Obesity is one of the most significant health problems of the modern world.
According to the World Health Organization (WHO), obesity is now recognised as a disease rather than an aesthetic issue.
It is associated with numerous complications, including type 2 diabetes, hypertension, cardiovascular diseases and sleep apnoea.
When conservative treatment (diet, medication, etc.) fails, bariatric procedures provide effective solutions for substantial weight loss and improvement in overall health.
When should patients with obesity undergo surgery?
Surgery is indicated when BMI (Body Mass Index), expressed in kg/m², is:
- Greater than 34 kg/m², accompanied by comorbidities such as type 2 diabetes, hypertension, cardiovascular disease or sleep apnoea.
- Greater than 40 kg/m² (an absolute indication for surgical intervention). In this scenario, obesity is classified as morbid obesity, as the patient will soon develop complications related to excess weight.
- Greater than 28 kg/m² in the presence of type 2 diabetes (metabolic surgery). In this case, laparoscopic gastric bypass is an absolute indication. There is currently considerable discussion regarding this operation as a surgical treatment for type 2 diabetes that is inadequately controlled with medication.
ONLY then is there an indication for patients to undergo surgery for obesity.
One of the best-known surgical methods since 2000 is laparoscopic gastric bypass.
The first laparoscopic gastric bypass in Greece was performed in November 2002 by the author.
The procedure is described as follows:
a. Restriction of food intake: the volume of the stomach is significantly reduced by surgically dividing it from the rest of the stomach.
b. Bypass of the distal/divided stomach using the initial portion of the small intestine.
The procedure functions as follows:
A. The patient consumes smaller quantities of food and therefore gradually loses body weight. Early satiety is achieved, reducing hunger and preventing excessive food intake.
B. There is malabsorption due to bypassing a long segment of small intestine, the length of which is determined by the surgeon. Thus, only part of the small amount of ingested food is absorbed.
C. Incretins are stimulated.
As a result, the patient achieves substantial weight loss.
The operation is preferred:
A. In patients who eat large quantities of food (“big eaters”), consume many sweet-tasting foods (sweets, chocolates, ice creams) or drink sweetened beverages (“sweet eaters”).
B. In patients with diabetes.
Before surgery, patients undergo a series of investigations, including gastroscopy, to identify known and unknown conditions.
A multidisciplinary team evaluates each patient preoperatively (pulmonologist, cardiologist, gastroenterologist, the operating surgeon, etc.).
The operation is performed under general anaesthesia.
Special laparoscopic instruments are used, and the procedure is carried out through 4–5 small abdominal incisions.
Hospital stay: typically 3 to a maximum of 4 days (as this procedure involves a form of gastrectomy and an entero-enteric anastomosis).
From the day of surgery, patients are mobilised immediately and encouraged to walk. Pain is generally minimal.
Patients do not drink or eat for 2–3 days but receive intravenous hydration.
Subsequently, they begin drinking liquids and then gradually progress to oral intake according to written instructions provided by the surgeon.
These instructions must be followed STRICTLY to prevent complications.
Postoperative course
Patients:
• Begin to lose body weight gradually, approaching their ideal body weight within approximately 2 years and maintaining it thereafter (the goal of the procedure).
• Are monitored until weight stabilises, with blood tests ensuring timely correction of vitamin deficiencies and anaemia.
• May require adjustment of preoperative medications (antihypertensives, antidiabetics, lipid-lowering agents). In some cases, discontinuation of these medications is recommended by the specialist — a major advantage of surgical treatment.
• May discontinue CPAP devices for sleep apnoea — another therapeutic benefit.
• Receive enteral nutritional supplements for a short period (1–2 months) to support adequate nutrient intake. During this period, patients are trained on how to eat properly (chewing, swallowing small quantities up to the point of satiety).
• Are encouraged to initiate physical activity — mild initially, then gradually increasing. This contributes both to faster weight loss and improvement in muscle tone.
Patients must receive lifelong intramuscular vitamin B12, as it cannot be adequately absorbed by the body after this procedure.
Postoperatively, all patients MUST be reviewed by their physician according to the prescribed follow-up protocol.
