All you need to know about obesity
Obesity is a chronic disease, which is strongly associated with diabetes mellitus, high levels of cholesterol, high levels of triglycerides, high blood pressure, sleep apnea, arthritis, low back pain, infertility, heart and lung disease.
That is why it can severely affect the quality of life and needs intervention to improve and resolve the comorbidities.
Obesity is one of the main causes of preventable death in the world, with three in five Americans considered overweight, about seven in ten Mexicans being overweight or obese. There are more than 400,000 deaths each year related to obesity.
Unfortunately, no matter how many diets you try the fact is that they have a minimal and short- term impact on weight loss. Surgery for obesity and related diseases is an established and integral part of the comprehensive management of obese patient, with excellent and sustainable results on weight loss. The best approach that we offer is minimal invasive surgery.
Am I Obese?
The simple way to determine if you are obese is to calculate the Body Mass Index that is a measure of body fat based on height and weight. The way to calculate the body mass index is: body mass (kilograms divided by the square of the body height. Patients are considered obese if they have a body mass index (BMI) greater that 30 kg/m2.
World Health Organization classification: Body Mass Index (BMI)
- 19-24 BMI: ideal weight
- 25-29 BMI: overweight
- 30-34 BMI: moderate obesity
- 35-39 BMI: severe obesity
- 40-49 BMI: morbid obesity
- >50 BMI: super morbid obesity
All you have to know about GASTRIC SLEEVE
Gastric sleeve consists of removing a 70-80% of the stomach leaving a narrow gastric tube through which food passes. The procedure mixes two mechanisms of action: Restrictive (cutting vertically 70-80 % of the stomach) and
Metabolic (cutting the fundus where hunger hormone is produced that is responsible for satiety).
Indications for Gastric Sleeve
- BMI 35-40 kg /m2 without comorbidities
- BMI 35-40 kg/m2 with co-morbidities such metabolic disorders, high blood pressure, lipid disorder, triglycerides disorder, sever joint disease, obesity-related severe psychological problems, sleep apnea, chronic lumbar pain, fatty liver
- Patients with liver disease
- A second step procedure
- BMI > 40 kg/m2 controlled T2DM
- BMI > 35 kg /m2 uncontrolled TD2M despite medical treatment
What are the benefits of Gastric Sleeve?
- Excellent and sustainable results with loss of 60-70% of your excess body weight.
- Improves health, weakness, mobility, cognitive functions
- When you reach a loss of 15% of your exceeding weight there is
- An improvement of comorbidities.
- Comorbidities resolves such as T2DM, high blood pressure, lipid disorder, triglycerides disorder, severe joint disease, obesity-related severe psychological problems, sleep apnea, chronic lumbar pain, fatty liver
- Stops or decreases the consumption of medication
- Low risk of complications comparing to other procedures like Cholecystectomy o Hysterectomy
- Decreased long-term costs
How do I prepare for surgery?
Let me explain the steps to prepare you for surgery:
- Please report any preoperative illnesses to Obesity Surgical Center before surgery.
- It’s important to follow a diet two weeks previous to surgery to decrease the size of the liver and also decrease risk of complications.
- Another important point is to stop the consumption of aspirin or anticoagulant for at least 48 hours prior to surgery to avoid bleeding.
- Bring all your medicine.
- You will arrive at the hotel the day before your surgery to rest from the trip as well as hydrate to avoid risks such as clots in veins of lower limbs or clots in your lung vessels.
- It is required 8 hours of fasting (do not consume neither liquids or solid foods) prior to start surgery.
- The next day you will be admitted to the hospital, two hours prior to the procedure, so we can perform preoperative work up such as hematic blood count, coagulation blood test, and blood chemistry and preoperative surgical risk assessment by Cardiologist or Internist.
- We start a peripheral IV solution and apply medications for heartburn and antibiotic prophylaxis.
- We also place compression stockings to avoid clots.
- Once you have completed all this, you will go to OR to start with your procedure. Do not worry at any time there will be someone from our team to guide you and solve any doubt Intraoperative work up.
- Already inside of the OR you will be monitored and start the process of anesthesia. The anesthetic process is safe and with a percentage of risk less than 1% and our team are qualified doctors.
- Once the anesthesia is done we start with the surgical procedure, which consists of vertically cutting of the stomach with a stapler, previous calibration of the stomach with 36 French calibration tube to avoid inadequate cuts of the stomach. We always do a staple line reinforcement to prevent bleeding or leakage, perform a test with methylene blue to verify that there are no leaks. Before completing the procedure we check the rest of the abdominal cavity and verify that there is no bleeding.
