Obesity is not just a cosmetic flaw. Obesity is a contributing factor in the development of heart disease, type II diabetes, high blood pressure, joint problems, sleep apnea, asthma and more. It is therefore vital to reduce excessive weight. No other method produces such effective and lasting weight loss as surgery.

Bariatric surgery is recommended for patients whose body mass index (BMI) is greater than 40. If the patient also suffers from high blood pressure, type II diabetes, joint problems or varicose veins, the required level of BMI drops to 35.

Bariatric surgeries can be divided into three groups according to the mechanism of action:

Most commonly, patients undergo the following procedures, which are recognized at present as the ‘gold standard’ in bariatric surgery:

Sleeve gastrectomy is based on the  principle of restriction: a large part of the stomach is removed during this surgery, and a thin tube (sleeve) is created out of the remaining stomach, with a diameter of 1 cm. Such a stomach can hold very little food, moreover, the narrow sleeve serves as an obstacle to the free passage of food. As a result, the food that passes through a long and very narrow ‘pipeline’ overcomes considerable resistance and, by remaining longer in the stomach, produces a lasting feeling of fullness with very small quantities of food.

In the case of gastric banding, an adjustable ring is placed around the upper part of the stomach, which is able to reduce or increase the size of the gastric lumen. The smaller stomach pouch, which is located above the ring, has a volume of only 10-15 ml, meaning that only one tablespoon of food is sufficient to fill it. The stomach wall is stretched at this site, and the satiation receptors send signals reporting the feeling of fullness to the brain. This is the most common bariatric surgical procedure, as it is well-tolerated and is completely reversible (the ring can be removed at any time). At the same time, for a weight loss procedure to be successful, the patient must carefully monitor their diet and regularly visit the doctor to get the ring adjusted.

In the case of gastric bypass surgery, the stomach is stapled with titanium staples, which creates a 30-50 ml stomach pouch in its upper part, which is then attached to a loop of the small intestine. Firstly, because the volume of the stomach pouch is only 30 ml, a patient is unable to eat a lot of food. Secondly, the eaten food bypasses most of the stomach and small intestine, and thus this surgery results in a reduction in nutrient absorption.

The choice of procedure must be made by the surgeon together with the patient, as it depends not only on the base data (the patient’s current state of health), but also on how well the patient is willing to comply with the post-operative recommendations such as following a diet, regularly coming to see the doctor, reducing physical exertion, etc.

The bariatric surgical procedures described here are performed using the laparoscopic approach (with minimal incisions) under general anesthesia. Depending on the type of surgery, duration can vary from 30 minutes (gastric banding) to 3-4 hours (other surgical procedures).

Patients undergoing a gastric banding procedure are usually discharged from the clinic on the morning after the operation. Gastric bypass surgery and sleeve gastrectomy usually require 3-5 days in hospital. Patients are usually able to return to work 2-3 days after the gastric banding procedure, and 2 weeks after gastric bypass surgery and sleeve gastrectomy. However, heavy physical work should be avoided for 2 months.