Laparoscopy = Key-hole surgery. To enter the abdomen Surgery is done, now, without a large incision but small openings. Pain and scars are lessen and allows a short postoperative stay. It decreases also wound complications and hernias and some of the surgical risks. All WLS (Weight Loss Surgery) operations are done, today, by laparoscopy
To access WL results today we only measure the %Excess of BMI loss
% EBMIL = 100 – [(Follow-up BMI - 25 / Beginning BMI - 25) x 100]
(Dieter M, Greenstein R.: Editorial. Recommendations for reporting weight loss. Obes Surg 2003; 13:159-60)
Good WL results occur with %EBMIL superior to 55%
There is not an "ideal technique" to treat everyone with morbid obesity. Patients should know:
1. Safety. The operative risk is similar with all the operations. Mortality is below 0.5% today in our hands, and the cause of death is associated more with pulmonary embolism, medical complications and the degree of obesity.
2. The operation should be very effective: Obesity is a disease very resistant to therapy.
Many operations have failed to control weight lost on the long-term. Usually "simple" operations such as VBG, SRBG, and adjustable bands are much less effective than the "complex procedures" such as gastric and bilio-pancreatic bypass.
3. Surgery should make the patients loose over 50% of their overweight: The weight loss should last for life. Many operations have short-term effects and give a poor quality of life. At least 75% of the patients should have good results.
4. Although operations are for life they are all reversible. The gastric part removed is not reversible
5. The reoperation rate should be very low: "Simple techniques" have a higher reoperation rates and the rate is much lower with the "complex" techniques.
6. Quality of life (QOL) should improve with surgery and secondary effects should be minimal (vomiting, diarrhea, etc.)
With these conditions in mind we recommend only:
- LDS (Laparoscopic Duodenal Switch). It is the most effective bariatric operation with %EBMIL over 75%. Safe (mortality under 0.5%), Very effective (in more than 90% of the subjects), Reversible (only the small bowel bypass – no the stomach resection) and very good QOL (Quality of life) since patients are in a free diet without restrictions.
- LSG (Laparoscopic Sleeve gastrectomy). It is a very effective technique for patients: 1-Super-obese as a staging operation for the LDS; 2-Patients with severe medical conditions such us AIDS, liver cirrhosis, Crohn, ulcerative colitis, organs transplants. etc.; 3-Low BMI patients – up to 45 BMI; 4-Patienst with a LapBand removed ; 5-Adolescents and children and 6) The elderly.
We perform ALL bariatric operations with:
3 fully trained and experience surgeons in general and laparoscopic surgery
2 anesthetists at induction and 1 anesthetist and a nurse throughout the operation
3 nurses (scrub, rotating and clean area)
Remember: WL is not immediate. It is slow and progressive. It will depend of the severity of the obesity and the technique used. After surgery the lowest weight is reached about 14-18 months after the operation.
Should I loose too much weight? It is unusual to reach the ideal weight for your height, as a matter of facts, in obesity surgery the ideal is to stay 10% above your ideal weight. Surgeons can not predict by any of the surgical techniques your final weight. |
