In which cases is it necessary to resort to surgery to treat obesity?
It is aimed at patients who have a body mass index above a certain figure, the body mass index is the resultant, the resultant of dividing the patient’s weight by the height in meters squared, that tells us if the patient is normal, in terms of weight I am talking about, or has a weight deficit, or is overweight. When we talk about overweight, it is considered an indication for strict surgery, from a body mass index of 40 kilos per meter squared.
From that point on, a patient is considered morbidly obese, what happens is that these limits are currently more lapsed because it has also been discovered that variant surgery, obesity surgery, can be used to treat other diseases even in patients who are not morbidly obese. The main indication is diabetes.
What techniques are used?
Basically the surgical techniques are divided into restrictive and mixed. The restrictive ones, what they do is make it difficult for the patient to swallow, they have a very narrow entrance, they are the tubular gastroplasties, the laparoscopic ring, basically and also the tubular gastrectomy.
And the other group of techniques are the mixed techniques. The mixed ones consist of making a small stomach, it is not removed, most of it is not removed, but a stomach is made, it is as if we partitioned a room, to make it smaller, and we made a new door to go out, there is an entrance and an exit. Then a small stomach is made and the small intestine, at a distance that one considers from the stomach or duodenum. So he makes a section of that intestine, cuts it and splices it into that small stomach. There are two splices.
Then there are other techniques that are endoscopic, that is to say that a tube is inserted through the mouth, the tube that is used to perform endoscopies and then either a balloon is inserted, the famous intragastric balloon, it is inserted empty but it is filled with liquid, with serum, in the stomach, and it is left for a period of time, usually six, seven months.
What are the advantages of using surgery?
As advantages, most of them, I am basically referring to bypasses, because they have very acceptable long-term results because the patient will always lose more than 50% of the excess weight. They have the advantage that at the present time there is no drug that can definitively stop the patient from being morbidly obese. At the present time, the only possibility to stop being morbidly obese is surgery. Variant surgery offers many advantages in terms of curing diseases associated with obesity, of the metabolic type, as we have said before, cholesterol, uric acid, diabetes and arterial hypertension. Hypertension, high cholesterol and diabetes, which is what used to be called syndrome X and is currently called metabolic syndrome, has a good chance of disappearing with surgery in the same way that arthrosis problems improve, there is less weight on the joints, the risk of female cancers decreases drastically, life expectancy increases much more, because the vascular risk practically disappears.
Should the patient be followed up after surgery?
Well, we advise patients and in fact we try to see them after the operation, we see them two weeks after the operation, after they go home, after one month, after three months, after six months, after one year, and of course whenever they need it, even if they are not scheduled.