When is Bariatric Surgery Necessary?
Bariatric or metabolic surgery is recommended for patients with a Body Mass Index (BMI) over 35 kg/m2,
or for those with a BMI of 32 kg/m2 if they suffer from obesity-related health conditions.
Two Main Mechanisms of Metabolic Surgery
Metabolic surgery is based on two primary mechanisms:
- Restriction: Reducing the stomach volume to decrease the amount of food needed to feel full.
- Malabsorption: Reducing the absorptive surface of the small intestine, limiting nutrient absorption.
The combination of these two effects enables long-term weight loss and better control of obesity-related
comorbidities.
Most Common Bariatric Procedures
The two most commonly performed bariatric surgeries are:
- Sleeve Gastrectomy
This procedure involves removing a large portion of the stomach to create a tube-like “sleeve,” resulting in a restrictive effect. It also reduces levels of the hunger hormone ghrelin, as the part of the stomach that secretes it is removed.
Originally performed in 1988 as part of a duodenal switch procedure, sleeve gastrectomy has proven to be highly effective and is now widely performed as a standalone surgery with a low risk of complications when done by an experienced bariatric surgeon.
Health Improvements After Bariatric Surgery
- Type 2 Diabetes: 75–80% of patients achieve full remission without insulin, while others significantly reduce their insulin dosage.
- Hypertension: Around 50% of patients reduce or completely eliminate the need for antihypertensive medications.
Advantages and Considerations of Laparoscopic Surgery
Laparoscopic bariatric procedures like sleeve gastrectomy and gastric bypass offer numerous benefits over traditional open surgeries:
- Minimally invasive, with faster recovery
- Fewer postoperative complications
- Quicker return to daily activities
However, it’s important to note that these surgeries alter the stomach’s anatomy, which can lead to new symptoms or worsen existing ones (e.g. acid reflux). For patients with significant reflux issues, gastric bypass is often recommended over sleeve gastrectomy.
Who Are the Candidates for Bariatric Surgery?
Surgical treatment of obesity is recommended for patients with:
- BMI over 35 kg/m2
- BMI over 32 kg/m2 with associated conditions such as type 2 diabetes, hypertension, sleep apnea, or other cardiovascular diseases
Conclusion
Laparoscopic metabolic procedures like sleeve gastrectomy and gastric bypass offer safe, effective, and long-term solutions for patients suffering from severe obesity and related health issues. These surgeries not only promote substantial weight loss but also help manage chronic conditions—greatly improving quality of life.
