In which cases is bariatric surgery indicated?

What does bariatric surgery consist of?

Obesity is one of the most important health problems in Western countries. Until the unfortunate appearance of the coronavirus, it was the most important pandemic of the 21st century.

Although many different types of diet, pharmacological and endoscopic treatments have been designed, they have all failed to achieve sustained weight loss over the years.

Nowadays, surgery is considered to be the only treatment capable of offering a substantial and sustained weight loss over time, improving comorbidities, expectations and quality of life of these patients.

In any of the cases, the treatment of obesity requires a multidisciplinary management based on teams with different specialists such as endocrinologists, dieticians-nutritionists, nurses, psychiatrists, psychologists, surgeons, anesthesiologists, gastroenterologists, pulmonologists, plastics, physiotherapists, etc., with the aim of achieving a set of changes ranging from an improvement in eating habits, through an increase in physical activity, behavioral and psychological support of patients.

In which cases is it indicated?

In general terms, bariatric surgery is considered indicated in those patients with a Body Mass Index (BMI) greater than 40 kg/m2, or those with a BMI greater than 35 kg/m2 and associated comorbidities: cardiorespiratory, metabolic, severe articular, psychological problems related to obesity, etc.

In recent years, a new indication for bariatric surgery has been created for diabetic patients with poor metabolic control despite medication, and who present a BMI between 30-35 kg/m2.

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How is this type of surgery performed?

Currently, the approach to perform any bariatric procedure is laparoscopic surgery. The instruments necessary to perform the operation are introduced through 5 small orifices of 5 and 12 mm. Studies published in the literature have reliably demonstrated that the results obtained in terms of weight loss and reduction of comorbidities are similar to those obtained with the classic open approach. In addition, minimally invasive surgery offers other advantages with respect to less postoperative pain, shorter hospital stay, fewer complications related to the abdominal wall, better cosmetic results and a faster return to work.

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What are the benefits of bariatric surgery?

Bariatric surgery will not only achieve a substantial and sustained weight loss over time, but will also solve multiple health problems related to the disease.

In general, bariatric surgery will improve or eliminate blood pressure, diabetes mellitus type 2, blood cholesterol levels, obstructive sleep apnea, non-alcoholic fatty liver disease or non-alcoholic steatohepatitis, gastroesophageal reflux disease, osteoarticular problems, polycystic ovary syndrome, fertility, etc.

In addition, it has been seen that bariatric surgery will not only reduce the risk of death due to heart disease or cancer, but in global terms it will increase life expectancy with a substantial improvement in quality of life due to an improvement in mobility, increased self-esteem, social, labor and sexual relations.

What care should the patient follow after the intervention?

In addition to the general care of surgical wounds, the patient must strictly follow the dietary recommendations indicated by the nutritionist, with special emphasis on the type of food, quantity, number of meals per day, water intake, etc.

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It is essential to take vitamin supplements to help counteract the loss of vitamins and trace elements caused by the surgery.

For the operation to be a success, the patient must be able to include physical exercise as a vital part of his or her new lifestyle. Finally, it is necessary to follow a strict nutritional and metabolic control by the endocrinologist and nutritionist to identify and/or treat possible medical and metabolic-nutritional complications associated with the intervention.