Bariatric surgery – Obesity treatment

Obesity surgery, also known as bariatric surgery, is the modern treatment indicated for patients suffering from morbid obesity. When all other methods — medication, diets, sport, endocrine treatments or behavioural therapies — have been exhausted without result, bariatric surgery remains the only safe and definitive way of treating obesity. The interventions include gastric banding, gastric bypass, longitudinal gastrectomy (gastric sleeve), gastric plication and abdominoplasty (the aesthetic intervention after weight loss).

Bariatric surgery at a glance

• Who it is for: patients with obesity (BMI over 30) or morbid obesity (BMI over 40), where conservative methods have failed
• Procedures: gastric sleeve, gastric plication, gastric bypass, adjustable gastric banding, plus abdominoplasty for the aesthetic correction after weight loss
• Approach: laparoscopic, minimally invasive — small incisions, little pain, fast recovery
• Reported results: 40–50% of excess weight lost after gastric banding, 65–80% after bypass, at about one year
• Long term: about 90% of patients maintain a loss of approximately 50% of their excess weight
• Additional benefit: improvement of comorbidities (type 2 diabetes, hypertension, sleep apnoea)

What is obesity and when does it become a surgical problem?

Obesity is a condition characterised by the excessive storage of body fat, which causes a significant increase in weight. Medical practice uses the body mass index (BMI) to measure it, calculated from weight and height: a BMI over 30 indicates obesity, and a BMI over 40 reveals morbid obesity.

Obesity has become a health problem affecting more and more developed and developing countries. Details about causes and complications on the Obesity page; you can check your category with the BMI calculator.

Why is surgery needed in the treatment of obesity?

When patients affected by obesity have exhausted every other treatment method — medication, diets, sport, endocrine treatments or behavioural therapies — they are advised to turn to bariatric surgery, the only safe and definitive way of treating obesity.

The global obesity epidemic calls for a firm attitude: correct medical education of the population and the application of effective therapeutic methods. Worldwide, over 600,000 bariatric procedures are performed annually for people with severe forms of obesity — still a small number, considering that over 100 million people are affected.

What results does bariatric surgery deliver?

The success rate for eliminating excess kilograms is reported as the highest with gastric bypass, but all modern surgical techniques for treating obesity deliver excellent results:

• studies demonstrate a loss of excess weight of 40–50% with gastric banding
• and a reduction of excess weight of 65–80% with gastric bypass, about one year after the operation
• as a rule, the loss of excess weight continues over a period of 18–24 months after the intervention
• it has been demonstrated that 90% of patients who turned to bariatric surgery managed to maintain a weight loss of about 50% over a very long period of time

Eliminating the excess weight improves comorbidities and many aspects of the patient’s psychosocial life. Bariatric procedures are essential ways of breaking the vicious circle of excess weight and undeniably improve the quality of life.

Why laparoscopic (minimally invasive) surgery?

Laparoscopic interventions are among the most used abdominal surgical procedures: they involve introducing a state-of-the-art video camera into the abdominal cavity, through which the entire operation can be visualised on screens. The benefits over traditional techniques are major:

• short operating time — which considerably reduces the stress and suffering felt by the patient
• minimal discomfort and pain compared with classic surgical methods
• very small incisions — small, barely noticeable scars, because the tissue suffers less damage
• reduced hospitalisation and much shorter recovery time
• greater accuracy — the video equipment allows perfect visualisation of the internal organs, and the surgeon benefits from maximum precision throughout the intervention

The minimal invasiveness of the operations and the very low aggression towards the tissues are essential for therapeutic success.

What bariatric procedures exist?

Gastric sleeve

Laparoscopic resection of about 85% of the stomach, keeping a gastric tube of 60–120 ml. It limits food intake and reduces hunger (by removing the area that produces the hunger hormone), without bypassing the intestine and without malabsorption. A one-time operation, with no implant and no later adjustments.

Gastric plication

Reducing the stomach by about 70% through folding and suturing the gastric wall, without resection, implants or metal staples. The only fully reversible major procedure, with the lowest complication rate.

Gastric bypass

The stomach becomes a 15–20 ml pouch connected directly to the small intestine: both food intake and absorption are reduced. It has the highest success rate and is indicated in advanced morbid obesity (BMI over 50).

Adjustable gastric banding

An inflatable balloon placed laparoscopically around the upper part of the stomach limits food intake to a few mouthfuls per meal. The diameter is adjusted from outside, without a new operation, and the intervention is reversible.

Abdominoplasty

The aesthetic correction of the abdomen after massive weight loss: removing the excess skin (the “abdominal apron”) and restoring the tone of the abdominal wall. It is not a weight-loss method, but a retouching one, done after reaching a stable weight.

How is the right procedure chosen?

The choice is made at the specialist consultation, based on the body mass index, age, associated conditions, medical history, eating habits and the patient’s preferences. As a guide: the bypass has the highest weight-loss rate (but requires lifelong supplements), the sleeve balances effectiveness with reduced risks, and plication and banding are reversible. Bariatric surgery brings major benefits, without the interventions depending on the pathology of the patients they are performed on.

What comes after the operation?

For optimal monitoring of the weight-loss process, good collaboration between patient and doctor is needed after the intervention. The goal is a gradual loss of the excess kilograms: weight loss is a gradual process, and losing weight too fast can create major health risks. The post-operative programme includes a staged diet, periodic check-ups and, depending on the procedure, vitamin and mineral supplements.

Frequently asked questions

Which is the best weight loss surgery?

There is no single procedure suitable for everyone. The bypass has the highest weight-loss rate (65–80%), the sleeve offers a very good balance between effectiveness and risks, and plication and banding are reversible. The choice is made at the consultation.

Am I a candidate for bariatric surgery?

The typical candidate has obesity (usually BMI over 35–40, or over 30 with associated conditions), has tried conservative methods without success and is ready for a lifestyle change. The final evaluation belongs to the doctor. Calculate your body mass index.

How much weight will I lose and in what time?

Depending on the procedure: 40–50% of the excess weight with gastric banding and 65–80% with bypass, at about one year. The loss usually continues for 18–24 months, and about 90% of patients maintain a long-term loss of approximately 50%.

Does bariatric surgery help with other diseases too?

Yes. Eliminating the excess weight improves obesity comorbidities: type 2 diabetes (which can go into remission after bypass), hypertension, sleep apnoea, joint and back pain, gastro-oesophageal reflux, as well as the psychosocial aspects of life.

How long is the recovery?

Hospitalisation of 1–3 days and return to work in 1–2 weeks for most laparoscopic interventions; full recovery takes around 3–4 weeks, depending on the procedure.