Obesity and bariatric surgery

Swiss1Chirurgie stands for many years of experience in the field of obesity surgery (bariatric surgery). Our interdisciplinary team will provide you with comprehensive care for conservative and surgical treatment of obesity. We are one of the largest centers for bariatric surgery in Switzerland.

Obesity (morbid obesity) is a chronic disease that has doubled in Switzerland in the last 30 years.

It is now known that this disease is caused by genetic, epigenetic and acquired factors. This means that although morbid obesity cannot be cured, it can be treated.

The treatment of obesity is complex. Lifestyle changes with a reduced-calorie diet and increased physical activity or even treatment with weight loss injections are often not enough to achieve sufficient weight reduction in the long term. Particularly in the case of obesity with a BMI > 35kg/m2, this is hardly possible using conservative methods.

Therefore, bariatric surgery is still the only way to ensure sustainable weight loss in severely overweight people. Although drug therapies are promising, they have not been effective enough to date and are not sustainable.

Which operations are common?

Gastric bypass

The gold standard operation, which causes rapid satiety and reduced nutrient absorption. In addition, hormonal changes lead to reduced appetite and rapid satiety.

During bypass surgery, most of the stomach and part of the small intestine are bypassed, which means that food no longer flows through the entire gastrointestinal tract.

Sleeve gastrectomy

The alternative operation which causes rapid satiety and a reduced feeling of hunger through hormonal effects.

Here, part of the stomach is cut away and a tube is formed.

What operations are available after a primary procedure?

Sleeve to bypass conversion surgery: After gastric sleeve surgery, conversion to a gastric bypass may be necessary in the event of insufficient weight loss, secondary weight gain or reflux symptoms.

Pouch revision: if the feeling of fullness is no longer sufficient and there is a renewed increase in weight, a reduction in the size of the gastric pouch or the insertion of a fob ring can sometimes help. This increases the restriction again and reduces food intake.

Apollo endosurgery: The same principle as pouch revision. The advantage here is the endoscopic surgical technique, which is very gentle. See separate section on our website.

Distalization of the gastric bypass: here the bypass is extended, i.e. the part of the small intestine that is without food. This can result in renewed weight loss. However, side effects such as deficiency symptoms and diarrhea are quite common. The indication for this procedure must therefore be made very carefully.

What secondary diseases does obesity lead to?

Metabolic diseases:

Blood sugar disease (diabetes mellitus type 2)
Elevated cholesterol and blood lipid levels

Cardiovascular diseases:

High blood pressure (arterial hypertension)
Strokes
Heart attack
Renal insufficiency

Pulmonary dysfunction:

Shortness of breath (dyspnoea)
Obstructive sleep apnea syndrome
Snoring

Vascular diseases:

Shortness of breath (dyspnoea)
Obstructive sleep apnoea syndrome
Varicose veins

Gastrointestinal diseases:

Acid reflux (reflux disease)
Fatty liver, liver inflammation
Gallstones

Mental illnesses:

Lack of self-esteem
Anxiety disorders
Depression
Addicition

Reproduction:

Erectile dysfunction
Polycystic ovarian syndrome (PCOS)
Infertility

Orthopedic diseases:

Joint problems (spine, hips, knees, feet)

Cancers:

Breast, uterus, prostate, colon, bile ducts, lymphomas

How are overweight and obesity defined?

The definition is based on the body mass index (BMI) as a measure of body fat mass:

Overweight: BMI 25 – 29.9 kg/m2
Obesity Grade 1: 30 – 34.9 kg/m2
Obesity Grad 2: 35 – 39.9 kg/m2
Obesity Grad 3: > 40 kg/m2

Who is eligible for bariatric surgery?

In principle, surgery is an option for patients who cannot achieve sufficient weight loss with the help of conservative measures (diet, exercise, medication). They must also have a BMI > 35 kg/m2. If secondary diseases such as diabetes mellitus are present, surgery can also be performed from a BMI > 30 kg/m2.

How is bariatric surgery planned?

Preoperative consultations and preliminary examinations are usually carried out at the Center for Bariatric Surgery.

Is the operation covered by health insurance?

Health insurance companies will cover the costs of obesity surgery if the following criteria are met:

Body mass index (BMI) > 35 kg/m2 (with diabetes mellitus ev > 30kg/m2)
You have tried (cumulatively) conservative therapies (diet, exercise, nutritional counseling, drug therapy, etc.) for at least 24 months
Between the first contact with a doctor specializing in obesity and the operation, you must be given 3 months to think about it

What diagnostics are necessary?

Bariatric surgery is always preceded by

Gastroscopy (gastroscopy)
Ultrasound of the upper abdomen
Nutritional advice
Psychological report
Laboratory tests
EKG

Sometimes:

Weitere kardiologische Abklärung
Pneumologische Abklärung
evtl. andere Untersuchungen

How do you prepare for the operation?

Nutritional counseling will teach you in advance how you will eat after the operation.

An information event, the “Bariatric Curriculum”, takes place in the week before your operation. Here you will get to know the hospital, the nursing staff, the nutritionist and physiotherapist and go to the anesthesia consultation.

How is the operation performed?

All bariatric operations are performed using a minimally invasive technique (laparoscopy, keyhole technique), which means that only small incisions are necessary. This reduces the recovery time and the risk of complications.

The operation takes 60-90 minutes.

In most cases, you will be able to go home after 3 to 4 days.

What happens after bariatric surgery?

After the operation, it is important to adapt to your new life. Your metabolism will change and you will need time to find your new rhythm.

The change in diet is demanding and is accompanied by our nutritional therapists.

Postoperative life-long follow-up checks are usually carried out at the Center for Bariatric Surgery in Bern.