and any other specialist doctors who need to consider your other medical problems before any surgery. You will be expected to hit certain weight loss targets prior to surgery, and they will keep in touch with you regularly. Along with education about food and calories, they will work with you to understand triggers that cause bad eating habits, and help you overcome these.
After surgery, care needs to be taken to give your gut a chance to heal. You will be on a diet of certain foods, mostly liquids and soft foods to start, and restricted calories. You will be guided how to build this up over weeks and months. You will also need nutrient supplements, which may be lifelong, depending on which surgery you have.
The aim is that you make lifelong lifestyle changes to keep the weight off permanently – the team are there to help and guide you through this.
Any major surgery carries risk of infection, bleeding and reacting badly to an anaesthetic, or even death.
Those who are obese are additionally high risk because of related medical conditions such as diabetes and high blood pressure that increases risk under anaesthetic medication. The excess weight means that you may suffer breathing problems that can affect you while on a ventilator, risk of wounds failing to heal (internally and on the skin) as the skin and tissues are under duress, and difficulty getting back on your feet afterwards, which puts you at risk of blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolus).
Risk of death is higher, but these are specialist teams using specially equipped theatres, to put you at the best chance of success.
The three main types of surgery are:
· gastric bypass, where the small intestine is connected to the upper part of the stomach, effectively making it smaller. This reduces the amount of food that can be consumed and the amount of nutrients that are absorbed.
· sleeve gastrectomy, where the stomach is stapled, thereby making it smaller, which gives you a feeling of fullness with a smaller meal.
· gastric band, which is an inflatable band inserted at the top of the stomach, thereby narrowing it and making you feel fuller with less food.
Your surgeon will recommend which surgery is best for you, and discuss all the risks and benefits. Surgery may be by laparoscopy (keyhole, whereby three holes are made to insert instruments and internal cameras) or laparotomy, where a larger cut is made down the centre of the stomach, and a surgeon can see directly where they are operating, rather than by cameras. It's likely to be at least a couple of nights’stay in hospital before going home.
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