Morbid obesity is one of the most common health issue caused by modern lifestyle. During the last decade, western societies have the unpleasant position to stand among the first European and American countries in morbid obesity prevalence. Obesity is defined as the condition that implicates rise of the body weight 20% above normal, caused by fat accumulation. Body Mass Index (BMI) is defined as the index of body weight in kilograms to body height in metres in square(kg/m2). Normal BMI is considered when the values are between 18,5 and 25. When the values are 35 and above, the condition is defined as morbid obesity.
It has been proof that morbid obesity increases the risk of cardiac and respitory disease, strokes, diabetes mellitus, metabolic and orthopaedic diseases. Body weight loss can reduce significant risk factors for the above medical conditions. Morbid obesity tends to become a modern epidemic condition and often is not able to be treated successfully only with dietary modifications.
Even though some obese patients manage to lose weight after exhausting diets, few among them manage to maintain low weight and most of them tend to regain it, or even more. This problem can be definitively solved by morbid obesity surgery. Modern international studies have shown that the safest and most effective method for both weight loss and low weight maintenance is the surgical treatment of morbid obesity.
Types of surgical procedures
The three most prevalent surgical procedures that are applied in the treatment of morbid obesity are the gastric banding placement, sleeve gastrectomy and gastric bypass. These procedures are successfully performed by the surgical team of Dr H.D. Konstantinidis.
Gastric band placement is a simple procedure performed with the robotic or laparoscopic technique through small incisions around the umbilicus. It is performed under general anaesthesia. The procedure lasts approximately one hour and the patients are discharged from hospital the next day.
Gastric band separates the stomach in two parts, a much smaller proximal and a larger peripheral. With the first bites the upper part is dilated and the patient feels satiated. The diameter is adjusted by a special valve in regular times to ensure its proper function. The majority of the patients can return at their work 4-5 days after surgery and are able to have systematic physical exercise in less than a month.
Sleeve gastrectomy includes the excision of the largest part of the stomach, leaving behind practically a narrow, tube-like part of it. The capacity of the stomach is reduced by 80% and food follows its natural route, unlike with gastric bypass.
The procedure is performed also with the robotic or laparoscopic technique under general anaesthesia and the patient is hospitalised for few days. The patient has limited capacity of the stomach and on the other hand doesn’t feel hungry because the part of the stomach that has been excised is responsible for the production of the hormone of hunger, called ghrelin. There is also no need for post-surgery follow up of the patient, unlike the other bariatric procedures.
During this procedure a small pouch in the upper part of the stomach is created with the addition of a by-pass of the small intestine, intending to actively reduce the length and the nutritional absorptive capacity of the small intestine. The median operative time is between 2 to 4 hours and the hospital stay between 4-5 days.
This method offers greater weight loss and improvement or full regression of the coexisting medical issues such type II diabetes mellitus and hyperlipidaemia. The patients undergoing such procedures often need multi-vitamin supplements and relatively regular medical supervision, especially when a large portion of the small intestine is bypassed.
The type of operation which is going to be performed is decided individually for each patient, according to the special characteristics of the patient’s condition and the coexisting medical issues. As a conclusion, we could say that morbid obesity surgery is the only treatment option that can sustain the long term weight loss, avert the presence and heal the coexisting diseases of morbid obesity.