Today, bariatric surgeries are performed in many medical centers around the world. They are shown as the only effective way to treat obesity of people with a BMI over 35, as well as with a BMI of 30 or more, burdened with concomitant diseases. The purpose of surgical operations is anatomical changes in the structure of the stomach or stomach and intestines, as a result of which most of the stomach, duodenum and part of the small intestine are excluded from the digestion process.
When the stomach can only hold a limited amount of food, and absorption of nutrients is reduced in the small intestine, then a person begins to lose excess weight without experiencing hunger and discomfort. Mostly such operations are performed using minimally invasive laparoscopy, which is usually a good alternative to traditional laparotomy.
Of course, provided that they are made by a bariatric surgeon with many years of experience in successful laparoscopic operations, and the clinic is equipped with modern equipment and all the necessary tools for bariatric surgery.
Statistical figures are convincing in the effectiveness and safety of bariatric surgery
According to the ASMBS Bariatric Centers of Excellence database, with about 60,000 patients undergoing bariatric surgery, the risk of life-threatening complications during and after such operations averages 0.13% (approximately one case in 1000 patients). This figure is significantly lower than the other surgeries such as gallbladder removal, hip replacement, and the like. Therefore, despite the poor general health of severely obese people before surgery, the likelihood of death is extremely low. In addition to getting rid of excess weight (from 50 to 100%) in the patient, mortality from concomitant diseases is reduced by 89%. For example:
- from cancer - by 50-60%;
- from diabetes - by 90-100%;
- from heart disease and stroke - by 50-60%.
How to Prepare for Bariatric Surgery: General Guidelines
The patient usually receives the necessary information during an online or offline consultation with a surgeon. In a face-to-face consultation, he gets acquainted with the conditions and methods of treatment that are practiced in the clinic of his choice. To establish or clarify the diagnosis, as well as a detailed assessment of the general state of health, the patient undergoes preoperative examination and takes the necessary tests.
By signing an agreement that prescribes the type of surgery recommended by the bariatric surgeon, the patient makes the final decision on the type of surgery to be performed. For maximum safety, the decision to perform an open or laparoscopic procedure remains with the surgeon.
The doctor carefully considers all the pros and cons of various methods of surgical intervention for a particular patient. If laparoscopy is preferred, the laparotomy technique is reserved for emergencies and emergencies. For example, the patient becomes unstable due to bleeding from internal organs, which must be eliminated as soon as possible in order to gain more convenient and wider access to the "accident" site. Fortunately, such complications are extremely rare.
Special training before bariatric surgery at the Center for Metabolic Surgery
Today, the Metabolic Surgery Center is considered the best clinic in Ukraine for the surgical treatment of obesity. The center has developed a special plan for preparing patients for bariatric surgery. From the first consultation to the recovery of obese patients, the leading candidate of medical sciences, a bariatric surgeon with 19 years of experience in successful laparoscopic operations, a member of the International Federation of Obesity Surgery, Andrian Ostapovich Reyty.
During the introductory conversation with the patient, the doctor collects anamnesis - he receives information from the patient's words and from the medical documents, the history of the disease, its course and development, and also determines the availability of indications for surgical treatment of excess weight. The physician must make sure that the patient is actually trying to lose weight through diets, therapies and physical activity, and is trying to lead a healthy lifestyle, but he is unable to reduce excess body weight.
The patient, independently or in our Center, undergoes a thorough examination (usually it takes 1-2 days), including:
- DI of the abdominal cavity;
- ECG and ECHO of the heart, Doppler ultrasound (USDG) of the veins of the lower extremities;
- fibrogastroduodenoscopy (FGDS) of the esophagus;
- stomach and duodenum;
- spirometry (examination of the function of external respiration);
- other additional instrumental examinations (if necessary and as prescribed by a doctor).
The patient undergoes laboratory tests to prepare for bariatric surgery:
- complete blood count minus platelets and ESR;
- blood test for lipids, leptin, ghrelin;
- biochemical analysis of blood composition, determination of blood group and Rh factor;
- blood test for B IL, hepatitis B, C, Wasserman reaction;
- hormonal spectrum;
- analysis of urine.
Diagnostic procedures, as well as, if necessary, additional consultations with narrow specialists: a cardiologist, an endocrinologist, a nutritionist - will help determine the presence and severity of concomitant diseases, exclude contraindications and choose the type of surgical treatment that is optimal for a particular patient.
After taking into account the patient's advantages and consent, the choice is made and the operation is scheduled, the doctor prescribes dietary adjustments - a diet that the patient must strictly follow for at least three weeks before the surgical procedure. It includes foods that are high in protein, low in carbohydrates (especially fast ones), and a fair amount of hardiness.
It is recommended to: completely exclude fatty and sweet foods from the diet; give preference to such protein products as eggs, meat, fish; reduce portions and avoid eating before bed. Such a diet will help: reduce the risk of bleeding during surgery; accelerate postoperative recovery; reduce the size of fatty deposits in the liver. At least one month before the operation, the patient must stop smoking and drinking alcoholic beverages.
Smoking increases the risk of complications such as myocardial infarction, stroke, thromboembolism, infection, pneumonia, etc. By narrowing the lumen of blood vessels, smoking slows down the healing of wound surfaces. Within six weeks after giving up this bad habit, lung function and oxygen supply to the body improve, the risk of blood clots decreases, and the immune system is strengthened.
Physical activity is highly recommended for patients. It improves well-being, general tone, lung and heart performance. To the usual daily activities (office work, shopping, cleaning, etc.), you should add walking, regular exercise and swimming for at least an hour a day. Patients with reduced physical activity are advised to visit the pool. Exercising in water is easier because the body becomes weightless.
The day before the operation
Before the procedure, the patient is again scheduled to meet with the surgeon. This is necessary in order to describe how the operation and the recovery period will go, to get acquainted with the anesthesiologist.
- Medical preparation for the procedure, aimed at preventing bleeding and thrombosis;
- the anesthesia to be applied and its effect;
- intended premedication - drugs to reduce preoperative anxiety and fear;
- banning food and drinks on the eve of the operation.
For his part, the patient must
- inform the anesthesiologist about the complications that happened to him in the past during surgical interventions (if any);
- ask those who are of interest to him;
- tell about the medications that he is taking, including medicinal herbs, dietary supplements and vitamins, since they may have contraindications for general use with drugs prescribed before and after surgery.
For example, aspirin, Plavix, tocopherol (vitamin E) increase the risk of bleeding, and birth control pills with estrogen can lead to blood clots.
Slow, careful preparation of the patient for bariatric surgery, adherence to the recommendations of the anesthesiologist and surgeon minimizes the risk of complications during the procedure, is the key to its successful implementation and quick recovery with good results.
