High BMI
With a weight of 140–180 kg, anesthetic risks (sleep apnea, cardiopulmonary stress) and technical complexity (thick abdominal wall, large liver) increase, so preparation is required: 2–4 weeks of low-calorie diet (reduces the liver by 20–30%), CPAP for apnea, prevention of thrombosis, breathing exercises. An experienced bariatric team and specialized equipment make the operation safe. Sometimes Sleeve is performed as the first step, followed by bypass surgery after weight loss. Observation and vitamin support - according to the standard program.
Indications
- BMI 40+ is a direct indication for bariatric surgery;
- BMI 35+ with type 2 diabetes, hypertension, sleep apnea, joint diseases;
- BMI 30–35 with poorly controlled type 2 diabetes (by decision of the council);
- ineffectiveness of diets and therapy over the years, weight swings.
How the operation is chosen
Sleeve resection - removal of 75–80% of the stomach with the formation of a narrow “tube”: the most common operation in the world, reduction of excess weight by 55–70%; gastric bypass (LGB) - a small ventricle is connected directly to the small intestine: more powerful in effect on diabetes and reflux; SAGI (gastroiliac anastomosis) is a combined operation with the greatest metabolic effect for complex cases. The choice is made by a bariatric surgeon with an endocrinologist on BMI, diabetes, reflux and eating behavior. All operations are performed laparoscopically with staplers; Type 2 diabetes goes into remission in 60–80% of patients.
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
