Bariatric / Weight Loss Surgery

• Before a patient can be accepted for surgery, they are required to undergo a thorough medical evaluation in order to rule out any other potential causes of their weight gain, such as genetic, metabolic or endocrine causes, as well as to assess their suitability for surgery. Various other vital tests, such as blood work, an electrocardiogram (ECG) and anesthesia evaluations, are also carried out before surgery.
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• It is important to note the expectation that patients looking to undergo surgery will have already tried weight loss through a determined effort of diet and exercise. If this is not the case, doctors will advise that patients first see a nutritionist to obtain professional dietary advice. Additionally, sleep studies will be undertaken to rule out sleep apnea. Patients will also attend bariatric support group meetings to understand the whole process and share their own experiences.

The American Hospital Dubai offers three types of weight loss procedure. Your surgeon will help you decide on which is your best option through a detailed discussion and evaluation that will concern a variety of individual factors, including your age, BMI, medical history and other related conditions.

Laparoscopic Vertical Sleeve Gastrectomy 

This operation involves medical stapling to create a smaller sleeve of the stomach, thereby reducing its size by around 80%. Due to the smaller and more restricted nature of the stomach pouch, the volume of food that can be consumed is greatly limited, although digestion and absorption continues as normal. Naturally, this change helps to reduce weight because there is an overall decrease in the calories that can be consumed.

As well as reducing stomach size, this surgery has a significant effect on gut hormones. This impacts a variety of features, including fullness, hunger and blood sugar level control, which is why vertical sleeve gastrectomy is an effective measure against type 2 diabetes.

Advantages:

1. Short recovery period
2. Induces desirable transformations regarding gut hormones
3. Effective step against obesity and other health related diseases

 Disadvantages:

1. Potential for vitamin deficiencies
2. The operation is non-reversible

Laparoscopic Adjustable Gastric Band

This operation involves the insertion of a band in the uppermost part of the stomach. This creates a smaller upper pouch, leaving the remainder of the stomach below as the larger pouch. This procedure is commonly referred to as the ‘lap band’.

The procedure works because the patient feels satisfied after eating a comparatively small portion of food. Of course, patient hunger satisfaction depends entirely on the size of the gastric band, and our doctors will progressively reduce the size of the gastric band over a period of time. The surgery is reversible, with digestion and absorption taking place as normal.

Advantages:

1. The procedure is reversible
2. Decreases the amount of calories consumed by reducing the amount of food the stomach can hold
3. Due to the minimally invasive nature of the procedure, patients can leave hospital within 24 hours.
4. The smallest chance of vitamin and mineral deficiencies

Disadvantages:

1. Complications can arise if the patient overeats
2. Weight loss can be slow and ineffective
3. The procedure requires a foreign object to exist within the body
4. The chance of success relies on the patient observing a strict postoperative diet

Laparoscopic Roux-en-Y Gastric Bypass

This operation involves the use of medical stapling to create a smaller upper pouch, which restricts the amount of food the patient is able to consume. The procedure is commonly referred to as a ‘gastric bypass’. Essentially, a large portion of the small bowel is bypassed, thus delaying food from mixing with digestive juices and avoiding complete calorie absorption. This leads to malabsorption which, in turn, leads to a significant weight loss.

Much like the other procedures, this method significantly reduces the overall size of the stomach pouch which, in turn, equates to a reduction in calories as less food in consumed. Furthermore, similar to the vertical sleeve gastrectomy, the ‘gastric bypass’ facilitates a transformation of gut hormones, which stimulate appetite suppression and helps to neutralize the threat of type 2 diabetes.

Advantages:

1. A proven and effective method of significant long-term weight loss in a vast amount of patients
2. Successfully restricts the amount of food
3. Induces desirable transformations regarding gut hormones
4. Very high success in curing type 2 diabetes

Disadvantages:

1. Likelihood of vitamin and mineral deficiencies, particularly vitamin B12, calcium and iron
2. The procedure demands a longer recovery time
3. Patients are obliged to follow strict dietary recommendations, as well as a long-running dependence on supplementary vitamins and minerals

Patients are typically discharged from hospital the day after either a lap band or a gastric sleeve procedure. Those who undergo a gastric bypass will spend on an average two nights in the hospital. Regardless of the type of surgery patients undergo, they will be placed on a post-operative bariatric liquid diet for the first two weeks.

Every surgery comes with its own set of risks and complications. Some are unique to the type of surgery you may be contemplating, whilst others will be particular to your individual disposition. A variety of factors, including your weight, age and medical history, will play a significant role in determining your specific risks for bariatric surgery. Risks include:

1. Abdominal hernias
2. Deep vein thrombosis
3. Dehydration
4. Enlarged heart
5. Infection
6. Gallstones
7. Adhesions
8. Nausea and vomiting
9. Stretching of the stomach

• Patients must remember that weight loss surgery is not cosmetic surgery!

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• However, it is the most effective way to lose weight and maintain that loss
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• The success of weight loss surgery is largely dependent on a long-term commitment to lifestyle changes, including diet, exercise and behaviour modification. A successful and healthy outcome depends on how strictly you follow your surgeon’s guidelines and recommendations.
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• The ball is in your court!