Bariatric surgery in question
Bariatric surgery in question

Bariatric surgery in question

See why exactly bariatric surgery is in question according to the experts.Follow the article for more!!

When the diet fails, weight loss surgery can take over. The spectacular results in terms of weight loss and wellness make you want to throw. However, complications exist and dietary constraints are heavy. To be able to weigh the pros and cons, we must be guided by an experienced multidisciplinary team for your  bariatric surgery.

Bariatric surgery is on the rise: 20 000 procedures were performed in France in 2009 and the number of interventions is on the increase. Thus, according to data from health insurance, 32,000 operations were performed for obesity in 2011, with growth of 65% per year. According to the National Health Authority (HAS), this treatment is only for adults, whose body mass index (BMI) greater than 40 or greater than 35 and have at least one complication (diabetes, joint disorder …).

Bariatric surgery should only be proposed if obesity is installed for several years and if she resisted conventional treatment (diet and physical activity) continued for at least 6 months 1.


The sleeve, bypass and ring are the 3 most used techniques

There are three techniques of surgeries of the most commonly practiced obesity, in descending order: the sleeve, the bypass and the installation of a gastric band. The sleeve has gradually gained ground on two other techniques. Indeed, the number of 2 latest techniques decreases year by year in recent years in favor of the sleeve technique. Thus, of the 32,000 procedures performed in 2011, 14,000 were sleeves, 10,000 of the bypass and about 8000 of adjustable gastric bands.

At the 51th Annual Conference of Nutrition and Dietetics 2, Prof. Jean-Luc Bouillot, surgeon Cochin Hospital in Paris, said their main advantages and disadvantages of the techniques of the bypass and gastric banding, which will remain in place. As for the advantages and disadvantages of the technique of the sleeve, the Health Authority decides its advantages and disadvantages.

The sleeve or sleeve gastrectomy

How does bariatric surgery works ? Bariatric surgery involves removing a large part of the stomach (the greater curvature) by practicing a vertical incision. Thus, 75% of the gastric volume is removed permanently without interrupting the continuity of the digestive tract since food will drain into the duodenum, which is conducted just after the stomach. Food is so slow and then quickly pour into the small intestine. The operation is done under general anesthesia and can be performed by laparoscopy, which reduces the importance of the incision on the belly. Although the technique has improved, there is nevertheless a risk of bleeding after surgery or fistulas often require further surgery.

As with other techniques of bariatric surgery, surgical patients are forced to reduce the size of their meals, el foods are less well understood. The risk of deficiencies is important and requires regular monitoring. Some patients regain weight a few years after surgery.

What weight loss? Weight loss varies but is estimated to average about 54% of the weight loss before surgery.

Its advantage: The technique has improved in recent years, it is increasingly used because of its durable efficacy, resulting in improved quality of life for patients provided that monitoring is appropriate (physical and psychological) .

Gastric bypass

How it works ? This is a technique that consists in keeping a small gastric pouch, which is connected directly to the jejunum, the second part of the small intestine. Surgeons and put off a large part of the stomach and the entire duodenum, the first part of the small intestine that normally occurs much of the assimilation of nutrients (carbohydrates, fats, proteins) .

As for the ring, people effected are forced to reduce the size of their meals. But in addition, much of the energy nutrients, such as carbohydrates (sugars) and lipids (fats), is no longer absorbed.

What weight loss? Hence the dramatic weight loss: on average, from 45 to 50 kilos after 2 years, 70% of the excess of initial weight.

Its advantage: “This procedure is technically difficult, post-operative mortality is about 1% said Professor Bouillot But its effectiveness is remarkable about the complications of obesity such as diabetes or sleep apnea.. “.

The gastric banding, gastroplasty or adjustable ring

How it works ? This technique is to encircle the upper part of the stomach by a ring. The stomach is thus separated into two parts: an upper pocket (where arrive the food) of very small volume (minimum 20 ml) and a larger lower pouch, the two pockets being connected by a very narrow channel.

