Obesity rates have been growing for the past 33 years. At this moment, there are more than 2 billion people in the world (nearly one-third of the world’s population) who are obese or overweight. Restrictions, psychological and esthetic problems – having an excessive weight is never a comfortable state of being.
That is why many people decide to have a bariatric (weight-loss) surgery, that is aimed at the adults who suffer from with morbid obesity (BMI > 40) or severe obesity (BMI > 35). Learn everything about bariatric surgery and gastric bypass surgery in France.
The choice of the surgical technique is made by a multidisciplinary team in agreement with the person concerned. This team has to take into account many criteria, such as obesity level, BMI level, age and previous medical and surgical history of a person, their digestive diseases, eating disorders, whether they have type 2 diabetes, etc.
Based on this information, they choose a purely restrictive technique, such as a gastric sleeve, or a mixed restrictive technique, such as gastric bypass (the RYGBP).
The gastric bypass surgery is performed to restrict the consummation by shrinking the volume of a stomach and adding a bypass to the small intestine. This way food goes directly to the middle part of the small intestine and therefore is absorbed in lesser amounts.
This derivation leads to malabsorption of the food nutrients, which leads to reducing the food intake and results in weight loss. In France, more than 30 % of 42 thousand bariatric interventions are performed in the gastric bypass technique, which makes it the most popular technique that seems to give the best results possible in a long term.
The surgery consists in making a transection of the stomach to create a small reservoir of 30 to 40 cc. Then, the small intestine is moved and connected directly to the reservoir. The length of a loop depends on how big the malabsorption effect must be. This is a major surgery that lasts from 1.5 to 3 hours.
The patients are hospitalized one day before the surgery and have to stay at the hospital for at least four and sometimes up to eight days. In most cases, the laparoscopic approach can be applied (if it is technically feasible). During the surgery, the fat isn’t removed at all, however, the expected weight loss is around 70-75 % of excess weight, which corresponds to around 35-40 kg (75-90 pounds).
Surely, this procedure is not without its risks, such as surgical complications (ulcer, bleeding, intestine occlusion, leakage in the stomach region), nutritional deficiencies or functional complications (glucose deficiency after a meal, dumping syndrome*, constipation). It is necessary for the patients to intake food supplements and vitamins to avoid vitamin deficiency.
*Dumping syndrome shows itself by feeling unwell (headaches, nausea, diarrhea, etc.) right after having a meal. This syndrome happens due to the massive and rapid arrival int the intestine of foods rich in fat or sugar.
The mini bypass is a recent development of the classic bypass. It’s gaining its popularity, as this surgical technique has much easier technical realization, which shortens the length of the surgery by 30 to 60 minutes allowing patients who suffer from obesity to tolerate the anesthesia better.
Another advantage is that it is a completely reversible surgery (unlike the classic gastric bypass, where the reverse surgery is extremely complicated) that can be performed in a simple less invasive, laparoscopic technique.
Of course, this surgery is not perfect, as the results are practically the same as in the classic bypass, moreover, it can sometimes cause a gastroesophageal reflux disease (heartburn and acid indigestion). It is important to notice that mini gastric bypass acts and has the same effect on the body as the classic bypass, therefore, constant health monitoring and vitamins intake are indispensable.
Recent studies show that surgical treatment of the type 2 diabetes can be much more efficient than the traditional anti-diabetic drugs and insulin injections in patients who suffer from obesity.
It has been confirmed that the people who underwent a bariatric surgery are more likely to be able to control their diabetes, reduce their insulin dependence and lose weight more significantly. In fact, undergoing a surgery to control diabetes proved to be 3 to 4 times as effective as doing it in a traditional way (dietary restrictions, physical exercises and taking medicine).
In many cases, already after a few weeks (even before the weight loss results become significative), the blood sugar level is normalized allowing many patients to suspend their anti-diabetic treatment. This is a positive effect of the way the intestinal cells absorb carbohydrates, as now the cells need more blood sugar to ensure their growth, which reduces the blood sugar level.
Apart from the beneficial effect on diabetes, digestive surgery can also help reduce the impact of obesity on the liver. It is known that obesity attacks liver in the same way as alcohol does, which is why losing weight with gastric bypass can help in case of nonalcoholic fatty liver disease (NAFLD).
If needed purely for the purpose of weight loss, both techniques are great and their effects are almost equal when performed by an experienced surgeon. Before choosing the right surgery, a medical team will take into account many factors (eating habits, BMI and obesity levels, etc.) to find the best solution for each individual case.
Sleeve gastrectomy is a safer procedure which reduces the hunger letting a person build new dietary habits; the recovery is more rapid and vitamin absorption is normal. However, for the diabetic patients and patients who have a hernia, most bariatric surgeons recommend gastric bypass, which requires a bit more work from both surgeon and patient, but has undisputed advantages comparing to sleeve gastrectomy and its effects are much better researched.
It is important to understand that bariatric surgery is not a miracle cure, but a first step in improving the patient’s well-being. It can only reduce the impact on various organs of such chronic disease as obesity. None of the weight loss results will be saved if the patient doesn’t change their eating habits.
Bariatric surgery helps to change the diet regime to consuming much smaller amounts over 3 meals and 2 snacks per day, to forget about overeating and vomiting. It is essential to undergo a regular medical monitoring to detect any complications, ensure compliance with the hygiene and dietary rules and screen eating disorders.
Based on the indications of Haute Autorité de Santé.