Obesity is a complex, chronic medical condition that requires evidence based treatments via a multidisciplinary team. Treatments can range from simple lifestyle change to medications and surgery.
The National Health and Medical Research Council of Australia advocates that while non-surgical intervention should be the first line approach for managing any form of obesity, no other currently available therapies are as effective as surgical management in achieving weight loss and improving obesity-related diseases in morbidly obese individuals. Extensive literature on the effectiveness of bariatric surgery clearly demonstrates that surgical interventions show greater and more sustained weight loss than those receiving non-surgical interventions. Studies have also found that post-surgical weight loss is maintained up to 10 years.
The appropriate form of bariatric surgery depends on the clinical needs and available supports of a patient as well as consideration of the relative risks and possible complications of any procedure. The most common surgeries performed are done under general anaesthetic and with a keyhole (laparoscopic) approach. These include:
1) Sleeve Gastrectomy:
This is a procedure that significantly reduces the size of the stomach without interrupting the continuity of the gastrointestinal tract (GIT). This means that food still passed along the entire length of the GIT, thereby reducing the risk of malnutrition. It works to restrict volume consumed at any given time and to increase satiety at this lower volume. The operation itself essentially turns the stomach into a thin, vertical tube – a ‘sleeve’ – rather than a capacious sack. This is done by measuring the amount of stomach to be left in place with a tube called a bougie and then using a surgical stapling device to remove the rest. The constitutes approximately the outer 2/3 of stomach after which time the sleeve can only accept about 1/10th of its previous volume. This is to be considered an irreversible procedure.
2) Roux-en-Y Gastric Bypass:
This procedure has been performed for over 40 years. Originally done with an open approach, it has now been refined to be performed with keyhole surgery. This makes it significantly less invasive and significantly easier for patients to recover from. It works in 2 ways. First, the top part of the stomach is fashioned into a small pouch (approximately 30-50ml) and then separating from the rest of the stomach. This acts to give a patient a feeling of satiety at much lower volumes, just like in the sleeve. The second part of the procedure is to join this new small pouch of to a length of small bowel (Roux limb), which works to transmit food from the stomach to the gut but not yet be exposed to digestive juices. This limb is reattached to the small bowel further down where it can mix with digestive juices and food can finally be absorbed. This essentially bypasses the first part of the intestine and excludes it from the digestive process. The rest of stomach and small bowel (Y/biliary limb) remain inside to produces hormones and digestive juices but are no longer exposed to food. This is also considered an irreversible procedure.
There are many other endoscopic and surgical options available in the bariatric space. Some have greater evidence than others and most have varying degrees of weight loss and side effects. The primary aim of our team is assess a patient’s specific needs and to tailor our approach as required. Of course safety is paramount and our surgeon will not perform new procedures until there is sufficient evidence to prove their effect and reliability.