The persons so effected are forced to limit the volume of their meals. Even by increasing food intake, energy intake is necessarily reduced and “sometimes less than 1000 kcal per day,” said Richard Agnetti, dietician-nutritionist.

It is thanks to this that weight loss is possible.

What weight loss? The expected weight loss is of the order of 25 to 30 kilos in 12 to 18 months after surgery, 40 to 50% of the excess of initial weight.

Its advantage: According to Professor Bouillot, “this surgery is not dangerous and has the advantage of being reversible as it is possible to loosen the ring.”

At these annual meetings, Prof. Bouillot stressed that the interest of bariatric surgery has been shown by a Swedish study, conducted over 15 years: at the end of follow-up, the group of obese surgical patients had lost 16, 1% of its weight, whereas in the conventionally treated group, the weight had increased by 1.6% 3. “If the choice of technique depends on the severity of obesity, it should be done as a function skill of the surgical team, “he recalls.

A follow-up to life after bariatric surgery

Following the intervention, the HAS recommends at least 4 consultations in the first year after surgery, then 1-2 a year, and throughout life.

Because bariatric surgery can result in multiple complications, which may occur at any time, even many months after the intervention.

Digestive problems, consequences of bariatric surgery: bowel obstruction, ulceration where stomach and jejunum are connected, hiatal hernia (the stomach rises above the diaphragm muscle) … They may require reoperation.

Discomfort after meals: a “dumping syndrome” big change of course need to lie, with vomiting or diarrhea, accompanied by hypoglycemia.

Multiple nutritional deficiencies, with their consequences: iron and anemia, vitamin D and osteoporosis …

Neurological problems due to deficiencies in vitamins B: memory problems, walking, sight …

“The patients are so happy with their weight loss, they tend to minimize problems, says Dr. Christine Poitou, of the Nutrition Department of the Pitié-Salpêtrière Hospital in Paris. In fact, do not hesitate to consult soon qu’interviennent unusual symptoms, even if they seem minor (fluctuating abdominal pain, blurred vision, accelerated weight loss) because they can translate a complication that needs to intervene urgently “.

Bariatric surgery: the best dietary constraints

“Whatever the intervention, warns Richard Agnetti, dietitian-nutritionist in Paris, people who receive bariatric surgery are forced to change their eating habits.” The key recommendations are followed by people who have undergone an operation:

Split meals 5-6 food intakes per day, at least the first month. “We must also subject themselves to eat slowly and chew food and do not drink with meals,” recalled Richard Agnetti. All this to digest and prevent reflux, vomiting or diarrhea.

“In some hospital services, as part of preoperative consultations, it provides an opportunity for patients to consume volume of food and suitable texture, that they really make the changes to implement.”

Eat balanced, to prevent muscle loss and nutritional deficiencies.

“The volume of food is limited, you need to consume enough protein rich foods. A significant weight loss necessarily results in decreased muscle mass along with fat mass,” the dietician.

But preserving the best muscles is essential, both to stay toned, in order to practice a physical activity that helps in weight management and to maintain its immune defenses.

“In the case of the ring, beware of soft or liquid energy foods (ice cream, soft drinks …) that pass like a letter in the mail and can hinder weight loss. As for the bypass of bariatric surgery, it induces multiple deficiencies in vitamins and minerals, due to their reduced assimilation. in addition to a more balanced diet possible, patients must take medication for life multivitamin supplements, “he added.

Limit sugary foods, choose those with low glycemic index (those who do not rise too quickly blood sugar) in the event of symptoms and hypoglycaemia after meals.

In total, concludes Richard Agnetti, “the people who opt for bariatric surgery must be followed by a dietician before and after the intervention, even in the long term, to maintain the focus on healthy eating habits, and have tailored advice according to their problematic (dislikes, digestive disorders, complicated social life …). ”

In France, all dietitians are not trained to monitor  bariatric surgery of  patients. “Therefore it is essential to move towards surgeons working with a multidisciplinary team (physician specializing in obesity, dietician, psychiatrist or psychologist …), insists dietician familiar with surgical fixtures and their consequences Plan on digestive and overall health. “

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