What is bariatric surgery?
Also called bariatric surgery, bariatric surgery can be used for people who are overweight or obese. Actually, it includes several types of surgery. These interventions are intended to help the patient lose weight and control certain diseases caused by excess weight, such as diabetes, high blood pressure, hypercholesterolemia or even sleep apnea. Three types of interventions are generally performed.
This technique is called “restrictive” because it reduces the size of the stomach and slows down the passage of food. A ring is placed around the upper part of the stomach, thus delimiting a small upper stomach pouch or gastric pouch. This small pocket fills up quickly from ingested food, and a feeling of fullness sets in quickly. According to the hourglass principle, food flows very slowly into the lower gastric pouch and then into the intestines. The gastric band technique does not disturb the digestion of food, which is all assimilated by the body, and it is the only adjustable technique: the diameter of the band is, in fact, modifiable and can therefore be adapted during the medical follow-up of the patient. .
Also restrictive, this operation consists of removing about 2/3 of the stomach, including the part that contains the cells that secrete the hormone that stimulates appetite: ghrelin. Therefore, the appetite is reduced and the stomach is no longer shaped like a pocket but rather a vertical tube. Therefore, food passes faster through the intestine, but like the gastric band, this technique has the advantage of not disturbing your digestion.
Unlike the two previous techniques, the bypass, also called Y-gastric bypass, is both a restrictive and a malabsorptive technique, that is, it also acts on the way the body digests food. By creating a short circuit of part of the stomach and the intestine, the bypass allows to reduce both the amount of food ingested, since the size of the stomach is reduced to a small bag, and the assimilation of these foods. by the body During this procedure no organ is removed or shrunk, but the food goes directly to the middle part of the small intestine and, therefore, is assimilated in less quantity.
These different operations are most often performed by laparoscopy, a surgical technique that allows access to the interior of the abdomen through small incisions in the abdominal wall. Therefore, it is necessary to be well prepared, both mentally and physically, and to be aware that all of them require postoperative follow-up for life, as well as a program of dietary education and physical activity.
Why undergo bariatric surgery?
Obesity can have serious physical consequences, especially if the overweight is located in the belly -we are talking about visceral fat-, but also psychological. Being overweight can be an obstacle to mobility, affect self-esteem, and even lead to body rejection in some cases. Therefore, it is important to know that there are solutions available to you if you are having trouble losing your excess weight and it is causing you discomfort. However, obesity surgery is not trivial. The treatment of obesity through surgery can only be considered by the patient or his doctor if the measures taken to combat obesity have not given the expected results. The fight against obesity begins with specialized medical care for several months with medical and dietary monitoring, a physical activity program and psychological support.
If you have already tried unsuccessfully to lose weight with these methods, do not hesitate to raise this issue with your doctor or the medical team in charge of your follow-up.
Indications and contraindications of bariatric surgery
Therefore, bariatric surgery is reserved for people:
- suffering from massive obesity (BMI ≥ 40 kg/m²) or severe obesity (BMI ≥ 35 kg/m²) if associated with at least one complication that can improve with surgery (diabetes, arterial hypertension, sleep apnea or joint disorders);
- who have already tried, without success, to lose weight thanks to specialized medical care;
- who do not present contraindications for surgery and general anesthesia, nor any particular operative risk;
- 18 to 60 years old: Although there is no real age limit for this type of intervention, other methods are preferred for younger or older patients;
- have no psychological contraindications.
The decision to operate must be made after numerous discussions between the patient and the medical team in charge of their follow-up, which may include the treating doctor, the surgeon, the endocrinologist, the nutritionist, the psychologist or the psychiatrist: it is a decision made collectively , systematically prioritizing the physical and mental well-being of the patient.
Since obesity is a serious disease, if surgery is possible, the medical team responsible for your follow-up will give you more information about the chosen surgical technique (ring, cuff or bypass). If you accept the operation, an intervention date is proposed and a prior agreement request is sent to your health insurance fund. The latter then reimburses all costs related to the intervention and hospitalization, once you have agreed to the prior agreement request.
