Bariatric surgery

Bariatric surgery, or weight loss surgery, is a type of gastric surgical procedure for those markedly overweight, who struggle with obesity, or those at high risk of obesity-related diseases. Bariatric surgery utilizes gastric surgery procedures (Sleeve gastrectomy, Roux-en-Y gastric bypass, or Endoscopic sleeve gastroplasty) to decrease the size of the gastric reservoir and alter the levels of gut hormones that control hunger and satiety, making you feel full faster and less hungry, resulting in better overall health. Bariatric surgery is considered a safe and effective treatment option for achieving long-term weight loss, reducing obesity-related complications, and improving overall physical health and well-being.

Why bariatric surgery for weight loss?

Obesity not only causes serious health issues such as diabetes, high blood pressure, heart disease, stroke, obstructive sleep apnea, infertility, amenorrhea, or personality and cosmetic issues, obesity or excess weight may also lead to a lower life expectancy, increased joint pain, and a higher risk of cancer, such as colon cancer or breast cancer. Obese are also at a higher risk of contracting COVID-19 and experiencing more severe symptoms than those with regular weights.

In addition, obesity can cause a lack of confidence and low self-esteem. Obesity specialists understand the complex mechanisms of weight gain as well as the human body's internal control system that resists weight loss and maintains body weight. Factors in the battle to lose weight include genetics, environment, underlying disease, hormones, and the individual's metabolism.

How is obesity assessed?

Doctors assess obesity by calculating body mass index, or BMI, which is calculated by dividing body weight (in kilograms) by height (in meters) squared, such as 100 kg and 165 cm or 1.65 m; the BMI formula is 100/ (1.65 x 1.65), BMI = 36.73 kg/sq. m.

According to medical standards, individuals with a BMI greater than 25.0 kg/m2 are overweight or obese and at risk of developing metabolic syndrome and its complications, which could eventually result in premature death. The appropriate body mass index, or BMI, in Asian people is less than 22.9 kg/m2.

Those with a BMI greater than 25-30 kg/m2 should consult with a specialist doctor to discuss how to lose weight. Those who have a BMI of 32.5 kg/m2 with diabetes symptoms and are unable to lose weight successfully should consider bariatric surgery for effective weight loss in collaboration with the medical team, dietitians, and nutritionists to reduce the risk of complications as soon as possible.

How many types of bariatric surgery?

The Gastrointestinal & Liver Center at MedPark Hospital in Bangkok, led by a team of specialists, utilizes minimally invasive laparoscopic gastric weight loss surgery based on the principles of gastric volume reduction to cause early satiety ad to limit the amount of food entering the body, reduce caloric intake, and altering the hormones that control hunger. There are 3 surgical approaches for reducing stomach size:

1. Sleeve gastrectomy (SG)

รูป1. การผ่าตัดแบบสลีฟ (Sleeve gastrectomy: SG)

Before vs After

Sleeve gastrectomy (SG) is a restrictive procedure with 75–80% of the stomach removed, decreasing its size to approximately 150 cc. The medical team utilizes a laparoscope and specialized surgical devices to perform sleeve gastrectomy with precision, efficiency, and safety. The stomach is cut and sewed into a long tube similar to a sleeve, reducing its capacity and production of the gastric hormone ghrelin, also known as "the hunger hormone," which stimulates appetite. The surgery results in effective weight loss without affecting calorie and nutrient absorption in the intestines.

2. Roux-en-Y gastric bypass surgery (RYGB)

รูปการผ่าตัดแบบบายพาส (Roux-en-Y gastric bypass: RYGB)

Before vs After

Roux-en-Y gastric bypass surgery (RYGB) reduces the size (restrictive procedure) as well as the absorptive capacity of the stomach (Mal-absorptive procedure), in which the surgical team divides the uppermost proximal stomach into a small pouch, approximately 1-2 ounce sizes, and connecting it to a diverted, 180-200 cm long of a limb of the upper small intestine to fashion a Y-shape intestinal bypass of the lower stomach and the proximal upper small intestine. As a result, the surgery makes you feel full faster, reduces appetite, and helps lower the volume of food entering the gastrointestinal tract. The medical team will perform Roux-en-Y gastric bypass surgery using laparoscopic techniques and specialized surgical devices to help make the surgery accurate, efficient, and safe.

