Obesity/Metabolic/Bariatric Surgery
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Preconditions
Patients with a BMI of ³40 kg/m2 or with a BMI of ³35 kg/m2 and suffering from obesity-associated comorbidities (such as hypertension, type 2 diabetes mellitus and sleep apnea) are candidates for obesity surgery. In certain circumstances (High cardiovascular risk, uncontrolled diabetes), patients with lower BMI (30-35 kg/m2) also might be candidates for metabolic surgery.
Body mass index (BMI)
The body mass index is a measure of relative weight based on an individual's mass and height. It is defined as the individual's body mass divided by the square of their height given in units of kg/m2.
Preliminary examinations
Certain investigations like endoscopy and blood tests are necessary before surgery. These investigations can be done on an outpatient basis or immediately before surgery
Surgical bariatric procedures
Expertise in following surgical techniques:
- Gastric Bypass
- Laparoscopic-adjustable gastric banding
- Sleeve Gastrectomy
- Biliopancreatic diversion
- Duodenal Switch
- Intragastric Balloon (non-surgical technique, up to 12 months)
All bariatric procedures are performed by laparoscopy („Key-hole technique“).
The biggest incision needed, is app. 1.2 cm. The abdominal cavity is filled with CO2 gas during the operation and visualization is gained by a 10 mm endoscope. The operation itself is performed using small bar-shaped instruments with a diameter between 5 and 10 mm. This minimally invasive technique has several advantages compared to traditional surgery like less scaring, faster recovery, shorter hospital stay, less pain, better cosmetics, reduced likelihood of postoperative complications like incisional hernia, infections or scarring.
Patients suffering from (morbid) obesity need an individual surgical approach: They differ regarding their eating habits, (e.g. high volume eater, sweet eater...) comorbidities (like diabetes, hypertension, gastro-esophageal reflux disease, spine and joint problems...) and amount of weight loss.
Therefore it is mandatory to explore the individual personal needs to offer the optimal surgical procedure to achieve the desired weight loss. From a surgical point of view it is important to offer different surgical options to adapt the surgical procedure to the patient and not vice versa...