Obesity surgery is the best technique to achieve weight loss and improvement of comorbidities in morbidly obese patients. With the introduction of minimally invasive surgery, post-surgical results have improved and, consequently, the satisfaction and degree of acceptance in the population.
All this has led to more and more interventions being performed in Spain every year with the incorporation of new surgical equipment.
Most commonly used techniques to combat obesity
The most accepted techniques are gastric bypass, adjustable gastric banding, Masson type vertical gastroplasty and biliopancreatic diversion. Any technique must be reversible and reproducible and provide in the long term (5 years) good quality of life and a loss of half of the excess weight in most of the patients operated on.
The different surgical techniques for obesity require the patient’s commitment to maintain healthy lifestyle habits.
Gastric Bypass
The success of gastric bypass depends on the surgeon, as it consists of creating a small-volume gastric reservoir to promote restriction and early satiety. As a complex procedure, it can have serious complications such as postoperative bleeding and digestive fistula.
There is scientific evidence that total mortality is 1-2% and weight loss is very important, reaching 70-80% of overweight in only 9 months.
The bypass is indicated in any type of obesity and provides very good results in patients who eat sweets due to the dumping effect that the technique induces. It is the technique of choice for many surgeons and represents 2 out of 3 interventions performed in Spain.
Adjustable gastric banding
Adjustable gastric banding is an infrequent restrictive procedure in Spain, but it is the number one surgery in Central Europe, Australia and South America. Unlike bypass, it is a simple technique, which consists of placing a subcardial inflatable band to create a virtual gastric reservoir.
The incidence of serious immediate complications is low. With this band, weight loss is slow because it depends on the gradual modification of the patient’s eating habits, but it can exceed a little more than half of the excess weight in the long term.
It is the least invasive technique and should probably be the treatment of choice for young patients who are willing to modify their habits without altering the digestive tract. The band works better in patients with a low BMI than in the superobese and controls diabetics poorly.
Biliopancreatic diversion
Biliopancreatic diversion is a hypoabsorptive technique that involves a quarter of the surgeries performed in Spain. It drastically reduces intestinal absorption capacity and is the procedure that offers the best quality of life, since the patient eats a hyperprotein free diet.
The long-term weight loss reaches almost the total overweight, although the malabsorption syndrome predisposes to severe nutritional deficits of proteins, minerals and fat-soluble vitamins.
Tubular gastroplasty
Tubular gastroplasty functions as a pure restrictive technique because it creates a gastric tube from the cardia to the pylorus of less than 2 cm in diameter. It is indicated as a first surgical procedure in patients with super-superobesity (BMI > 60) or with significant risk factors so that, after weight loss and correction of comorbidities, a bypass procedure, either a duodenal switch or a bypass, can be scheduled.
Weight loss at 2 years after gastric tubular is about half of the overweight. It should be carefully evaluated before offering it to a morbidly obese patient because it is neither a simple procedure nor is it free of serious complications such as subcardial fistulas.
What are the most complicated obesity operations?
The immediate challenges surgeons face are obesity surgery in those over 65 years of age and, above all, in adolescents with extreme obesity.
The organization of expert teams consisting of surgeons, anesthesiologists, endocrinologists and specialists in nutrition and eating disorders is becoming increasingly important in order to study and select patients and offer them individually the least aggressive and safest treatment.
Prognosis
Obesity is a chronic incurable disease, surgery is only a tool for the patient and the final success will depend on the good use of it.