WEIGHT LOSS SURGERY
A Happier, Healthier You
BodyClinique is one the largest EU providers of Bariatric weight loss surgery. Our partnering surgeon performs 1000’s of weight loss procedures a year.
Evidence suggests that obesity is on the rise with 1 in 4 adults now obese. Together with our partnering surgeon we are helping to reduce those figures with a combination of weight loss surgery and support – with some great weight loss results!
Our patients are successful
after their surgery because of our excellent bariatric surgeon, weight loss surgery aftercare and expert weight loss specialist dietician support.
In a recent weight loss surgery survey, over 99% of our Bariatric surgery patients achieved weight loss after surgery.
FACTS AND FIGURES ABOUT WLS
Metabolic & Bariatric surgery help to improve or resolve diseases such as Heart Disease, Type II Diabetes, Sleep Apnea, Infertility and Hypertention.
Mortality from coronary artery disease is reduced by 56% after surgery.
76.8% of patients no longer have Diabetes.
Bariatric surgery reduces the risk of premature death by 40%.
Bariatric Surgery has been shown to be the most effective and durable treatment for severe obesity.
Clinical studies have demonstrated significant improvement in safety showing the risk of death is 0.1%
Patients may lose as much as 60% of excess weight 6 months after surgery and 77% of excess weight as early as 12 months after surgery.
*Information taken from American Society for Metabolic & Bariatric Surgery.
WEIGHT LOSS SURGERY
The surgery of obesity, so called bariatric surgery, weight reduction surgery or weight loss surgery (WLS), represents a series of various operations that have been employed in patients with morbid obesity that has failed to respond to previous conservative treatment or recurs with a yo-yo effect. The rationale for the operative treatment is based on the fact that the severe obesity significantly increases the health risks and shortens the life. The conservative therapy for obesity consisting of exercise, dietary and psychological treatment and pharmacotherapy, often achieves only a partial, and more importantly, only a temporary effect on the weight.
Classification of obesity is based on BMI (body mass index) which is calculated from weight (kg) and height (m). The BMI of a person = (his/her weight [kg]) / (his/her height [m])2. According to the World Health Organisation obesity is classified in degrees: BMI of 30 and above means the 1st degree, BMI above 35 the 2nd degree and BMI above 40 the 3rd degree of obesity. Morbid obesity is labeled either BMI of 40 and above or in cases with severe health comorbidities also BMI
of 35 and above.
WHAT ARE THE BARIATRIC INDICATION CRITERIA?
According to internationally accepted guidelines the bariatric surgery is indicated only in morbid obesity keeping the primary goal to reduce its serious health risks under following criteria:
Morbid obesity, BMI 40 or more or BMI 35 and more in patients with comorbidities (e.g. type II diabetes, hypertension, hyperlipemia, metabolic syndrome, sleep apnoea and joints and backbone overloading)
Conservative treatment failure and/or insufficiency
Consensual indication by the surgeon, obesitologist and psychologist
Patient capable to stand an operation under general anaesthesia (lasting about 2 hours)
No systemic disease
No bulimia, serious psychiatric disease or abuse of drugs and/or alcohol
The age of less than 60 years and no short life expectancy for any reason
Presumption of a good and a smooth pre and postoperative cooperation, compliance of the patient
WHAT KIND OF BARIATRIC OPERATIONS HAVE BEEN IN USE?
Bariatric operations can be divided into purely restrictive, limiting the gastric volume (as Gastric Banding, Gastric Sleeve Resection and Greater Curvature Gastric Plication), purely malabsorptive, reducing the intestinal absorption (as Biliopancreatic Diversion, Duodenal Switch) and those which act by both effects, restriction together with moderate malabsorbtion (as Roux-en-Y Gastric Bypass, MiniGastric Bypass). Some other new methods have also been studied under experimental study, (Gastric Pacing, Stimulation). Currently we offer our clients restrictive procedures – Gastric vertical sleeve resection and Greater curvature gastric plication. All these operations are performed under a general anesthesia at the operating theater by means of minimally invasive surgery.
