There bariatric surgeryalso called obesity surgery, is not intended for all obese people: in 2018, it represented 50,000 operations in France. “In the context of obesity, surgery is a treatment of last resort.says Professor David Nocca, head of the bariatric surgery unit at Montpellier University Hospital and co-founder of the League Against Obesity.
Who does it concern? “The surgery is intended for patients with severe obesity, i.e. over 35 kg/m2 with serious complications, such as diabetes, high blood pressure or fatty liver disease (NASH)”, says the specialist. These patients must be between the ages of 18 and 60 and also be in treatment failure from all other forms of treatment for at least one year.
The operation requires a multidisciplinary preparation ofa minimum of six months, with the support of several specialists including the attending physician, an endocrinologist, a psychologist or a dietitian in order to carry out a complete health check-up and to ensure the patient’s motivation and the interest in resorting to this intervention. This period will also allow the implementation of new food and hygiene habits: weaning from tobacco, reduction of alcohol consumption, implementation of physical activity (“But not just anyrecalls Professor Nocca. You cannot make a person who is severely or morbidly obese do a jog“)…
During surgery?
The operation lasts today between 1 and 2 hours And “requires between one to three days of hospitalization”says the specialist.
There are three types of surgery:
- There sleeve gastrectomy (or sleeve), which is the most practiced: it represents 35,000 operations out of the 50,000 in 2018. “It reduces the size of the stomach by two thirdssays Professor Nocca. Nevertheless, in 35 to 40% of cases, it can lead to complications such as gastroesophageal reflux disease (GERD)” ;
- THE gastric bypassalso called bypass: “It is performed in the event of sleeve failure and represents around 15,000 operations in France each year., he continues. It consists of placing a bypass between the upper part of the intestine and the stomach, thus reducing the surface area for food absorption;
- I’Gastric Band : “Very carried out in the early 2000s, this operation now represents barely more than 1,000 interventions.admits the professor.
What efficiency? “The effectiveness of surgery is between 50 and 70% long-term excess weight loss”, says Professor David Nocca. It is also more effective in young patients than in older patients. Be careful though, it’s not a miracle operation : in the long term, it is necessary to change lifestyle, resume appropriate physical activity and avoid excesses.
“A 2019 study from Sweden showed that there was a lower risk of having surgery than remaining morbidly obese, due to an increased risk of cancer, heart attack and many other diseases. other pathologies”, says the specialist. The mortality rate with the operation is less than 0.1%, compared to just under 0.5% in the early 2000s.
The risk of failure exists:25 to 30% of people regain excess weight. It can happen because of a technical or psychological problem, or it is patients who should not have been operated and who fell through the cracks, it sometimes happens”, recognizes Professor David Nocca. In some university hospitals, particularly in Montpellier, day hospitalizations for failure are offered in order to understand why the intervention did not work and to offer surgical, medical, psychological and nutritional follow-up to the patient.
And after the surgery?
Once the operation is over, the patients are monitored for life, always within the framework of multidisciplinary care. According to Professor Nocca, it is essential to combine surgery with a total change in lifestyle, without which it simply cannot work.
Five rules to follow absolutely (and for life) after surgery:
- Eat slowly;
- Chew well;
- Do not drink while eating;
- Avoid soft drinks;
- Avoid high calorie drinks such as fruit juice or soda.