On the other hand, health insurance does not systematically cover:
- certain vitamin supplements as part of the preparation for the operation or post-operative follow-up;
- consultations with psychologists or liberal dieticians;
- certain acts of reconstructive surgery, such as abdominoplasty.
You can ask your doctor or surgeon for advice, and get information from your health insurance or mutual insurance company.
How to prepare for bariatric surgery?
Depending on your doctor’s recommendations, and even before considering surgery, it’s essential to put yourself in a positive and willing frame of mind: weight loss can be slow to observe and difficult to manage in the long term. It is necessary to establish new eating habits and think about a physical activity adapted to your state of health, your tastes and your possibilities: food and physical exercise should continue to be moments of pleasure if possible, at the risk of getting tired or generating too much. a feeling of deprivation. Health professionals are here to help you and offer you different activities: there are, for example, cooking workshops and specialized physical activity programs.
If you wish to have bariatric surgery, several health professionals working together in a multidisciplinary team will be there to support you, but also to monitor your health status. You will be prescribed various examinations to carry out a complete assessment of your state of health and your lifestyle and eating habits, and to treat certain conditions that you may have before the operation (deficiencies, diabetes, hypertension, respiratory disorders). Therefore, you may need to undergo blood tests, an endoscopy of the digestive tract and, if necessary, several X-rays or an evaluation of respiratory and cardiac function. You will also be offered a psychological assessment to consider the best psychotherapeutic care if necessary, as well as information on pregnancy and contraception for women of childbearing age. As these tests and exams can be restrictive or distressing, it can be very helpful to meet people during this time who have had bariatric surgery and have gone through the same preparation protocols.
How’s it going?
Once the type of intervention has been determined by the medical team, the operation is performed under general anesthesia, most of the time by laparoscopy, a minimally invasive technique that limits pain and allows the patient to return to normal activity more quickly. Sometimes it is necessary to open the abdomen (laparotomy), but doctors try to use this as little as possible.
Hospitalization can last from 2 to 10 days: it will depend on the type of intervention chosen and your general state of health. In order to recover as well as possible, it will be necessary to plan at least 2 weeks off work after leaving the hospital. The consequences of surgery on the abdomen can be painful, the medical team will prescribe painkillers if you need it.
What are the possible complications?
Like any surgical procedure, certain complications can sometimes appear depending on your age or your general state of health:
- Mechanical complications: as the diameter of the gastric band is controlled by a subcutaneous box, it is possible that discomfort, infection or injury may develop at the box or band level;
- Functional complications: vomiting, inability to eat, esophageal or transit disorders;
- nutritional deficiencies;
- Bleeding or ulcers;
- psychological complications.
In some cases of serious complications, a new operation may be necessary to remove the band or perform another obesity surgery technique.
What to do after the operation?
Bariatric surgery is only effective in the long term if you change your eating habits, increase your physical activity and undergo lifelong medical follow-up. In fact, for the benefits of bariatric surgery in obese people to be long-lasting and to avoid the appearance of side effects, medical follow-up of patients is essential. This monitoring includes:
- Four follow-up visits with your medical team in the first year, then one or two per year;
- Periodic consultations with the treating physician;
- Take certain vitamin supplements in case of gastric band.
To facilitate healing, rest is recommended, not carrying heavy loads and only resuming physical activity between the 2nd and 4th week after the operation, following the recommendations of your doctor.
You will also benefit from a work stoppage. This can last from 2 to 4 weeks depending on the type of professional activity you carry out and your state of health. In the event of a stoppage of more than 30 days, a visit to the work doctor prior to resuming is mandatory. Be aware that work accommodation may be necessary during your recovery, for example, setting up therapeutic part-time for a short period, or adapting your work station.
If you once benefited from a bariatric surgery for obesity, your physical medical suave, but also mental, is paramount: in effect, the modification of your corps et de son appearance may entail a psychological bouleversement quail est parfaits difficile d’apprhender Single. It is completely normal to need a period of adaptation to change, both for you and for those around you. If you wish or if your doctor considers it necessary, a psychologist or psychiatrist can help you accept these changes.