WHAT PRE-OPERATIVE PROCEDURES ARE NEEDED?
Pre-operative diet. A preoperative weight loss of at least half a stone 7lb (3 kg) within 2 – 3 weeks before the surgery is required as a significant contribution by the patient towards the smooth course of the laparoscopic operation. Patients who are very obese, with a high BMI will be expected to lose a greater amount, in order to make a significant contribution towards ensuring the surgery can be carried out as safely as possible and the post-operative recovery in the hospital is not impaired. A strict reduction diet is necessary in order to diminish the liver and it should contain only 4.000 kJ [4MJ] (about 1000 Calories) of energy intake per a day comprising mainly from proteins (at least 50%). The diet should substantially limit any carbohydrates and sacharids (sugars) (to only 25% - 30%) and should avoid any fat, lipids (to only 20%-25%). Lots of vitamins and unflavoured/unsweetened water are recommended.
Preoperative examinations. On the day of your admission to the hospital the following preoperative exams are on the schedule:
laboratory test from your blood and urine
abdominal ultrasound examination (sonography),
lung and heart X-ray (RTG),
electrocardiography (ECG) alternatively with ergometry
spirometry alternatively with complete pulmonary examination
endoscopic examination of the stomach (gastroscopy)
evaluation of your general health status by the internal specialist and by the anaesthesiologist.
final preoperative consultation by the psychologist and the bariatric surgeon
HOW IS THE LAPAROSCOPIC SURGERY PERFORMED?
Firstly the minimally invasive, laparoscopic approach requires an inflation of the peritoneal cavity by gas (CO2) through a special needle. The inflated belly gives enough of room for the surgeon to see and to manipulate the intra-abdominal organs. Then more trocars, 5mm to 12 mm canulas are introduced through the abdominal wall. Through trocars special thin and long laparoscopic instruments are used which enables a mini-invasive performance of the whole operation. Then in all bariatric operations the left lobe of the liver has to be elevated to get an approach to the upper part of the stomach. Further technical details differ in each type of bariatric procedure. Extremely rarely, for example in huge fatty liver, when the laparoscopic procedure is not possible a 15 to 20 cm long incision has to be made to do the procedure in an open, traditional way.
WHAT IS THE LENGTH OF THE HOSPITALISATION AND ARE THERE ANY SIDE EFFECTS
The operation is scheduled to be performed by a minimally invasive approach, therefore if everything goes normally the discharge should be on the third postoperative day.
Possible side effects
Heartburn and other signs of gastro-oesophageal reflux occur frequently and have tendency to decrease. The lifelong change in eating habits has to be accepted and kept, otherwise some deglutination problems may occur. Within the phase of rapid weight loss especially within the first year after the WLS it is recommended to women not to become pregnant. Some temporary hair loss can be quite common during periods of rapid weight loss (whether the weight loss is as a result of surgery or “conservative” means). These effects can be minimised or avoided by following a protein-rich diet and ensuring daily oral vitamin & mineral supplements are taken.
WHAT IS THE POST-OPERATIVE COURSE LIKE?
In laparoscopic surgery the postoperative recovery is short as the bodily pain from the abdominal wall is minor due to the absence of a long incision. Low doses of painkillers are usually sufficient. Also the inner organs start their work and recover sooner after laparoscopic procedure, which allows quick re-alimentation and an early discharge from hospital.
Nausea and vomiting are usual in most patients during the first couple of postoperative days.
At night after the operation and the first day after the Gastric operation tea, water and liquids only are offered, on the second day soup and yogurt.
Usually one night after the operation is spent at the ICU, hospitalization at the ward lasts a further two days.
