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The Role of a Bariatric Surgeon in Sleeve Gastrectomy and Obesity Management

Published on: May 2, 2023

Table of Contents

The Role of a Bariatric Surgeon in Sleeve Gastrectomy and Obesity Management

Introduction

Obesity has become a pressing global health issue, with an estimated 650 million people suffering worldwide [1]. Not only does obesity contribute to a range of physical health problems, such as type 2 diabetes, cardiovascular disease, and hypertension, but it also significantly impacts individuals’ mental well-being and quality of life [2]. Consequently, effective obesity management strategies are essential, particularly for individuals struggling to achieve and maintain a healthy weight through lifestyle modifications alone. For many, bariatric surgery has become a valuable tool in their weight loss journey, offering significant and sustainable outcomes and improvements in obesity-related comorbidities [3]. This article will explore the vital role of a bariatric surgeon in sleeve gastrectomy and obesity management.

Sleeve gastrectomy has become one of the most commonly performed bariatric procedures worldwide [4]. This procedure involves the removal of a significant portion of the stomach, creating a smaller, sleeve-like structure that restricts food intake, alters gut hormones, and ultimately promotes weight loss [1]. Bariatric surgeons are crucial in successfully implementing this procedure, from assessing and selecting suitable candidates to providing ongoing postoperative care and support.

Complexities of obesity management within a multidisciplinary team

In addition to their surgical expertise, bariatric surgeons must also navigate the complexities of obesity management within a multidisciplinary team. A holistic approach to obesity management is critical to ensure the best possible patient outcomes, with bariatric surgeons collaborating closely with nutritionists, dietitians, mental health professionals, and primary care physicians [5]. These partnerships enable comprehensive patient care, addressing not only the physical aspects of obesity but also the psychological and social factors that contribute to the condition.

In this article, we will delve into the bariatric surgeon’s role in sleeve gastrectomy and obesity management, examining the entire patient journey from preoperative assessment to postoperative care. We will also discuss the importance of a multidisciplinary approach to obesity management and the overall impact of bariatric surgery on obesity and related health conditions.

Bariatric Surgery and Sleeve Gastrectomy

Definition of Bariatric Surgery

Bariatric surgery is a group of surgical procedures designed to help patients with obesity lose weight by altering their digestive system’s anatomy and function [6]. These surgeries primarily work by either restricting the amount of food that can be consumed or by decreasing the absorption of nutrients. In some cases, they induce hormonal changes that aid in weight loss and metabolic regulation [7].

Different Types of Bariatric Surgery Procedures

There are several bariatric surgery procedures, each with advantages and drawbacks. The most common methods include:

Also known as Roux-en-Y gastric bypass, this procedure involves creating a small pouch from the upper part of the stomach and connecting it directly to the small intestine, bypassing a large portion of the stomach and the first part of the small intestine [8]—This dual approach results in both reduced food intake and decreased nutrient absorption.

  • Adjustable Gastric Band:

This procedure involves placing an inflatable band around the upper portion of the stomach, creating a small pouch. The band can be tightened or loosened to control the passage of food between the pouch and the lower stomach [9]. This reversible procedure does not involve cutting or stapling the stomach or intestine.

  • Biliopancreatic Diversion with Duodenal Switch:

This complex procedure involves removing a portion of the stomach and rerouting the small intestine to decrease nutrient absorption [10]. This surgery is typically reserved for patients with extreme obesity or severe comorbidities, as it carries a higher risk of complications and nutritional deficiencies.

  • Sleeve Gastrectomy:

This procedure removes approximately 80% of the stomach, creating a sleeve-like structure [6]. This surgery restricts food intake and induces hormonal changes that aid in weight loss and appetite control.

The Sleeve Gastrectomy Procedure

Description of the Surgery

During a sleeve gastrectomy, the surgeon removes a large portion of the stomach, leaving behind a narrow, sleeve-like structure [6]. This procedure is typically performed using minimally invasive laparoscopic techniques, resulting in smaller incisions, reduced scarring, and a quicker recovery than traditional open surgery [11].

Mechanism of Action

Sleeve gastrectomy works through a combination of mechanisms. The reduction in stomach size limits the amount of food consumed at once, promoting a feeling of fullness with smaller meals [6]. Additionally, the procedure leads to changes in gut hormones, such as ghrelin and peptide YY, which help regulate appetite and satiety [7]. This combination of restricted food intake and altered hormonal signalling contributes to significant and sustained weight loss.

