bariatric surgery-obesity

Obesity is a chronic disease recognized by the World Health Organization (WHO) in 1997. It is characterized by the excessive accumulation of body fat, which can harm health. Obesity is typically measured by the body mass index (BMI):

  • BMI (kg/m²) = Weight (kg) / (Height (m)²)

Obesity is classified based on BMI:

  • Moderate Obesity: BMI between 30-35
  • Severe Obesity: BMI between 35-40
  • Morbid Obesity: BMI above 40

The prevalence of morbid obesity has quadrupled in France over the past 12 years, affecting approximately 9.4 million people, with over 700,000 in the morbid obesity category.

Symptoms

Severe or morbid obesity can significantly impact daily life. It is associated with several health conditions, including:

  • Diabetes
  • Hypertension
  • Hypercholesterolemia
  • Sleep Apnea
  • Osteoarticular diseases

These conditions have a significant effect on both quality of life and life expectancy.

Treatment

Bariatric surgery is the most effective treatment for obesity. This involves a multidisciplinary approach, including assessment of related health conditions and tailored dietary and psychological support for each patient.

Our team has a well-established clinical pathway for the surgical management of morbid obesity, involving several medical teams: surgeons, hepatologists, endocrinologists, psychiatrists, psychologists, dietitians, pulmonologists, sleep specialists, and anesthesiologists. This process typically lasts between 6 to 12 months.

The main indications for surgery are patients aged 18-65 with a BMI above 40 or a BMI above 35 with associated comorbidities.

Surgical Options

Three main laparoscopic surgical techniques are commonly used:

Gastric Banding

A purely restrictive procedure that involves placing a band around the stomach. This technique has fewer immediate complications but often requires frequent adjustments and has a higher failure rate. It is rarely used by our team.

Gastric Bypass

A combined restrictive and malabsorptive technique. It remains a highly effective reference method, extensively studied for over 25 years. It requires lifelong vitamin supplementation and prevents endoscopic exploration of parts of the digestive system.

Sleeve Gastrectomy

A more recent procedure validated by the French Health Authority in 2008. It works through two mechanisms:

  1. Mechanical restriction: Reducing stomach volume.
  2. Hormonal changes: Removing tissue that produces hormones like ghrelin (reducing appetite) and increasing GLP-1 and PYY.

Sleeve gastrectomy is a partial stomach resection and is generally more complex than gastric banding but less complicated than gastric bypass. Potential surgical complications include:

  • Hemorrhage
  • Fistulas (1-5% risk)

Sleeve gastrectomy was originally performed using seven trocars. Our team has refined the technique, making it possible to carry out the procedure with just three trocars—or even through a single incision. This minimally invasive approach means less post-operative pain, a shorter hospital stay, and a faster, more comfortable recovery

Procedure Overview: de l’intervention :

  • The patient is typically admitted the day before surgery.
  • The surgery is performed in the morning.
  • No post-operative drainage or gastric tube is generally needed.
  • The patient remains fasting for 48 hours.
  • Refeeding begins after 2 days, with a follow-up scan to check for complications.
  • The patient is usually discharged after 3-4 days, with pain management, gastric protection, and anticoagulant therapy.

Suivi post-opératoire :

  • Follow-ups at 1 month, 3 months, 6 months, and 12 months.
  • Comprehensive evaluation at 3 months and 1 year during a day hospital stay.
  • Lifelong follow-up every 6 months.

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Cécile.huber@aphp.fr
Ibrahim.dagher@aphp.fr