After the surgery, which lasts approximately one hour to an hour and a half, you go to the recovery room, where you will be 2 hours monitoring your vital signs and recovering from the anesthesia, then you will go to a room to continue your recovery. You may feel nausea, dizziness, abdominal distension, abdominal pain, pain in the back and shoulders, which is temporary and improves over time.
You’ll also be expected to get out of bed and into a chair beginning the night of surgery, as well as walk in the halls with assistance, to avoid the formation of blood clots. We take care all the time that your recovery will be adequate by indicating painkillers and medicine for nausea. The first 24 hours you can only suck on ice chips, and then we perform a study to check the anatomy of the gastric sleeve and verify there is no leak. You will start drinking clear liquids after the leak test. If you feel comfortable and if there are no complications you will be discharged to the hotel.
FREQUENTLY ASKED QUESTIONS
- What are the advantages of the Laparoscopic Approach in Gastric Sleeve Surgery?
- Short hospital stay
- Less postoperative pain
- Best cosmetic results
- Faster return to work
- What are the risks of the gastric sleeve?
- They are uncommon; sometimes experiencing temporary difficulty swallowing and this is because you have a narrow tube, it usually resolves between one to three months after surgery
- Gastro esophageal Reflux it’s a minor complication and resolves with antacid medicine. It’s important to known if you had Gastro esophageal reflux and hiatal hernia previous to surgery.
- Leakage of the staple line occurs in less than 2% and this means that the gastric contents are filtered through the staple line; the symptoms are usually increase in heart rate, abdominal pain and fever. These symptoms occur 3 to 5 days after surgery, if you present any of these do not hesitate to contact us.
- Bleeding occurs in less than 3%, the most important site of bleeding is the staple line, so it is important to reinforce it.
- Stenosis occurs in less than 1%, the cause is the close cut to the lesser curvature of the stomach, to avoid this complication its important put a calibration tube before cutting the stomach
- What can I expect after my surgery?
The Gastric Sleeve surgery is a safe procedure, with excellent results. It is common that after surgery you have pain, which gradually decrease and appears with movements such as getting up, coughing, laughing, etc. If you present constant pain and do not decrease with painkillers do not hesitate to contact us.
Surgical wounds may occasionally drain blood and serum, which is normal for the first 5 days. All you have to do is wash them with soap and water and leave them dry. If you have a change in the characteristics of wounds with drain that becomes cloudy, thick and smelly as well as changes in the skin (red, warm, bulging and painful when you touch it) will probably have a wound infection, so do not hesitate to contact us. If you have fever, pain that gets worse over time, diet intolerance, persistent vomiting you should contact us to verify that you don´t have complications
- How soon will I return to work?
After the Gastric Sleeve surgery the patient usually return to normal activities in seven days.
- When can I exercise?
The first 20 days is recommended relative rest, this means that you can perform basic tasks such as getting up, going to the bathroom, personal hygiene and most important walking. It is necessary to walk, with this you have bowel movements, don´t accumulate secretions in the lungs and prevent blood clot formation. From 20 days to 3 months after surgery it is recommended to carry out low impact activities like walking and swimming. After 3 months you can do your normal activities.
- What are the expected results of weight loss after gastric sleeve?
- In the first 2 months you may lose 15-20% of your excess body weight,
- 6 months after surgery you may lose 50% of your excess body weight
- At one year you may lose 60-70% of your excess body weight
- Will I need any additional supplements?
We recommend take a multivitamin, B12, B1, calcium, iron and a diet high in protein (75%) each day. This is to prevent nutritional deficiencies, avoid malnutrition and loss of lean mass. It also increases the metabolic effect of surgery.
- Can I take my other pills and medications after surgery?
You should continue to take your other medications as prescribed. The first two weeks after surgery you have to crush them or consume in liquid form.
- Can I drink alcoholic beverages?
You may experience unexpected responses to alcohol and should also avoid it due to empty calories. Surgery for obesity and related diseases is a safe procedure and with an excellent result in terms of weight loss and control of related diseases.
About the author
Dr. Jorge Reyes Mendiola is a renowned Gastrodigestive Surgeon specialized in gastrointestinal surgery, abdominal wall surgery and multidisciplinary management of obesity. Dr. Jorge Reyes Mendiola is an active member of the Mexican Association of General Surgery, Mexican Association of Endoscopic Surgery, Mexican Association of Hernia, International Federation for the Surgery Obesity and Metabolic Disorders
Hoping that this information helped you get a more clear understanding of bariatric surgery, we hope that you will not hesitate to contact Dr. Jorge Reyes Mendiola in case you need more details.