Sleeve gastrectomy: When does medicine recommend bariatric surgery? What are its benefits and risks?

Over the past few days, questions have swirled about the dangers of stomach surgeries, after it was announced that Wadih, the son of artist George Wassouf, had died from health complications that plagued him after having performed one of these operations a few days later.

Wassouf’s family has issued no confirmation or denial of a medical error that led to the death of the Syrian singer’s eldest son. However, questions about the circumstances of the operation and its risks have occupied many communication sites, with the dissemination of some false health information about it.

Weight loss surgeries have grown significantly over the past two decades and have become part of the protocol doctors follow to help patients improve their health and quality of life.

But how does medicine determine its benefits or its risks? What are the criteria that qualify a patient to undergo stomach surgery? How do doctors assess his physical and psychological state before and after surgery? How to avoid complications?

BBC News Arabic in Beirut put these questions to specialists, in search of precise answers.

Stomach surgeries began in the fifties of the last century, and with the development of medicine and surgical techniques, doctors find that it is a relatively safe surgery, since the mortality rate varies between 0.05 and 2.0%, according to the peer review “Obesity Surgery”, specializing in the publication of medical studies from around the world on the subject. Techniques of bariatric surgery.

According to surgeon Georges El Khoury, head of the Department of Laparoscopic Surgery and Excessive Obesity, at the Lebanese American University, which includes Rizk University Hospital in the capital, Beirut, and St. John University Hospital in the city ​​of Jounieh.

Al-Khoury says obesity surgery is divided into two parts, “a section for the treatment of obesity and a section for the treatment of diseases such as diabetes and cirrhosis of the liver and their complications.” Al-Khoury explains that surgeons who specialize in this type of surgery are not “plastic surgeons, but rather we specialize in treating a condition called obesity, which is a chronic condition just like diabetes and other chronic diseases”.

Al-Khoury explains that a distinction must be made “between obesity and morbid obesity, because not everyone who is obese or overweight needs surgery. When obesity becomes a threat to human life, in that it leads to dangerous health complications, such as high blood pressure, breathing difficulties, joint and back pain, diabetes and fat in the arteries, we call it excessive obesity and recommend surgery.

The surgeon, who has seen hundreds of patients over the course of his career, says: “If an obese person visits us, who does not suffer from serious complications due to weight, we do not immediately advise him to have surgery, but instead, we ask them to make lifestyle changes, such as healthy eating and exercise.

He also explains that the surgery is performed to help people with diabetes or other diseases such as cirrhosis of the liver, regardless of their weight, as it helps reduce the absorption of sugar by the body and prevents the fat accumulation, and thus helps to prevent deterioration of the patient’s health. condition.

Talking about the prevalence of stomach reduction surgeries may suggest that the decision to perform them is easier than it actually is, with documentation of patient experiences indicating that there is sometimes chaos in the standards and procedures, or that it is easy to turn to the surgical option, even if the patient’s condition does not require it. .

How do specialists assess the situation before making a decision conduct sleeve gastrectomy or not?

Doctor George El-Khoury specifies that obesity surgery requires the consultation of an integrated team of doctors, in addition to a surgeon specialized in laparoscopic and obesity surgeries.

“The surgeon must have the necessary experience to choose the surgery that is appropriate for the patient’s condition, with the consultation of a gastroenterologist, a pulmonologist, an anesthetist and a nutritionist, in addition to a psychiatrist, to assess the person’s psychological state, and make sure there are no conditions that may pose a threat to him, such as alcohol or drug addiction.

The doctor explains that the patient needs preparation by the specialized team before the intervention and careful follow-up after the intervention. “Each person has a different condition. We cannot generalize or put everyone in one category. Each patient has a health condition that we assess based on their needs.”

Before the procedure, the doctor explains to the person what to expect in terms of pain, change in lifestyle, the quantities of food they can eat and the types of food they should avoid. . After surgery, the patient is instructed to consume liquids for a set period of time and then fragile, easily digestible foods for weeks, depending on each patient’s needs and the stomach’s response to food.

Al-Khoury says: “If a person suffers, for example, from alcoholism or drug addiction, we ask the psychiatrist to help him solve these problems before the operation, in order to ensure that he gets rid of the habits that threaten his life. , and if we have any doubts, we will wait for the operation.