3. Endoscopic Sleeve Gastroplasty (ESG)

รูปการส่องกล้องเย็บกระเพาะอาหารเพื่อลดน้ำหนัก (Endoscopic sleeve gastroplasty: LSG)

Before vs After

Endoscopic sleeve gastroplasty (ESG) is the newest bariatric surgery for weight loss that utilizes an endoscope inserted through the patient's mouth into the stomach to decrease its lumen down to the size of a banana by sewing together its opposing walls with specialized surgical devices (Endoscopic suturing system) under anesthesia. It is a natural orifice transluminal endoscopic surgery (NOTES) with no external abdominal scars, resulting in less pain, faster recovery, and fewer complications. This treatment method is another recognized option for weight loss that is effective, safe, and offers good outcomes.

How to prepare before and after bariatric surgery?

Before surgery

Candidates considering bariatric surgery for weight loss undergo a physical examination and medical readiness assessment by a specialist doctor to learn about the treatment plan, surgical method, and rules of healthy eating regimens before and after surgery. The doctor will perform an endoscopic examination of the stomach, a liver ultrasound to diagnose fatty liver, cirrhosis, or gallbladder stones, and blood tests to assess readiness and plan for surgery.

During surgery

Anesthesiologists will administer general anesthesia to patients undergoing bariatric surgery, utilizing a minimally invasive laparoscopic or an endoscopic surgery technique for the first two weight loss surgery options and the third option, respectively. The surgery will take approximately 2-3 hours, and you will recuperate at the hospital for 4-5 days to assess the conditions after recovery from the surgery before returning home.

Post-surgery

Physicians, dietitians, and nutritionists collaborate to provide post-surgery instructions and guidelines for eating habit adjustments. The diets recommended for the first four weeks are only liquid or soft food, easy to digest and help to condition the stomach and digestion process, such as porridge, soup, and poached eggs. After four weeks, the patient can consume a regular diet in the appropriate amount, enabling an effective treatment outcome and preventing obesity recurrence.

Is bariatric surgery dangerous?

Bariatric surgery for weight loss utilizing endoscopic or laparoscopic, minimally invasive surgical techniques, with no or minimal wound size, lessens pain and speeds up recovery by surgical specialists collaborating with a multidisciplinary team resulting in high-precision, and reducing the risk of complications. Most people who have undergone bariatric surgery have successful treatment outcomes.

Will I regain weight after bariatric surgery?

Patients undergoing bariatric surgery for weight loss will experience rapid weight loss in the first years after surgery, particularly the first 1-2 years when the weight decreases the most. Weight gain may occur after a couple of years due to age factors, diet, and lack of exercise. However, compared to gaining better long-term health, bariatric surgery is a clinically efficacious and cost-effective treatment option for obesity and related diseases.

What are the complications of bariatric surgery?

Infection can occur after bariatric surgery if the gastric suture line leaks due to poor anastomosis. However, with the superior quality of a modern laparoscope and specialized surgical devices, patients can be sure of a secured stomach suture line with no leakage or infection. The doctor may prescribe vitamin supplements for a patient with a vitamin deficiency.

What is the weight loss benefit of bariatric surgery?

Bariatric surgery for weight loss aids in the recovery from obesity and obesity-related diseases such as diabetes, high blood pressure, heart disease, stroke, sleep apnea, infertility, snoring, and irregular menstruation, as well as those who have body image, personality issues and a lack of self-confidence. Bariatric surgery also reduces the risk of cancer and helps improve agility in activities of daily life as well.

Bariatric surgery for weight Loss at MedPark Hospital

MedPark Hospital's bariatric surgery for weight loss employs best practice, systematic and holistic approaches to reducing obesity-related complications. Led by a team of experienced surgeon specialists and multidisciplinary medical professionals, along with state-of-the-art medical technology, graceful, excellent services are delivered to provide bariatric surgery patients with good quality of life, free from diseases and longer, healthier life.