What is Weightloss / Bariatric Surgery ?
Weight loss surgery or Bariatric Surgery refers to Internal operations in body carried out on Stomach or Intestine aimed at reducing weight in severely obese individual. Today these Operations have expanded in to “Metabolic” Surgery or disease controlling surgery as well. This means that “Not so obese” patients with obesity associated illnesses like Diabetes are offered these operations with the aim of controlling their disease than reducing weight. Today these operations are done world wide; and in Sri Lanka as Laparoscopic (Key hole) Operations.
Bariatric Surgery is entirely different to External fat reduction operations (Plastic Surgeries) like abdomino-plasties and liposuctions; which deal with removal of excess fat deposited on body surfaces. Bariatric Surgery leads to reduction of external and internal fat rapidly and permanently enabling most patients to achieve their ideal body weight in 1-2 years after surgery.
Are you a candidate for Bariatic Surgery ?
In adults the globally accepted measurement to assess suitability for Bariatric Surgery is Body Mass Index (BMI). This is calculated by dividing an individuals body weight (in Kg) by the square of the individual’s height (In Meters)
A normal Healthy adult should be in the BMI range of 19-25 kg/m2
From BMI 25-29 – Categorized as Over weight
From BMI 30-34 – Class 1 obesity
From BMI 35-39 – Class 2 Obesity
From BMI 40 and above Class 3 obesity or Morbid Obesity (In Asia this figure is set at BMI 37)
The present criteria for obesity Surgery in Asia are Body Mass Index (BMI) more than 37 or BMI over 32 with obesity associated illnesses like uncontrolled Diabetes, Hypertension, Fatty Liver disease, Obstructive sleep apnoea and Subfertility.
In older age groups obesity associated severe mechanical joint pains in knees , ankles , hips and Back which severly restricts mobility; by itself is a valid reason to consider bariatric Surgery.
In Sri Lanka we offer Bariatric Surgery to morbidly obese individuals from 14 years to 65 years of age.
Why should you consider Bariatric Surgery ?
When You fall in to the class 3 obesity category the chances of loosing adequate excess weight and remain long term at a normal BMI is less than 5%. Temporary weight losses by enforced dieting would give a maximum transient weight loss of around 10%, but will reach a higher weight than the starting weight when the determination for strict control of food intake weans off. This well recognized phenomenon seen in morbid obese people attempting weight loss by dieting is called “rebound weight gain”.
Medication and other therapies also can reduce excess weight by 6-7% which is inadequate at Class 3 obesity and is effective only while the patient is on treatment.
It is clinically and scientifically proven beyond any doubt that Bariatric / Obesity Surgery is the ONLY EFFECTIVE long term treatment option currently available to treat morbid obesity with over 90% of patients managing to reach and maintain their weight loss targets long term world wide.
These are the same results that we have observed in analyzing data of more than 100 Laparoscopic bariatric surgical procedures performed by my team in Sri Lanka.
Negative/ side effects of Bariatric Surgery
Like any operation done inside the abdomen these operations also carry the possibility of Surgical and Anesthetic complications in the immediate post operative period and long term nutritional complications if not followed up properly after surgery.
Today with the advanced highly refined techniques the overall chance of developing a serious surgical complication is 2-3% and the chance of Death after surgery is 0.5%-2%(which mainly depends on the status of your health at time of surgery than the adverse event). It is emphasized that these figures are on par with ANY other non bariatric operation carried out in a normal sized individual involving intestine and stomach.
A detailed discussion on specific surgery related complications will be discussed with the individual patient and the spouse or Guardian after the exact type of operation is decided.
Limitations to undergo Bariatric Surgery
WHEN WE WILL SAY NO!
Today in Sri Lankan Guidelines (College of Endocrinology Guidelines) we are allowed to operate suitable patients from ages 14 up to 65 years.
Having other diseases is NOT a contraindication for surgery and in fact as mentioned above it is a very important indication to undergo bariatric surgery. This is because with the weight loss most of the associated illnesses either get cured or well controlled within 2 years post surgery.
We sometimes have to refuse Surgery due to “Unacceptably high risk ” of Anesthesia in some patients where Heart and Lung functions are significantly impaired due to Severe neglected obesity over long time period.
Patients who have had major open abdominal operations may sometimes not be suitable for key hole surgery. However, our team has successfully performed keyhole bariatric surgical procedures on patients who have had several open abdominal operations before.
Revision Surgery (Re-doing bariatric surgery due to failure of initial operation) may be associated with higher surgical complications.