Benefits and Risks

Sleeve gastrectomy has become increasingly popular due to its effectiveness in weight loss and improving obesity-related comorbidities, such as type 2 diabetes, hypertension, and sleep apnea [12]. It is generally considered safer than gastric bypass and biliopancreatic diversion with duodenal switch, with fewer complications and nutritional deficiencies [10]. However, as with any surgery, there are potential risks, including bleeding, infection, and leaks from the staple line. Additionally, because the procedure is irreversible, patients must be committed to long-term lifestyle changes and follow-up care to maintain weight loss and overall health.

The Bariatric Surgeon's Role in Sleeve Gastrectomy

Patient Assessment and Selection

Bariatric surgeons are critical in determining whether a patient is an appropriate candidate for sleeve gastrectomy. They evaluate patients based on  body mass index (BMI), previous weight loss attempts, and obesity-related comorbidities [13]. Additionally, they assess patients’ readiness for surgery by evaluating their understanding of the procedure, expectations, and commitment to the required lifestyle changes.

Preoperative Assessment and Preparation

Before surgery, bariatric surgeons work closely with other healthcare professionals to ensure patients are physically and mentally prepared for the procedure. This may involve medical tests, nutritional counselling, psychological evaluations, and discussions about the potential risks and benefits of the surgery [14]. Patients may also be asked to make specific lifestyle changes, such as quitting smoking or losing a small amount of weight, to improve surgical outcomes and reduce complications.

Performing the Sleeve Gastrectomy

Bariatric surgeons are responsible for conducting the sleeve gastrectomy using the appropriate surgical techniques and adhering to best practices to minimise complications during surgery. Advancements in surgical technology, such as laparoscopic and robotic-assisted procedures, have made sleeve gastrectomy safer and more precise, with quicker recovery times and reduced scarring [15].

Postoperative Care and Follow-Up Monitoring Recovery and Complications

After surgery, bariatric surgeons monitor patients’ recovery and identify potential complications, such as infection, bleeding, or leaks from the staple line. They work closely with other healthcare professionals to manage these complications and ensure patients receive appropriate care and support during their recovery.

Nutritional and Lifestyle Guidance

Bariatric surgeons collaborate with dietitians and nutritionists to provide patients with tailored nutritional counselling and support, helping them adapt to their new dietary needs and maintain long-term weight loss [16]. This may include guidance on meal planning, portion sizes, and specific nutrient requirements to prevent deficiencies and promote overall health.

Psychological Support

As patients adjust to their new lifestyle and cope with the emotional aspects of weight loss, bariatric surgeons often work with mental health professionals to ensure patients receive appropriate psychological support. This may include counselling, support groups, or referrals to specialised therapists [17].

In conclusion, bariatric surgeons play a vital role in managing obesity through sleeve gastrectomy. Their expertise spans the entire patient journey, from preoperative assessment and selection to the surgery and the postoperative care required for successful weight loss and improved health. By working closely with a multidisciplinary team of healthcare professionals, bariatric surgeons are uniquely positioned to help patients achieve their weight loss goals and enjoy a healthier, more fulfilling life.

Multidisciplinary Approach to Obesity Management

Importance of a Multidisciplinary Team

Obesity is a complex and multifaceted condition that requires a comprehensive and coordinated approach to treatment. As such, managing obesity, including sleeve gastrectomy, often involves a multidisciplinary team of healthcare professionals working together to address the various aspects of the patient’s health [18]. This collaborative approach ensures that patients receive well-rounded care, managing their weight and nutritional, psychological, and lifestyle needs.

Key Members of the Multidisciplinary Team

Dietitians and Nutritionists

Dietitians and nutritionists are crucial in providing patients with personalised nutritional counselling and guidance before and after surgery [19]. They help patients develop and maintain healthy eating habits, essential for achieving long-term weight loss and overall health improvement.

Psychologists and Psychiatrists

Mental health professionals such as psychologists and psychiatrists often care for bariatric surgery patients to address the psychological aspects of obesity and weight loss [20]. They provide counselling, support, and therapy to help patients cope with the emotional challenges that can arise during their weight loss journey.

Exercise Physiologists and Physical Therapists

Exercise physiologists and physical therapists help patients develop and maintain an appropriate exercise regimen tailored to their needs and abilities [21]. Regular physical activity is essential to long-term weight loss success and overall health improvement.

Primary Care Physicians and Endocrinologists

Primary care physicians and endocrinologists work closely with bariatric surgeons to manage patients’ obesity-related comorbidities, such as diabetes, hypertension, and sleep apnea [23]. They ensure patients receive appropriate medical care and monitoring before and after surgery.

Benefits of a Multidisciplinary Approach

Comprehensive Care

A multidisciplinary approach to obesity management ensures that patients receive comprehensive care addressing all health aspects. By involving a team of healthcare professionals with expertise in various fields, patients can receive well-rounded support throughout their weight loss journey.

