1. What is bariatric / metabolic surgery?
• Bariatric and metabolic surgery are a group of general surgery procedures that modify the gastrointestinal tract, particularly the stomach and the small intestine. The surgery is done under general anesthesia and through laparoscopic (minimally invasive) access into the abdomen through small incisions.
2. What is BMI (Body Mass Index)?
• BMI is the internationally accepted basis for assessing the weight of the patient in relation to their height. It is computed through the following formula (Weight in kg /Height in m2). A person’s BMI can be an indicator of any potential lifestyle related health risk. The ideal range of BMI is a score of 18.5-24.9. Below this range means the person is underweight, beyond this results in being overweight
3. What are the indications for bariatric and metabolic surgery?
• BMI remains to be the most widely accepted basis for bariatric and metabolic surgery. There are various organizations that have given their recommendations as to when should surgery be considered (see table on the right). The Philippines follows
the IFSO-APC Guidelines of 2011.
10. What will happen during surgery?
• All patients will undergo laparoscopic surgery, of which necessitates having the patient undergo general anesthesia. Once you are placed on the operating table, the anesthesiologist will give sedative through your IV line. Within a few seconds, you will feel drowsy and will be brought to a deep sleep.
At this point, you will be completely oblivious to what is happening outside, not even painful stimuli will wake you up. At this state, we will begin putting airway access with an endotracheal tube. Once completely anesthetized, all necessary procedures relating to the operation will be done (ie making incisions, putting gas into the abdomen, dissecting the stomach and/or intestine, etc). Once the operation is done, you will still be anesthetized but will be slowly be brought to awake status.
5. How is the surgery done?
• The surgery is done completely laparoscopically, which is through small key hole incisions made through the abdomen. Patients may have between 5-6 incisions, about 5-15mm in size. All patients undergo general anesthesia during the procedure. Your anesthesiologist will place you in sedation first before doing intubation. You will be asleep during the entire process of intubation and surgery. The operation is done in the operating room to ensure sterile conditions.
6. Can the surgery be done as inpatient or outpatient?
• Both options are made available to all patients, however, it is important to note that there is a criteria that must be fulfilled if patients are considering undergoing outpatient bariatric surgery. These include the following:
• must be 50 years old or less
• generally, must have no other co-morbid conditions (hypertension, diabetes, sleep apnea
• if there are co-morbid conditions, must have all conditions deemed stable or controlled
• A detailed breakdown of the criteria will be endorsed to you at the clinic
7. What do I do before the surgery?
• You will need to undergo several laboratory tests and diagnostic workups, whose purpose is to know if you have (1) any underlying medical conditions that may cause obesity, (2) create a baseline of your health parameters, (3) know from a medical standpoint if you’ll be able to tolerate the anesthesia.
• After the workups, you will be referred to a cardiologist and/or various other medical specialists to give a risk stratification for the procedure.
8. Why is it important to undergo weight loss before surgery?
• Around 10-14 days prior to your surgery, you will need undergo a very low calorie diet regimen. This is an important step in the preoperative process because it will improve your overall medical condition plus reduce the size of the liver which is usually enlarged during obesity. Following the regimen will result in a faster surgery and quicker recovery
• This also prepares you for the post-operative phase, wherein you will remain in a strict liquid diet for several weeks. Your diet will progress thereafter
9. After preparations, what do I do next?
• Once all clearances are done and the necessary weight loss has been achieved, we can begin with the final preparations for the operation. If you have considered being admitted for the surgery, you will be given instructions and admitting papers to the affiliated hospitals for the operation. If you are a candidate and have considered undergoing outpatient laparoscopic, a detailed step-by-step guide will be given to you as well as a proper orientation with your surgeon every aspect of the pre-operation and post-operation process. Your surgeon is also accessible through various channels
11. What happens after the surgery?
• The surgery may range from 2-3 hours depending on the type of procedure and other factors such as BMI and liver size. Once done, you will awake at the recovery room and you might notice several dressings placed on your abdomen. You might feel pain in the stomach and may feel nauseous. Medicines will be given to treat these symptoms. Once assessed by the anesthesiologist and nurses that you’re awake, you will be returned to your room. For patients who’ve opted to undergo outpatient procedures, you might stay for 2-4 hours at the recovery room before discharge. Instructions for feeding or drinking will be given to you by the staff.
• For the first week, all patients will be kept on clear liquid diet. It is imperative you make sure you consume about 1.5 liters of liquid per day at this time. Diet progression will be advised by your surgeon at each of the interval.
• All patients are advised to follow up on the 1st week and then on the 1st, 3rd, 6th and 12th month after the operation.
4. What are the types of bariatric surgeries?
• There are several types of operations that can be done. These are the following: adjustable gastric banding, sleeve gastrectomy, roux-en-y gastric bypass, and mini- gastric bypass. Decisions on which surgery is to be done is based on the patient’s overall health status and medical conditions and preferences. Your surgeon will endorse to you which surgery is best suited for you.
Jose Paolo C. Porciuncula, MD, FPCS, FPSGS, FPALES