Where only the size of the patient’s stomach is reduced a bit, but the strength of the operation is mainly in the malabsorption, with the crossing or modification of the intestinal anatomy. In this group would be the Duodenal Crossing, the MiniGastric Bypass or Bypass of a single anastomosis, and the Biliopancreatic Bypass.
They are the most effective, those that best treat diabetes and super obesity, however they are the operations that have more adverse effects and can alter the quality of life of the patient. The American Association of Barbaric and Metabolic Surgery does not advise its use, and in fact they are very little used in the US, although they are used in Europe. We do not have any of these techniques protocolized. Currently with The SADIS Bypass, we achieve an efficiency similar to that of malabsorptive operations, without its adverse effects.
There may be excessive weight loss and an undesirable loss of nutrients difficult to correct, despite oral vitamin supplements. Patients can have soft and annoying bowel movements for life.
There are therefore many types of Stomach Reduction, and by common sense, when so many surgical techniques have been developed for the control of morbid obesity, it is because neither is perfect or infallible. So the most important thing is to study the patient well and choose the most appropriate technique and correctly “sized” to your case, and with the involvement of the patient who must know the pros and cons of the operation offered, and agree to accept the limitations of the operation. We do this regularly with our patients, and an operation is not decided until the patient is completely convinced that this is the best technique for him, accepts the limitations of that operation, and therefore feels able to put on their part what is necessary to avoid these limitations (for example eating sweets, or bread-type foods and rice in excess, for restrictive operations).
- The higher the degree of obesity, the “greater operation” should be recommended to the patient.
- The more metabolic problems, especially Diabetes, “greater operation” should be recommended.
- The younger, “minor operation” should be recommended.
- The older (> 65 years) and more severe health problems that increase the risk of the operation “minor operation” should be recommended.
As can be seen, it is necessary that a good team dedicated to morbid obesity, know or master different surgical techniques to be able to correctly apply the most appropriate operation to each patient.
Most often, surgeons or teams have one of the techniques for obesity very well protocolized, and that only offers that to their patients, whatever the patient may be. This usually happens, because they are very complex techniques to develop and put into practice, and many times the surgeon prefers the safety of the one who already knows and has experience.
However, with this practice, many patients are over or under treated.
So, when a patient suffers from a morbid obesity and needs an operation of obesity, he should NOT do the operation that dominates the bariatric surgeon who has come, but the one that the patient needs. The patient should be told the pros and cons of the most frequent surgical techniques, the most suitable for him, and the alternative technique to the ideal one.
For this reason, centers specialized in obesity should have protocolized the main surgical techniques for the treatment of obesity, and especially should be performed by highly specialized surgeons, and that if possible have obtained specialized qualification through the agencies or Scientific Societies.