Sleeve Gastrectomy: Trend or responsibility? – What you have to know before doing this surgery!
Obesity kills: life expectancy of a 20-year-old person with a BMI of 40 (for example 121kg/174cm tall) is 13 years shorter compared to a person of the same age with a normal BMI. Obesity is measured by body mass index or “BMI.” BMI is the weight in kg divided by squared meter height. Surgery has been proven to be the most effective, and long lasting treatment for morbid obesity and its related conditions, and results in significant weight loss compared to slimming diets (“yo-yo” effect of weight regain) or intra-gastric balloons (weight regain after removal). This new trend to do Sleeve Gastrectomy completely changes the person’s life and life expectancy. People are realizing that after surgical weight loss that they will enjoy a new quality of life. 96 percent of the patients are satisfied with their life and body changes.
I remember a patient coming to my clinic in a wheelchair because her excess weight gave her knee problems which caused her difficulty walking. Eight months after the operation, she had lost 45 kg, and she could go walking with her children along the oceanfront. Her wheelchair was relegated into the garage. Sleeve Gastrectomy is not a cosmetic surgery. Of course it changes your silhouette, but the main goals of this operation are to reduce mortality risks due to obesity. People with a BMI of 30 or more are considered obese, and have a 50 to100 percent increased risk of premature death compared to individuals with a healthy weight, as well as an increased risk of developing more than 40 obesityrelated diseases (diabetes, heart disease, sleep problems, acidity reflux, high blood pressure, cancers…). Who is eligible for this surgery? Above a BMI of 30, indications for surgery can be discussed depending on other diseases the person may have.
Obese people with diabetes are the best candidates for surgery because it may cure obesity and diabetes at the same time. Patients usually leave the hospital without any anti-diabetic medications. How to be prepared for surgery? It is important to be involved in a weight loss management program driven by a multidisciplinary team, composed of different specialists with support groups. A team approach will help patients to lose weight by changing their habits, including the way they think about food. Depending on their BMI, some patients may not need surgery at all if they are given the support to stay motivated. I recognize how difficult it is for people to decide to take the outrageous step of opting for obesity surgery.
It is important to do a rigorous preoperative workup based on international guidelines. This will include gastroscopy, diet and nutrition counseling, psychological and lifestyle assessment. The various members of the team will support the patient through the different steps of the surgical route. Patient screening and selection before surgery and close follow-up after surgery are the keys to a successful outcome. . Having established a successful center of excellence for obesity surgery in France, I have learned that a team approach is necessary, paying special attention to nutritional and metabolic issues. Once the operation is finished, all the work is not done: the patient has to modify his unhealthy diet habits and make healthy changes including regular exercise. Sometimes psychological follow-up is necessary because the image of the body is completely changed after surgery What are the different types of obesity operations? Sleeve gastrectomy is not the only operation but it is the most popular in Kuwait. There are also Gastric Bypass, Gastric Band, Duodenal Switch, and Gastric Plicature (investigational). What are the possible complications of Sleeve Gastrectomy? The risk of death for obese patients who do not have surgery is 89 percent higher than after surgery. The most important complication related to surgery is leaking (1- 3 percent).
The management of such a problem is complex and takes time. Unlike with Gastric Bypass, the incidence of vitamin deficiencies is uncommon with Sleeve Gastrectomy, and there are no changes in bowel movements. Weight loss begins quickly after surgery and continues for 18 to 24 months. It may leave an excess of skin that may need to removed surgically after weight loss is complete. A patient once told me, “before the operation I was 165kg and I was like furniture in my home. My children saw me sitting in a chair all day, and when they wanted to be read a story or to go outside to play, they asked my husband. I was miserable and felt depressed. Today, after losing 55kg, I am now able to do a lot of activities with them”.
So in conclusion, if all the surgical options including risks, treatment plans before and after surgery, and follow up are clearly explained to the patient, and they are followed by a multidisciplinary team using international recommendations, then they may expect to succeed with obesity surgery. Surgery helps to allow patients to enjoy a longer, healthier and happier life.
-KT ********************************************************************************************
