Bariatric surgery is the name given to a major operation that’s performed to treat obesity. It’s designed to change the anatomy of your gut to ensure you can only eat smaller meals, and so you take in less calories as a result. It requires a great deal of commitment pre-surgery to lose weight, and sticking to certain rules after surgery to ensure success.
The upsides are long-term reduction in weight, improvement to aches and pains in your joints, and improvement or reversal of risk factors such as Type 2 diabetes and high blood pressure that carry a risk of stroke, heart attacks and early death. It’s life-saving but it isn’t any kind of quick fix, and must never be undertaken lightly.
It’s reserved for people who are very obese, with a body mass index (BMI) of over 40 kg/m sq. and who have tried and failed to lose substantial weight through diet and exercise alone. It may also be considered in people with an obesity-related medical condition - such as Type 2 diabetes or high blood pressure - if they have a BMI between 35 and 40 kg/m sq.
Potential candidates are also advised they must have attended a supervised, structured weight management for at least 12 months before surgery.
Bariatric surgery involves a whole team of experts, not just surgeons. There are psychologists, dieticians, nurse specialists and any other specialist doctors who need to consider your other medical problems before any surgery. You will be expected to hit certain weight loss targets prior to surgery, and they will keep in touch with you regularly. Along with education about food and calories, they will work with you to understand triggers that cause bad eating habits, and help you overcome these.
After surgery, care needs to be taken to give your gut a chance to heal. You will be on a diet of certain foods, mostly liquids and soft foods to start, and restricted calories. You will be guided how to build this up over weeks and months. You will also need nutrient supplements, which may need to be taken for life, depending on which surgery you have.
The aim is that you make lifelong lifestyle changes to keep the weight off permanently – the team are there to help and guide you through this.
Any major surgery carries risk of infection, bleeding and reacting badly to an anaesthetic, or even death.
Those who are obese are additionally high risk because of related medical conditions such as diabetes and high blood pressure that increases risk under anaesthetic medication. The excess weight means that you may suffer breathing problems that can affect you while on a ventilator, risk of wounds failing to heal (internally and on the skin) as the skin and tissues are under duress, and difficulty getting back on your feet afterwards, which puts you at risk of blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolus).
You may also be left with large excessive skin folds if you lose a great deal of weight, and may need further surgery to remove these although this often needs to be done as a private operation.
The three main types of surgery are:
Your surgeon will recommend which surgery is best for you, and discuss all the risks and benefits. Surgery may be by laparoscopy (keyhole, whereby three holes are made to insert instruments and internal cameras) or laparotomy, where a larger cut is made down the centre of the stomach, and a surgeon can see directly where they are operating, rather than by cameras. It's likely to be at least a couple of nights’ stay in hospital before going home.
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