Surgical Solutions.
Bariatric surgery.
Criteria to qualify for bariatric surgery from the International Federation for the surgery of Obesity & Metabolic disorders 2022:
Bariatric surgery is recommended for all patients with a BMI >35.
Bariatric surgery is recommended for patients with a BMI >30 with comorbidities - e.g. diabetes, high blood pressure.
Bariatric surgery can be considered for patients with a BMI >30 who have not achieved substantial or durable weight loss, or co-morbidity improvement, using non-surgical methods.
Clinical obesity in the Asian population is recognised in individuals with BMI >25.
Adolescents with a BMI >120% of the 95th percentile and major comorbidity, or a BMI >140% of the 95th percentile should be considered for surgery after evaluation by a multidisciplinary team.
Bariatric surgery is an effective treatment of clinically severe obesity in patients who need other specialty surgery, such as: joint replacement, abdominal wall hernia repair, or organ transplantation.
There is no upper age group limit for bariatric surgery - older adults should be considered for surgery after careful assessment of their comorbidities and frailty.
Our surgeons offer several weight loss operations - the main procedures have been listed below:
Surgical options include:
Laparoscopic Sleeve Gastrectomy:
A sleeve gastrectomy is a weight loss procedure in which a thin vertical sleeve of stomach is created, using a stapling device. This is performed via keyhole surgery.
Normally, the stomach can hold up to 2 litres of volume. Once a gastric sleeve is created, the stomach can only hold 100-150ml. This therefore reduces the amount of food the patient can eat.
The removed portion of the stomach, is usually the part that secretes many digestive hormones. By removing this portion, the patient’s response to food, their appetite, and their food preferences may all change.
So in essence, food still passes through the digestive tract in the normal manner. Acid continues to be made to assist digestion, and vitamins and nutrients continue to be absorbed into the body.
Benefits of the sleeve gastrectomy:
the sleeve has a restrictive effect that allows you to feel full and satisfied with smaller meals, preventing overeating.
you feel less hungry in between meals. A sleeve gastrectomy can alter your appetite by changing the patient’s biochemical response to food.
it also changes the way the gut handles fatty and sugary food groups - therefore, reducing cravings for these foods, and making healthier choices.
patients typically lose up to 60-70% of their excess body weight.
the sleeve resolves obesity-related conditions, including rapid resolution of type 2 diabetes in 80% of patients, within the first month post-op, long before significant weight loss occurs.
it is a relatively quick key-hole procedure, with less potential post-operative complications, in comparison to the gastric bypass.
most patients stay in hospital for 1-3 nights after the surgery and usually only need 10-14 days off work.
Laparoscopic Roux en Y Gastric Bypass:
A gastric bypass is more complex and surgically more technical than the sleeve.
It is a procedure that alters the pathway of food from the stomach to the small bowel. The new pathway creates a smaller pouch of stomach, and diverts food away from the first part of the small bowel.
It is both a restrictive and malabsorptive form of bariatric surgery. The smaller stomach size restricts the amount of food that can be consumed, therefore, making the patient feel full.
It also alters the release of gut hormones that control appetite. By bypassing the first section of the small bowel, the procedure causes a reduced absorption of calories and nutrients.
It carries a higher risk of post-operative complications and long-term nutritional deficiencies - therefore, it requires more frequent monitoring.
The gastric bypass also effectively resolves obesity-related conditions, including the resolution of type 2 diabetes in 80% of patients within weeks after the operation.
It is the best weight loss operation for those patients who suffer with gastroesophageal reflux disease, especially those with Barrett’s oesophagus.
The gastric bypass has a long term, proven track record - it has been the most commonly performed weight loss operation in the USA over the last 20 years.
Most patients typically stay 1-3 nights following surgery, and usually will need 10-14 days off work.
Laparoscopic One Anastomosis Gastric Bypass (omega loop):
The ‘mini gastric bypass’ or single anastomosis gastric bypass is a procedure where a small stomach pouch is created and then connected to the small intestine downstream, bypassing up to 1.5-2 metres of small intestine.
This leaves approximately 6 metres of small intestine remaining, to absorb the nutrients from food.
The mini bypass differs from the traditional Roux en Y, as it is only a single connection (anastomosis), and the Roux en Y involves 2 anastomoses. As there is only a single anastomosis, there is only one potential site for abnormal protrusion (herniation) of the bowel.
The mini bypass is a less complex operation, taking roughly 90 minutes to perform.
It is a safe and effective procedure, and most patients stay 1-3 nights following surgery. They may only need 10-14 days off work.
* Please note there are other surgical options available, such as: SADI. We have only discussed the most common procedures.
Benefits for the patient:
Long term studies across the last 15 years have in fact confirmed the safety, efficacy, durability and cost-effectiveness of bariatric surgery. Surgical methods of weight loss are superior to non-surgical interventions, with a low peri-operative mortality rate of 0.03-0.2%.
Patients experience a significant improvement in their cardiac and metabolic diseases, along with an increase in their quality of life.
There is a significant decrease in overall morbidity and mortality after bariatric surgery.