Bariatric surgery tackles morbid obesity

By Lee Hyuk-joon

While there are still starving people in one part of the world, there are many people suffering too much body weight in another part of the world. So, the bariatric surgery was once simply regarded as one of the anesthetic surgeries that eliminate the effort of self-control.

However, “morbid obesity” is a disease status, which can be separated from simple overweight, in the aspect that weight loss is seldom successful with non-surgical treatments and many patients have serious associated diseases.

Morbid obesity is defined when the “body mass index” (BMI, body weight(kilogram)/height (in centimeters squared)) is 35 or more; over 101 kilograms in case of a man 170 centimeters tall.

Surgical treatment is indicated when the patient has a motivation to endure a difficult process before and after the operation, and the BMI is over 40 or 35 with two or more co-morbidities.

Because most of this patient fails to lose body weight with medical treatments, and if ever, eventually return to the previous situation, a consensus was made that the bariatric surgery is the most effective treatment for the morbid obesity by National Health Institute (NIH) in 1992.

Now, the bariatric surgery is one of the most commonly practiced operations in Western countries. Over 200,000 cases are reported a year in the United States alone.

The basic principle of the surgery is to reduce the volume of the stomach or to bypass the upper gastrointestinal tract (stomach, duodenum, and proximal jejunum), or the combination of two methods.

The most frequently used surgical methods are laparoscopic gastric banding, gastric sleeve resection, and Roux-en-Y gastric bypass.

The gastric banding is simple and has low complication rate and the Roux-en-Y bypass is the most effective method. The sleeve resection has shown relatively low complication rate as well as good results compatible to Roux-en-Y bypass.

All of these procedures can be performed laparoscopically but a conversion to the open method with long abdominal incision can happen in less than 10 percent of cases, because the exposure of the surgical field or the control of bleeding is sometimes impossible in laparoscopic view in morbid obese patients.

The result of the bariatric surgery is very effective in weight loss as well as, surprisingly, in treatment of co-morbid metabolic diseases.

Many researches have reported that various kind of related diseases such as diabetes, hypertension, hyperlipidemia, fatty liver, gastro-esophageal reflux, sleep apnea, gout, and osteoarthritis (knee pain) were dramatically improved or even completely cured in many patients.

Even the mortality rate from cardiovascular disease could be reduced with operation, which means that the bariatric surgery is not a just anesthetic surgery but also a life-saving surgery.

Based on these good results for the metabolic diseases, the indication of the surgery is now being expanded to the less obese patients with the metabolic diseases, too.

It must be emphasized that the bariatric surgery is not an easy magic bullet, but just the greatest help in the long-suffering process of patient’s own struggles.

The patient must keep the tightly controlled diet and exercises before and after the operation, which is not an easy process, otherwise the surgery is useless especially the patient indulges in snacks, ice-cream or yogurt.

In Korea, many doctors and patients hopes that the expense of the operation can be reimbursed by the health-insurance as soon as possible, because the bariatric surgery is the most effective way to save the total expense of treatment, to treat related life-threatening diseases, and to provide a new social life to usually alienated morbid obese patients as well.

The author is an assistant professor of Department of Surgery and Cancer Research Institute at Seoul National University College of Medicine.