In order to indicate an obesity surgery, the specialist must evaluate the patient’s disease exhaustively, observing the complications and limitations, as well as the surgical risks. In addition, the patient must take into account that the surgery not only involves a change in weight, but also in lifestyle.
When is obesity surgery indicated?
When medical and dietary treatment repeatedly fails, surgery is fully indicated. When these patients come to the surgeon, they must bring the assessment of the endocrinologist or nutritionist to reflect that the diet does not work in that patient.
In this sense, the treatment of these patients is multidisciplinary, so that the surgeon must have the help of the endocrinologist to establish an adequate control of the diet and follow up the patient. It is also recommended that the patient should consult a psychologist to find out the origin of the excessive and constant intake. On the other hand, a bariatric surgeon should follow up patients who have already undergone surgery.
What type of intervention should be performed in each case?
To choose the type of surgery, the patient’s age, surgical and anesthetic risk, which must be studied and treated preoperatively, must be taken into account.
In cases between 18 and 30 years of age, the most advisable is the tubular gastrectomy, which is a safe procedure, with few side effects, indicated also in those over 60 years of age and in women of childbearing age who want to have offspring.
Generally, to decide the surgical technique, we base our decision on the Body Mass Index (BMI), that is, your kilos in relation to your height in meters squared.
In patients with a BMI between 30 and 35, who are at high risk due to accompanying co-morbidities such as sleep apnea syndrome, heart disease, hypertension or diabetes, surgery may be exceptionally indicated. In these cases, the most recommended is tubular gastrectomy or intragastric balloon.
In patients with a BMI of 35 to 40, tubular or sleeve gastrectomy is recommended.
When the BMI is between 40 and 50, we are dealing with patients who are not going to lose weight with diets, so the indicated surgery in these cases is long-loop gastric bypass and tubular gastrectomy.
A patient with a BMI between 50 and 60 is a severely ill patient with a low life expectancy. In them, a bilio-pancreatic diversion or distal by-pass is most suitable.
In patients with a BMI of 60 or more, a sleeve gastrectomy should be performed first and after 1 or 2 years, when they have already lost about 50 kg, a bilio-pancreatic diversion or a distal By-pass is performed.