What is it about ?
By obesity surgery or bariatric surgery, we mean all the surgical procedures performed on the gastrointestinal tract that aim to reduce food consumption and thus lose weight and support changes in the way of life.
How often is it applied?
In recent decades, we have noticed an increase in the number of obese people. An increase that goes hand in hand with an increase in the number of interventions. In Belgium, around 9,500 interventions were carried out in 2012, compared to more than 14,000 in 2017.
For whom is the intervention reimbursed by health insurance?
- You must have been on a diet for at least a year without success.
- You must be over 18 years old.
- Your BMI or body mass index should be over 40 or over 35 if you have diabetes, sleep apnea, or severe hypertension at the same time. BMI is a number that indicates the severity of being overweight.
- A team made up of a surgeon, an internal disease specialist and a psychologist should judge that you are a good candidate.
- No other health problem should hinder the intervention.
Contraindications to the intervention are as follows: serious eating disorders, alcohol problems, systemic diseases, upper digestive system disorders, unstable psychiatric disorders, need to take anti-inflammatory drugs regularly, inability to lose weight with conservative treatment.
The cost of an intervention can be very high, even with reimbursement by health insurance. A ‘gastric bypass’ costs on average between 8,000 and 10,000 euros based on a single room. The mutual company takes a large part of it on its own, but the rest is at your expense. If you share a room with other people, you will still have to pay around 1,200 euros yourself. On the other hand, you are naturally assumed to be healthier after the procedure, and therefore have lower long-term medical costs.
How is the intervention prepared?
If you meet the criteria for a procedure, a gastroscopy is first done to check the condition of the stomach and esophagus. If you are noticed to have a bacterial Helicobacter pylori infection in your stomach, it will first be treated with antibiotics. Sometimes an ultrasound is also done to assess the size of the liver. Before the operation, you usually need to eat a low-calorie diet to reduce liver fat and size, and lose weight. Finally, it will be decided by mutual agreement what type of intervention will be carried out.
What are the possible interventions?
- Gastric bypass: this procedure is the procedure of first choice. It involves ‘bypassing’ almost the entire stomach and a piece of the small intestine. This procedure is performed laparoscopically and takes about an hour and a half. The changes made are irreversible.
- Gastric ring: this procedure involves placing a ring filled with silicone around the upper part of the stomach. An injection port is attached to the side of the stomach. This injection orifice makes it possible to tighten the ring more or less strongly. The long-term effect of this intervention is less beneficial than that of other bariatric interventions.
- Sleeve gastrectomy: this procedure involves removing part of the stomach and rebuilding a smaller stomach.
What results can you expect and what are the possible complications?
Bariatric surgery is proven effective for long term weight loss. This weight loss has health benefits, especially with regard to diseases related to obesity. Thus, early diabetes can normalize, as can excess fat in the blood or blood pressure, while sleep apnea also improves. Besides, you will also feel better about yourself. In young women, fertility may improve. Bariatric surgery reduces the risk of gestational diabetes, but may increase the risk of growth failure in an unborn child.
Possible complications of the operation:
- The intervention carries a low risk of death (<1/200). The risk increases with weight and age.
- As in all procedures, there is a risk of blood clots forming in the veins of the legs (venous thrombosis). These clots can break off and reach the lungs via the bloodstream.
- In 3% of cases, reoperation is necessary due to bleeding or leaking sutures.
- At a later stage, a narrowing of the intestines may occur, or a fracture or hernia may occur in the area of the scar. These complications occur in 10 to 20% of people operated on. They are resolved with reoperation.
- In 10% of cases, people are not satisfied because of complications or insufficient weight loss.
What happens after the procedure?
Hospitalization usually lasts 2 to 3 days. Medicines (mainly for diabetes and blood pressure) are adapted after the procedure.
Immediately after the procedure, you can only consume liquids. And this only after confirmation of the absence of leaks by an examination with a contrast agent.
The first 3 to 7 weeks, only semi-liquid foods are allowed (fruit juice, broth, fruit puree, soup, …), as well as soft foods (breadcrumbs, bananas, cooked fish, minced meat ). You need to chew well and eat slowly. Your diet should contain enough protein (60 to 120 g per day).
One month after the operation, a check-up is carried out by the surgeon. It assesses weight loss, fluid balance and vitamin status. These checks are continued for 2 years.
After the procedure, your body absorbs less vitamins and trace elements (such as iron and calcium). Therefore, you need to take multivitamins, calcium, vitamin D, and possibly vitamin B12 for life.
Due to the rapid weight loss, your skin may droop in saggy folds in places. Sometimes the excess skin can be removed with plastic surgery.
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