WHO (World Health Organization) officially called obesity a global epidemic of our time. Those who do not have a weight problem often do not realize that the aesthetic issues associated with obesity are just the tip of the iceberg. Underneath are heart disease, high blood pressure, circulation problems, arteriosclerosis, strokes, type 2 diabetes, gastrointestinal disease, difficulty moving, bone and joint degeneration, incl. knee, sleep apnea, and even an increase in the likelihood of developing certain cancers (including the colon and prostate in men, and the breast and ovaries in women). Extremely obese people live shorter lives.
Bariatrics is no fad
One of the simpler methods of assessing the degree of overweight is to calculate your Body Mass Index (BMI – calculate your BMI – editor’s note). Just divide your weight in kilograms by your height in meters squared. We talk about morbid obesity when the BMI index exceeds 40 kg / m2. If the diets used by the patient, because such obesity is already morbid, do not work, he may be qualified for a surgical procedure that will help to lose unnecessary kilograms. The indication for surgery is obesity, described by the indicator of 35 kg / m2 with accompanying diseases, the treatment of which is conditioned by weight loss. Obesity, treated surgically, cannot be the result of disease, or hormonal or mental disorders, but only the result of consuming too much food!
Bariatrics is the branch of medicine that deals with the treatment of obesity. However, bariatric surgery is not plastic surgery! They are not meant to make a formerly obese man suddenly fit into half-size clothes and amaze his family and neighbors. These treatments save not only health, but also life. For those often weighing nearly 200 kilograms, they are the only chance for a normal existence. The patient will have to deal with plastic surgery later, when it may become necessary to remove excess “stray” skin that remains after a sharp weight loss, but for this to happen, you first need to lose weight.
A breakthrough in bariatric surgery was the popularization of laparoscopic procedures without the need for surgical opening of the abdominal integuments. After such a procedure, the patient recovers faster, and postoperative complications are also less frequent.
Stomach minimization
Bariatric surgeries either limit the amount of food consumed or exclude part of the gastrointestinal tract from use. Some combine both of these methods.
The simplest procedure for enforcing food abstinence is gastroscopic insertion into the stomach of a silicone balloon filled with physiological saline, the presence of which simulates the feeling of satiety. The procedure lasts only a dozen or so minutes, it is performed under short-term general anesthesia, and the balloon is removed from the stomach after six months, during which the patient acquires correct eating habits and, by losing weight, mobilizes to maintain weight. The balloon allows you to drop about 22% of the starting weight.
An adjustable bandage reducing the capacity of the stomach is an equally minimally invasive method. A laparoscopically applied bandage filled with physiological saline divides the stomach into two parts, the top of which has a capacity of approx. 20-30 ml (about two tablespoons), thanks to which (or maybe “what”) the patient feels full almost immediately after a meal and forced is for taking small portions of food at large intervals. The degree of clamp is adjustable and the band can be removed. Thanks to this method, excess weight can be reduced by as much as half. The procedure of vertical stomach stitching works in a similar way – it also involves separating a container with a capacity of about 20-30 ml from the stomach, but it is done thanks to a special suture. The non-adjustable clamp separates the smaller tank from the larger one. The weight loss is approximately 55%.
A sleeve or cuffed gastrectomy is a radical and irreversible procedure as it completely removes approximately 80% of the stomach. The remaining fragment, which will act as the entire stomach from now on, has the capacity of a glass.
Surgeries that eliminate some part of the gastrointestinal tract from the digestive process are more complicated: depending on the method of the operation, it is biliary and pancreatic exclusion, duodenal exclusion or gastrointestinal exclusion. The purpose of this action is to prevent the body from getting nutrients from the digested food, in short, fattening substances. This can be done in several ways, e.g. with the separation of a part of the stomach, from which a conduit formed from a fragment of the jejunum is drained, shortcuts and bypassing e.g. duodenum. It happens that part of the stomach is completely removed. This type of surgery allows you to lose up to 70% of your starting weight, but you may need additional vitamins and minerals that are “lost” on the short bypass.
The psyche, not just the stomach!
Bariatric operations are preceded by a very careful medical interview, a series of tests, not only standard ones, as well as numerous specialist consultations, including psychological or psychiatric examination. The patient’s attitude to the enormous life change that awaits him and his readiness to cooperate with doctors are crucial for the success of treatment. And it is not only about the awareness of the risks that each surgical intervention carries, but above all about making the patient, who has consumed huge amounts of food so far, aware that now his stomach will contain much less than half a glass of food at a time. If he eats more, he will vomit. It will no longer be possible to eat sorrows. You need to develop new methods of coping with stress. This is a very difficult test, even with the patient’s high motivation.
Public health, Agnieszka Wojciechowska-Kulik, medical assistant at the Bariatrics Clinic at the Pulsmed Private Hospital in Łódź, says:
– We attach great importance to the mental condition of a patient qualified for gastric balloon implantation. Not only mental illnesses may be a contraindication, but also the risk of the patient’s lack of cooperation. After the treatment, for a period of six months, the patient has access to qualified psychotherapists included in the package.
It is believed that bariatric surgeries are currently the most effective method of treating morbid obesity. However, it is necessary to diligently prepare not only the body, but also the psyche for the procedure itself and for the new reality that follows.
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