Bariatric surgery can be, for some patients, the solution to problems of obesity. Dr. Giuseppe Marinari, Head of Bariatric Surgery, spoke about the different types of treatment, the possible results and how to manage the post-operative period in an interview with Ok salute.
The course is dedicated to patients suffering from obesity, with a body mass index of more than 40 or more than 35, but with the presence of other conditions such as diabetes, hypertension, night apnea or serious joint problems.
Before assessing whether or not to perform the operation, the specialist will draw a picture of the patient, evaluate his clinical history and lifestyle, as Dr. Marinari explains in fact: “Surgery is never the first option. It is necessary that in the past the patient has followed diets under medical supervision and these diets have not worked or patients recovered weight immediately after. Psychological suitability is also required through a preparation process under the guidance of a psychologist or psychiatrist, at the end of which the specialist must confirm that there are no contraindications. The best thing is to go to those facilities where the surgeon and the psychologist work as a team”.
The different types of intervention
The main interventions are the gastrectomy sleeve, the gastric bypass, the bilio-pancreatic diversion and the adjustable gastric bandage.
The gastrectomy sleeve and the gastric bypass are restrictive hormonal interventions. The first consists of vertical gastric resection, with the removal of much of the stomach and tubularization of the remaining stomach. “It reduces the secretion of hunger hormones and increases the production of other hormones that can increase the sense of satiety,” explains Marinari.
Gastric bypass offers good long-term results and it is a powerful therapy against type 2 diabetes and gastric reflux.
Bilio-pancreatic diversion involves the removal of most of the stomach, while the adjustable gastric bandage is a mechanical restrictive intervention that forcibly reduces the introduction of food.
Results vary from patient to patient. Young tall men, for example, are more advantaged and can lose up to 80% of their extra kilos. A woman older and with low stature will lose about 60%. “Sports then have a key role in maintaining weight through carrying out regular physical activity,” emphasizes Dr. Marinari.
Eating after surgery
After the operation the patient eats much less; “An operated person will eat 30 grams of rice or 50 grams of fish for a few months. After some time you eat a little more, but the quantities will always be very small. Of course, the patient must be taught to eat quality food,” the specialist explains.
After the operation, the intake of supplements could also be indicated: “There are interventions that require you to take supplements because they lead to a reduction in intestinal absorption. Even in other cases it is still recommended to take iron and vitamin supplements for a few months, because eating so little can be useful,” explained Dr. Marinari.