Page 14 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 1 - Introduction
energy expenditure and thereby also causes weight loss 41. Surgery is advised to patients with a BMI ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 with comorbid conditions 14,37. There are several types of bariatric surgery. The most popular types are the Roux- en-Y gastric bypass (RYGB) and gastric sleeve (GS) 42. With the RYGB a small new stomach, pouch, is first created. Then the small intestine is dissected and connected to this pouch. Subsequently, the distal part of this small intestine is connected to the other portion of the small intestine. As a result, food will bypass the greater part of the stomach, the duodenum and part of jejunum. With the gastric sleeve, a large part of the stomach is removed, resulting in a small, longitudinal stomach.
Compared to life-style intervention programs, bariatric surgery has proven to be a superior treatment for morbid obesity 2,43-45. In the first and largest controlled trial com- paring bariatric surgery with a standard life-style intervention, the SOS-study, weight loss up to 15 years was significantly higher in patients undergoing bariatric surgery (27% in RYGB patients versus around 3% in the control group) 2. In addition, diabetes remission rates were significantly higher (30.4% versus 6.5%) and surgery was asso- ciated with reductions in cancer incidence, cardiovascular events and cardiovascular deaths 2,46,47. These outcomes have since then been replicated by other studies 43,48. Showing that bariatric surgery is currently the most effective treatment for morbid obesity. Hence, the number of patients undergoing bariatric surgery continues to in- crease worldwide: 579,517 patients were operated in 2014 compared to 685,874 in 2016 42,49.
BARIATRIC SURGERY
Whether a patient qualifies for bariatric surgery should be determined after a compre- hensive multidisciplinary assessment by a team experienced in bariatric surgery 17. This team assesses if the patient meets the criteria for bariatric surgery, which have been developed by the International Federation for the Surgery of Obesity and Met- abolic Disorders (the IFSO) 17,50. The IFSO-criteria state that a candidate for bariatric surgery is an adult obese patient with:
• a BMI:
• ≥ 40 kg/m2, or
• 35.0 - 39.9 kg/m2 with obesity related comorbidities that will be positively influenced by bariatric surgery, like diabetes mellitus, hypertension, cardio- respiratory problems, severe joint disease and obesity-related severe psy- chological problems (not further specified)
• longstanding obesity (more than 5 years)
• proven failure of nutritional and behavioural therapy
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