Understanding obesity is the basis of successful treatment. Often, for those who suffer from this disease, surgery is not an alternative to conservative treatment, but the only possibility to recover and feel healthy for a long time.
Spreading more and more around the world, obesity results from a long-time positive energy balance, which means that every day you get more energy with food than your body can use. In more than 90%, this causes fat deposits and obesity.
Together with bad eating habits, such as consuming fatty foods, or irregular food intake, a sedentary lifestyle is crucial in weight gain. Numerous social and cultural factors also contribute to the rapid, epidemic – according to the WHO – growth of morbid obesity among the population. These include the prevalence of passive leisure. Advertising on TV and online promotes high-calorie foods, sweets and fast food. In some cases, metabolic diseases or intake of some medications can lead to obesity or contribute to its development.
The role of genetic factors has been studied for many years and, till now, it is not single-valued.
There is a variety of surgical treatments for obesity.
The causes of overweight are complex; the disease can only be cured only by joint efforts of an interdisciplinary team. If conservative treatment is not successful, surgery is the only method that ensures weight loss for long time, improves metabolism, and results in a number of other positive effects.
Surgical treatment of obesity is one of specializations of the Surgery Department of Clinical Center of Friedrichshafen. The years of experience, high quality standards and cooperation with other specialists are the basis of our success in treatment of excess weight.
Weight-loss surgery for obesity in our clinic includes:
Surgery for excess weight can be considered after a number of steps and considerations, which includes:
In some cases, surgical treatment can be indicated with BMI > 32 kg/m².
Depending on the type of the operation, you can lose up to 40-70% of the excess weight, after which you can start gaining weight again. The greatest weight loss occurs in the first two years after the surgery and, then, it slows down.
There are many surgical procedures for obesity. All the methods are based on restriction (reduced food intake due to the reduction of the stomach), malabsorption (limited absorption of nutrients due to a lesser contact of food with digestive juices), or combination of the both techniques. In addition, the hormonal effect of surgery also plays an important role, decreasing the feeling of hunger.
This surgery is the most common and progressive method widely applied for treatment of obesity. It combines both reduction and malabsorption.
A smaller part (called the pouch) is separated from the stomach and, then, connected directly to the small intestine. Apart from reducing the stomach size, this procedure enables delayed exposure of food or drinks to the bile and pancreatic juice necessary for digestion. The creation of a new passage has an effect on insulin production and, in about 3 months, 80% of patients with type 2 diabetes can stop the medication or insulin therapy. As a rule, excess weight is reduced by 70% in the first year after the surgery.
The two principles of weight reduction are used in this surgery:
When gastric bypass is performed with staples, the stomach is sewn with overlapping seam in the horizontal or vertical direction (depending on the technique) and subsequently dissected along the seam, forming, thus, a small pouch with a volume of about 30-50 ml.
At the second step, the small intestine is bypassed at 50 to 100 cm from its beginning. After this, the distal (further) part is connected to the pouch, and the proximal (closer) part of the small intestine is connected to the distal part in, at least, 1.0 m from the pouch.
Thus, bile and pancreatic juice, containing enzymes necessary for digestion and absorption of food, meet with the food much later than it was before the surgery, thereby excluding at least 1.5 m of the small intestine from digestion.
Variations of the operation may involve increasing or decreasing of the pouch size and vertical or horizontal stomach bypass, as well as a significant increasing of the disconnected portion of the small intestine, so that the length of the small intestine where nutrient absorption takes place can be reduced to only 2,0-2,5 m.
In the first 2-3 years, there may be a deficiency of vitamins, iron, microelements and proteins in the body. To compensate this, it is enough to take regular courses of complex medications containing the above components. No in-patient treatment is required.
After gastric bypass surgery became the common standard, a couple of years ago, Friedrichshafen Clinic had stopped surgeries for gastric band placing. We perform many revision surgeries to the patients who had a gastric bandage installed and experience problems due to its improper work. In most cases, we remove the bandage and do gastric bypass. This technically complex operation is carried out in our center in Germany on the permanent base and with a tendency to increase in number.
A gastric band decreases the stomach volume. As a rule, the surgery is minimally invasive. The band is installed around the upper part of the stomach, which divides the stomach into two unequal parts. The width of the band can be changed through a port system installed subcutaneously. Due to the gastric band, the food intake decreases sharply by mechanical means and you feel full faster. Provided a patient has good cooperation with a doctor, the average weight loss can reach 50%.
This is another type of surgery to reduce the stomach volume. In addition to the restriction of food intake, this operation leads to limited production of gastric acid, whilst hormonal effects reduce the feeling of hunger.
The surgery involves almost complete removal of the stomach, except its small part. This procedure is performed with laparoscopic method. As a result, in two years, the patient loses 50-70% of the excess weight.
The long-term effects are still being studied. In some cases, it is necessary to remove the gastric band placed in the past (especially if there is no weight loss or, even, some gain take place), and perform gastric bypass instead, in one surgery.
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