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Obesity rates are increasing at an alarming rate. About one in three individuals in Austria are obese and should reduce weight for health reasons. More than 11% are defined as obese in Austria (Body Mass Index (BMI) > 30 kg/m2). Morbid obesity is defined as 100% overweight respectively as BMI > 40kg/m2. In such cases, bariatric surgery is absolutely recommended.

Why should morbid obese patients undergo a bariatric surgery?

The primary goal of bariatric surgery is to improve obesity-related diseases such as hypertonia, diabetes, hyperlipidemia, etc. Additionally, the weight reduction after bariatric surgery promotes positive attitudes and increases the general well-being.

The treatment of morbid obesity is very complex and should be provided only by a multidisciplinary team (surgeons, endocrinologists, gastroenterologists, radiologists, dieticians, psychologist). Therefore experts who create an individually designed concept for each patient treat our patients.

The decision for bariatric surgery is difficult and must be considered carefully. To help patients make the decision we cooperate with self-help groups and establish contact between patients and self-help groups.

The operation is only the beginning and not the end of the treatment. Therapy success can only be expected when patients are able to change their eating habits and lifestyle after bariatric surgery. In this context follow up is absolutely reasonable and necessary.

Am I a candidate for bariatric surgery?

Insurance companies cover bariatric surgery as long as the following criteria are fulfilled:

• BMI > 40kg/m2
• BMI > 35kg/m2 combined with one obesity-associated disease (for example Diabetes II)
• Age between 18-65 years
• No other disease as a reason for obesity
• Adequate compliance
• Proof of unsuccessful conservative methods (for example diets)
• Psychological test of suitability

What kind of bariatric procedures do exist?

There are different effective bariatric procedures for weight reduction, which are meant to be performed on patients with a BMI above 40 mg/m² (respectively BMI 35 kg/m² and severe comorbidities). A distinction is made between restrictive and malabsorptive procedures.

• Restrictive methods show a reduction of gastric capacity/volume such as “Gastric banding” and the “Sleeve Gastrectomy”. The consequence is a significant reduction in food quantity and a rapid onset of saturation feeling.
• Malabsorptive procedures are based on bypassing the small intestine to decrease the digestive capacity (Gastric Bypass, Duodenal Switch). This kind of operation often leads to appetite modifications.

Today exist modern endoscopic procedures for patients with BMI between 27 kg/m² and 35 kg/m². These Procedures are performed during gastroscopy, which means there is no surgery and no scars. During these gastroscopies patients are under sedoanalgesia, some kind of general anesthesia, so there is no pain. These procedures are:

• Gastric Balloon
• Gastric Plication

Liposuction is no reasonable method for the successful treatment of morbid obesity.

What is a “Sleeve Gastrectomy” and what is a “Gastric Bypass”?

Sleeve Gastrectomy

This is the most recent method among bariatric procedure and is characterized by the resection of a predefined part of the stomach. The consequence is a significant reduction of food quantity and a rapid onset of saturation feeling. If necessary, “Sleeve Gastrectomy” can be converted into a “Gastric Bypass or Duodenal Switch”

Gastric Bypass

The Gastric Bypass has been considered as “Gold Standard” among bariatric procedures for a long time. This operation is preferred for patients who have a notorious sweet tooth, no discipline and a BMI > 55kg/m2. The mechanism of action is a restriction and malabsorption. This procedure is technically more complex than the “Sleeve Gastrectomy”, but shows the faster and slightly better weight reduction. Bariatric procedures can be performed laparoscopically.

What are the risks of bariatric procedures?

Complications can occur after each surgery, so after bariatric surgery. Bleedings, perforations with consecutive peritonitis or wound healing disorders have to be mentioned in this context. Bariatric procedures are no trifle interventions!

In general obese patients have a higher operation and general anesthesia risk. Especially respiratory complications can occur so that intensive medical care can be necessary postoperatively. The thrombosis risk is among obese patients higher as well.

The risk to die after the operation is very low and is about 0.3%. Nevertheless, bariatric procedures can be considered safe in general.

Chirurgische Eingriffe zur Behandlung der Adipositas sind daher als sehr sichere Verfahren anzusehen.

What are the prospects of success after bariatric surgery?

Therapeutic success is defined as a weight reduction of 50% of the overweight for at least 5 years postoperatively. The success rates are 70% after Sleeve Gastrectomy and 75% after Gastric Bypass.

Weight reduction after bariatric surgery is gradually and can be 1-1.5kg a week. Time periods of weight stagnation are absolutely normal and should not be interpreted as therapy failures. After 1.5 years postoperatively weight reduction is nearly finished. Improvement of obesity-associated comorbidities can be expected in 75%.

What do I have to expect after bariatric surgery?

The changes after bariatric surgery are wide-ranging due to the catabolic metabolism:

• Reduction of frequency and quantity of stool
• Hair loss, weak and brittle nails, skin alterations
• Reduction of blood pressure
• Decreasing blood sugar levels (intended in diabetics)
• Strengthening of libido, regulation of menstrual cycle and fertility in women (contraception 2 years postoperatively!)
• Seldom difficulties in social integration
• Seldom psychological disorders
• Malnutrition due to insufficient intake of vitamins and mineral nutrients (especially after Gastric Bypass and Duodenal Switch) – Follow Up!