The removal of external stitches (10th- to 20th day) could be done either by a family doctor (GP) a NHS Walk-in Centre or at the surgical outpatient department. You will be given a letter for your GP explaining him/her your surgery. It is recommended that patients should visit their GP for a blood test and general health check twice at least in the first year, to ensure there are no problems with mineral and vitamin deficiencies which could possibly occur during any period of rapid weight loss. Thereafter it is recommended that an annual test should be carried out. Some nutritional supplements of some minerals esp. calcium and iron and vitamins, especially B, D and folic acid are suitable in form of one multivitamin tablet a day especially within first months after the surgery. We strongly suggest Gastric Plication patients take 1 x multivitamin with minerals and iron, 1 x calcium (not at the same time as the iron), and 1 x Vitamin B12 supplement daily after surgery
At least written email, text message or telephone information on post-operative weight loss and progress has to be sent to BodyClinique, for onward transmission of statistical data to Dr M.Cierny.
Immediate check-up is necessary anytime in case of any problems either at home country or in Breclav Hospital.
WHAT ARE THE MOST COMMON COMPLICATIONS IN RESTRICTIVE BARIATRIC SURGERY?
The risk of an operation is lower than the risk of staying morbidly obese on a waiting list. Even in a very meticulous execution there may arise a complication during the operation or postoperatively. The most frequently cited are:
Perioperative bleeding – can be usually controlled during the procedure by ultrasound haemostasis or electrocoagulation. In less than 1% transfusion or frozen plasma is required for blood substitution and improvement of the haemostatic properties of the blood. Postoperative continuing or recurrent bleeding should be signalled by the abdominal drainage. In case of insufficiency of conservative treatment a reoperation may be required, yet extremely rarely.
Leak and peritonitis from perforation of stomach along a stitch is also extremely rare complication, which according to literary data usually was due to extremely increased intra-abdominal pressure after an uncontrolled nausea and vomiting. If recognised during the operation and repaired by a suture it has very good prognosis. Any bacterial spillage of the peritoneal cavity with possible more serious consequences often requires either an open or a laparoscopic re-operations.
Venous thrombosis and pulmonary embolism is a possible complication correlating with the length of the operation and immobilisation. Rarely, it may occur even if all recommended prophylactic measures are taken. Early postoperative physical activity and mobilisation on the first day are very important as a prophylactic measure.
Superficial and dermal lesion – may emerge as a consequence of a heavy body, of a local compression or a local reaction to disinfection solution and burn injury from short circuit of electric current.
Bacterial infection of the wound or of the foreign body is the most common complication that requires usually removal of the foreign material and prolonged local treatment with antibiotics and repeated change of the wound dressing.
WHAT ARE THE LONG TERM RESULTS OF BARIATRIC OPERATIONS?
The long term results and the weight reduction depends on many factors, particularly on the cooperation of the patient, on his/her compliance with the restrictive bariatric procedure, with his/her adherence to diet without overeating and supplementation of energy intake. It also depends on the level of the hereditary burden and on the physical activity level of the patient. Long term and significant weight reduction lowers the health risk from obesity related diseases, prolongs the life expectancy and improves the quality of life. No malnutrition has been noticed in connection with restrictive procedures.
The weight loss after Adjustable gastric band usually takes longer and reaches the Excess Weight Loss (EWL) in average close to 50% within few years. In general the WL after Greater Curvature Gastric Plication similarly to Sleeve Resection appears to be more rapid, usually exceeding 50% of EWL within the first year after surgery A Sleeve Gastrectomy can be converted to a Gastric Bypass, should this prove necessary and Gastric plication gives similar chances. However, in order to avoid weight regain and consequent further surgery it is most important that patients follow the advice of the Surgeon and BodyClinique, to develop and maintain lifelong good eating habits, maintain a healthy well-balanced diet and increase energy output through a planned exercise regime.
It has been well documented that those patients who are most likely to succeed with post-operative weight loss and are most likely to sustain a stable reduced BMI over the years take full advantage of the support and advice offered by nutritionists and after-care providers. For this reason we require all patients to agree to complete and forward BodyClinique Weight & Measurement charts regularly as requested. Patients must also consent and agree to complete any food diaries and questionnaires sent to them by BodyClinique from time to time, and to approach the company for support, encouragement or any specific advice, to inform BodyClinique if they believe they have reached a plateau in their weight loss before reaching the goal weight or if they have any other issues or problems related to weight loss and the maintenance of correct weight and healthy eating plans following the surgery.