Bariatric surgery - Medical specialists

Bariatric surgery and metabolic surgery refer to surgical procedures to support weight loss in cases of severe overweight (obesity). Surgical therapy should only be considered if conventional weight loss measures are unsuccessful or if severe weight-related secondary diseases are already present. Frequent procedures in bariatric surgery include the gastric band, the gastric sleeve and the gastric bypass. These surgeries are usually performed in an obesity centre.

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Bariatric surgery - Further information

What is bariatric surgery?

Obesity surgery is a special field of visceral surgery and is also called bariatric surgery. This medical field includes all surgical methods to treat obesity. Bariatric surgeries are usually performed only on the gastric tract, but in individual cases can also extend to the intestinal tract.

The goal of bariatric surgery is to reduce the weight of those affected, which can be achieved by two basic principles. A component of bariatric surgery is the reduction of the size of the stomach so that less food can be consumed. Another principle of bariatric surgery is the shortening of the intestinal tract. The body is thus supplied with fewer nutrients and calories.

Bariatric surgery is only used if other curative methods have not led to the desired success.

What weight is considered to be overweight?

Obesity refers to a nutritional and metabolic disease that leads to severe overweight and causes severe suffering in the person affected. Many different facets usually contribute to obesity. A limited amount of exercise, a high-fat, low-carbohydrate diet and genetic predisposition all contribute to obesity. In rare cases, obesity occurs as a side effect of other primary diseases or the intake of medication.

Obesity is determined and categorized internationally using the Body Mass Index (BMI) as a measuring instrument. The following intervals are defined for the evaluation:

  • BMI below 18.5 = underweight
  • BMI 18.5 - 24.9= Normal weight
  • BMI 25.0 - 29.9 = overweight
  • BMI 30.0 - 34.9 = Obesity grade I
  • BMI 35.0 - 39.9 = Obesity grade II
  • BMI above 40.0 = Obesity grade III

When should bariatric surgery be considered?

For patients with obesity grade II or higher as classified by the Body Mass Index, the use of bariatric surgery can be evaluated. A bariatric surgeon decides on the type and extent of a possible surgery in close consultation with the general practitioner and/or the specialist. Furthermore, bariatric surgery is tied to certain prerequisites in order to be covered by health insurance.

Bariatric surgery can be performed:

  • in patients with a BMI of more than 40 (according to the specialist medical guidelines in Germany),
  • in patients with a BMI of more than 35 with accompanying diseases such as diabetes, high blood pressure, etc.,
  • as a general rule, when the patient is between 18 and 65 years old (obesity centres also operate on younger or older patients in exceptional cases),
  • if other methods, such as nutrition counselling, exercise training or behavioral therapy, have been exhausted over a period of 24 months and have not led to the desired success,
  • if there are no serious psychiatric conditions,
  • if no addiction is present

Regardless which treatment method is used, it is always combined with behavioral therapy. Those affected should change their dietary habits and movement habits in the long-term in order to achieve and maintain the desired weight.

What surgica methods are used in bariatric surgery?

Bariatric surgery is an important treatment method for obesity, but should not be considered as the only available treatment. The patient must be prepared to change his lifestyle and dietary habits.

The methods of bariatric surgery differ significantly in terms of the way they work, possible weight loss, risks and long-term effects. An experienced bariatric surgeon decides which surgical procedure is to be used in each individual case. The consultation should take place individually and repeatedly in order to completely clarify the patient's wishes and influencing factors. Today, all primary interventions in bariatric surgery are performed laparoscopically. With this "keyhole technique" the instruments are inserted through small incisions in the abdominal cavity using a camera.

Gastric band: The gastric band is a procedure in bariatric surgery. The bariatric surgeon places a silicone band around the stomach and separates the stomach into a small upper part and the remaining stomach. When food is ingested, the food first reaches the upper stomach first and then slowly reaches the lower stomach. After just a few bites, the stomach is full and a feeling of satiety occurs. An advantage of the gastric band in bariatric surgery is the possibility to remove the gastric band completely. Nowadays, the gastric band is only used in exceptional cases, as it has been shown that the gastric band can lead to more complications.

Gastric sleeve: The sleeve gastrectomy is a procedure of bariatric surgery, where the stomach is completely removed except for a residual gastric sleeve. The production site of the hormone ghrelin is removed. Affected persons have fewer cravings and the feeling of satiety occurs more quickly.

Gastric bypass: A gastric bypass is a combined procedure in obesity surgery. The intestine as well as the stomach are surgically changed. The upper part of the stomach is tied off. The upper small stomach pocket is quickly filled and the affected person has a feeling of satiety. After the food has passed through the stomach, it is not fed into the duodenum as usual, but immediately into the small intestine. Only in the middle of the small intestine the food and digestive juices mix. Due to the brevity of the small intestine, fewer calories are absorbed. A large part of the food is excreted unprocessed by the body. In a gastric bypass, the remaining stomach and duodenum are not surgically removed but remain connected to the small intestine to pass on digestive juices from the gall bladder and pancreas. Affected persons can achieve a reduction of about 75 percent of their body weight with this method. The gastric bypass is therefore only performed in bariatric surgery in severely overweight people. Due to the poor utilization of nutrients, patients have to take vitamin and nutrient supplements for the rest of their lives.

Biliopancreatic division (diversion): The stomach is reduced in size and a large part of the small intestine is excluded from food intake (absorption) because the digestive juices from the duodenum (bile and pancreas) required for this are only supplied to it much further down. By creating a common digestive channel, which is only 50-100 cm long, fat and starch from the food are no longer absorbed well. However, since other food components are also no longer absorbed, certain vitamins and trace elements must be given as a lifelong supplementary therapy.

Who pays for the procedure?

Bariatric surgeries can only be applied for in individual cases, as they are not covered by standard health insurance funds. The prerequisite is proof of having participated in a multimodal concept. In Switzerland, surgeries for patients with a BMI of more than 35 are covered by the basic health insurance. The patient must have followed a conservative diet for a period of 24 months. Only if these treatments do not achieve the desired success bariatric surgery can be considered.

How is aftercare structured?

Aftercare takes place for 5 years in the Obesity Center. Occasionally, the general practitioner can also carry out follow-up checks in consultation with the Obesity Center. The Obesity Center is obliged to check the patients for at least 5 years.

In long-term studies, the bariatric surgical procedures have proven to be extremely effective. Meanwhile, bariatric surgery also includes the planning of the surgeries required in most cases to restore the body contours after weight loss.

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