Improved Outcomes

Research has shown that a multidisciplinary approach to obesity management can improve patient outcomes, including more significant weight loss, better adherence to lifestyle changes, and higher satisfaction with care [22]. By addressing the various factors that contribute to obesity, a multidisciplinary team can help patients achieve and maintain their weight loss goals.

Enhanced Patient Support

A multidisciplinary team can provide patients with enhanced support by addressing their unique needs and challenges. By working together, healthcare professionals can develop a personalised plan of care that meets the patient’s specific requirements and helps them overcome obstacles to success.

In conclusion, a multidisciplinary approach to obesity management, including sleeve gastrectomy, is essential for comprehensive and effective patient care. By involving a team of healthcare professionals with expertise in various fields, patients can receive well-rounded support that addresses all aspects of their health and well-being. This collaborative approach can improve outcomes and patient satisfaction, helping individuals achieve lasting weight loss and improved quality of life.

The Impact of Bariatric Surgery on Obesity and Related Health Conditions

Weight Loss and Maintenance

Sleeve gastrectomy is an effective obesity treatment, resulting in significant weight loss and improved patient health outcomes. On average, patients can lose 50-70% of their excess body weight within the first two years following surgery, with many maintaining significant weight loss over the long term [24]. The extent of weight loss and maintenance can vary among individuals, depending on factors such as adherence to dietary and lifestyle changes and other health conditions.

Improvement in Obesity-Related Comorbidities

Bariatric surgery, including sleeve gastrectomy, has been demonstrated to significantly impact obesity-related comorbidities, including type 2 diabetes, hypertension, and sleep apnea. Research has shown that many patients experience improving or resolving these conditions following surgery, leading to better overall health and quality of life [25].

Type 2 Diabetes

Sleeve gastrectomy has been shown to profoundly impact type 2 diabetes management, with many patients achieving remission or improved glycemic control after surgery [26]. This improvement is attributed to factors such as weight loss, changes in gut hormones, and improved insulin sensitivity.

Hypertension

Bariatric surgery has been associated with significant improvements in blood pressure control, with many patients experiencing a reduction in the need for antihypertensive medications or even achieving normotensive status after surgery [27].

Sleep Apnea

Weight loss following bariatric surgery, including sleeve gastrectomy, can significantly improve sleep apnea symptoms and severity. In some cases, patients may experience complete resolution of sleep apnea following substantial weight loss [28].

Mental Health and Quality of Life Improvements

In addition to the physical health benefits associated with bariatric surgery, many patients experience improvements in mental health and overall quality of life. Factors such as increased self-esteem, reduced depression and anxiety symptoms, and improved social functioning have been reported following significant weight loss after surgery [29].

Potential Risks and Complications

While bariatric surgery, including sleeve gastrectomy, is an effective treatment for obesity and related health conditions, it has risks. Potential complications can include surgical site infections, bleeding, leaks from the staple line, and nutrient deficiencies [30]. Patients must work closely with their healthcare team, including their bariatric surgeon, to minimise these risks and manage any possible complications.

In conclusion, bariatric surgery, particularly sleeve gastrectomy, significantly impacts obesity and related health conditions. Patients often experience substantial weight loss, improvements in obesity-related comorbidities, and enhanced mental health and quality of life. However, it is crucial to recognise the potential risks and complications associated with surgery and to work closely with a multidisciplinary team of healthcare professionals to ensure the best possible outcomes.

Conclusion

Sleeve gastrectomy has emerged as a highly effective surgical option for treating obesity and related health conditions. The role of a bariatric surgeon in sleeve gastrectomy and obesity management is crucial, as they are responsible for selecting appropriate candidates, performing the surgery, and overseeing postoperative care and follow-up [31].

A multidisciplinary approach to obesity management is essential for achieving optimal patient outcomes, ensuring that all aspects of the patient’s health are addressed. This approach involves collaboration among healthcare professionals, including dietitians, psychologists, exercise physiologists, and primary care physicians [21].

The impact of bariatric surgery on obesity

The impact of bariatric surgery on obesity and related health conditions is significant, with patients often experiencing substantial weight loss, improvements in comorbidities such as type 2 diabetes and hypertension, and enhanced mental health and quality of life [27, 29, 30, 31]. However, potential risks and complications must be considered and managed with the help of a comprehensive healthcare team [29].

In conclusion, the role of a bariatric surgeon in sleeve gastrectomy and obesity management is vital to the success of the treatment. With a multidisciplinary team, bariatric surgeons can help patients achieve lasting weight loss and improved health outcomes, enhancing their overall quality of life [21].

References

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