Obesity is one of the most significant health problems of the modern world.
According to the World Health Organization (WHO), obesity is today classified as a disease and not merely an aesthetic concern.
It is associated with numerous complications, including type 2 diabetes, hypertension, cardiovascular diseases and sleep apnoea.
When conservative treatment (diet, medication, etc.) fails, bariatric surgery provides effective solutions for substantial weight loss and overall improvement of health.
When should patients with obesity undergo surgery?
Surgery is indicated when the BMI (Body Mass Index), expressed in kg/m², is:
• Greater than 34 kg/m², combined with the presence of comorbidities such as type 2 diabetes, hypertension, cardiovascular disease or sleep apnoea.
• Greater than 40 kg/m² (an absolute indication for surgery). In this case, obesity is defined as morbid obesity, as the patient is expected to develop complications soon due to excess weight.
• Greater than 28 kg/m² in the presence of type 2 diabetes (metabolic surgery).
ONLY then is there an indication for patients to undergo surgery.
One of the best-known surgical methods since 2001 is the laparoscopic sleeve gastrectomy, commonly referred to by patients as the “gastric sleeve”.
Today, however, when robotic systems are available, the operation can be performed robotically.
Robotic sleeve gastrectomy is performed in hospitals equipped with a robotic platform and offers the following:
Advantages
• Exceptional stability of surgical movements, allowing the surgeon to operate with enhanced precision, even at a distance.
Disadvantage
• The increased cost of the procedure compared with laparoscopic surgery.
The operation restricts food intake (the volume of the stomach is surgically reduced), enabling the patient to consume smaller quantities of food and therefore gradually reduce body weight.
Additionally, patients experience early satiety and thus do not feel hungry or desire to eat larger portions.
As a result, patients achieve significant weight loss. This procedure is particularly suitable for individuals who consume large quantities of food (“big eaters”).
Before surgery, patients undergo a series of investigations, including gastroscopy, to identify known or unknown issues.
A multidisciplinary team evaluates each patient (pulmonologist, cardiologist, gastroenterologist, the operating surgeon, etc.).
The procedure is performed under general anaesthesia.
Special laparoscopic instruments are used and the operation is carried out through 4–5 small abdominal incisions.
Hospital stay: typically 3 to a maximum of 4 days (noting that the procedure constitutes a form of gastrectomy).
From the day of surgery, the patient is mobilised immediately and encouraged to walk. Postoperative pain is minimal.
The patient does not drink or eat for 2–3 days but is hydrated with appropriate intravenous fluids.
Subsequently, hydration begins with liquids and later food intake, following strictly written postoperative instructionsprovided by the surgeon.
These instructions must be followed rigorously to prevent complications.
Postoperative course
Patients:
• Begin to gradually lose weight so that within 2 years they approach their ideal body weight (the primary aim of the procedure).
• Are monitored until weight stabilises, with blood tests to assess vitamin deficiencies, anaemia, etc.
• May require adjustment of preoperative medication (antihypertensives, antidiabetics, lipid-lowering agents). In some patients, discontinuation of these medications may be recommended by a specialist — a therapeutic advantage of bariatric surgery.
• May no longer require CPAP devices for sleep apnoea — another important therapeutic benefit.
• Receive enteral nutritional supplements for a short period only (1–2 months) to support adequate nutrient intake. During this period, patients are educated on how to eat properly (chewing well, swallowing small quantities up to the point of satiety).
• Are advised to begin physical activity — initially mild, then gradually increasing — contributing both to weight loss and to toning of the body.
Postoperatively, all patients MUST be reviewed by their physician according to the prescribed follow-up protocol.