After the surgery, the patient is subjected to intensive monitoring in terms of blood pressure measurement, breathing pattern and body temperature, in addition to being given anticoagulant needles to prevent clots.

The doctor says the purpose of these surgeries is to help patients, not endanger them, and that “any patient who prepares well and follows instructions has a lower risk of complications, and precaution remains a priority.” .

It is true that the risks of complications after stomach surgery exist like any other surgery. Al-Khoury explains that there are several scenarios that can be fatal, such as the patient who does not follow the diet is prescribed to him after the surgery and who consumes prohibited foods. food or drink.

There is also the negligence of some doctors, who are inexperienced, and ignore certain serious symptoms, such as a rapid heartbeat or a high temperature, during the days following the intervention.

He says: “If a patient calls me saying he has a fever after the operation, I ask him to come to the hospital immediately and refer him to the radiology department, and I don’t tell him just take two painkiller pills. There is a protocol that must be followed when similar symptoms occur to avoid any unforeseen complications. Therefore, patients are advised to choose the appropriate hospital that has an integrated work team that can contain any complication as quickly as needed.

The specialized surgeon insists on the importance of a psychological evaluation of the person, before performing bariatric surgery, and this is also the opinion of Melissa Rizk, a psychotherapist specializing in eating disorders.

Rizk says the social and media obsession with body image we live in today “has a big impact on people’s relationship with their bodies and with food. We live in a time that is witnessing a cult from outward appearance, linking it to beauty, to individuals’ will and ability to control themselves, and sometimes even to social status, which puts pressure on us all to be in a certain state of mind. get fit and lose weight.

Rizk notes that the issue of weight loss has become a constant discussion in our lives, whether we go shopping, to the movies or are invited to a social event, “the question of weight remains present”. But, on the other hand, “there is an ongoing food and food industry promotion that spends billions of dollars promoting fast food, and we see it all over our phone screens all the time. time, on TV and on billboards.”

In addition to the sanitary preparations necessary before any bariatric surgery, the therapist specifies that it is necessary to ensure that the person does not suffer from an eating disorder.

She tells us, “The most common eating disorder among candidates for obesity surgery is ‘bulimia’ or ‘binge eating disorder’, which means a person has an episode of overeating, which can last about two hours, during which she loses control. completely, then feels remorse and guilt, he tries to eat less.

People with bulimic disorder live in a steady state of dieting, but they fail to lose weight because they go through uncontrollable binges and need the intervention of a specialized therapist to resolve them.

The therapist says there are a number of different eating disorders, but in general they have in common an obsession with weight and shape and an attempt to control them. “There are obese people who don’t have an eating disorder, and they can see a doctor out of concern for their health if they experience joint pain or if their heart and artery health deteriorates. “

She explains: “Not all obese people suffer from bulimia, but when we notice a problematic relationship between him and food, and an obsession with weight and shape, we hypothesize that he has an eating disorder that needs a solution. Many people who suffer from bulimia eat nothing all day, or eat very little for example, and when they come home tired and hungry after a long day, they go into a state of constant binge eating.

Melissa Rizk oversees the cases of a number of patients who need obesity surgery, and says working to fix the eating disorder, if it existed before the surgery, is a better option, to help the person regulate their eating habits.

She says she makes it clear to each patient that they won’t be able to eat the amounts of food they used to use before surgery, and helps them understand what types of foods they should avoid like chocolate, ice cream, alcohol, and potato chips that may prevent him from losing weight in the long term.

The therapist points out that society’s widespread phobia of obesity, as well as the bullying and ridicule of obese people, has counterproductive results, “especially for those who suffer from the problem of emotional eating, because the increased pressure on them makes them anxious and angry. , so they eat more.

She says, “There’s a beautiful trend that started in the United States called ‘Health in Every Measure.’ Her goal is to move away from the obsession with weight and shape, and focus on healthy habits of all sizes, encouraging sensory eating. , eat natural, organic, and preservative-free foods, and build a long-term balanced lifestyle that includes good sleep, movement, and healthy eating, rather than obsessing over dieting, d to be slim and fit.