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  • Dr Mounir Ben Chatouh

Obesity & Bariatric Surgery

Updated: May 16, 2021

From a medical point of view, obesity is an "excess of fat mass causing adverse health effects". How do you assess a person's body fat?

Explication et tableau de calcul de l'IMC:

Fat mass is assessed from the calculation of the Body Mass Index (or BMI) which takes into account weight and height. It is obvious that a person weighing 100 kilos does not have the same BMI if they are 1.60m or 1.80m !!

Calculate your BMI. The BMI value makes it possible to determine a condition, a reflection of "corpulence": normality, overweight or obesity.

Complications de L’obésité:

Recognized by WHO as a serious "chronic" disease causing severe and sometimes fatal complications. Obesity is a major global public health issue.

an obese person is three times more likely to have diabetes than a non-obese person.

over 80% of type 2 diabetes can be attributed to obesity.


Other pathologies are associated with the development of obesity and insulin resistance: arterial hypertension (hypertension), myocardial infarction, cerebrovascular accidents (stroke), diffuse arterial disease and other complications specific to these conditions. pathological. Dyslipidemias, associated with the metabolic syndrome linked to hepatic dysfunction, increase the vascular risk.

Respiratory problems:

The respiratory problems linked to Obesity are above all problems of alveolar hypo-ventilation and sleep apnea (apnea is defined by an interruption of air flow for more than 10 seconds and sleep apnea in France is defined by a frequency of occurrence of apnea during sleep> 10 apneas / hour). These sleep apneas affect 20 to 30% of obese subjects.

Rheumatological problems:

Rheumatological problems are also frequent, responsible for disabling arthralgias caused by osteoarthritis lesions of the hips, knees and vertebrae, inducing a significant consumption of analgesics or even anti-depressants. In the lower limbs, obesity is also the cause of heavy legs, varicose veins and phlebitis limiting quality of life.

Overweight and some cancers:

There is also a relationship between being overweight and certain cancers. Thus, in men, the incidences of gastric, prostate and renal cancers are increased in obese people while in women the same phenomenon is observed for breast and uterine cancers

The Gastric Balloon is not a solution for morbid obesity:

Obesity is a chronic disease often associated with other chronic diseases such as diabetes, hypertension….

So it doesn't make sense to give it temporary treatment!

Because indeed the balloon is imperatively removed after a few months.

In addition, the insertion and removal of the gastric balloon is done under general anesthesia. the gastric balloon is very often poorly tolerated.


In super-obese patients (BMI> 50 kg / m2) before bariatric surgery.

Sleeve gastrectomy and gastric By-Pass now represent 85% of surgical procedures.

These are two non-reversible, definitive techniques, except in extreme cases. Sleeve gastrectomy alone represents 60% of operations. This is the most common solution because it is simple to perform and gives generally satisfactory results.

Does the gastric band seem less popular?

Indeed, today, we remove more rings than we put. This procedure, for a person who nibbles or drinks a lot of sodas, sugary drinks, will be in a situation of failure with a ring. There will be little or no weight loss. In addition, the quality of life associated with the ring is quite poor.

Gastric bypass:


Gastric bypass is a reduction in the size of the stomach that food passes through and part of the intestine bypassed.

How it works ?

The bypass therefore has a double action:

  1. Restrictive because the size of the stomach is reduced to a volume of 30ml (corresponds to a pot of yogurt).

  2. Malabsorptive because part of the intestine is no longer used for digestion, food follows a shorter intestinal route and is therefore less well digested.


Best known intervention because it has been carried out for several decades.

Greater weight loss than the sleeve in the medium term (proven) and long term (likely).

Can be performed even with gastroesophageal reflux disease.

Effective in hyperphages (heavy eaters during meals) as in snackers.

The consequences of a leak (fistula) on one of the digestive sutures are less serious than after a sleeve.


Technically the most difficult intervention therefore the longest (between 1 hour and 2 hours).

Possible nutritional deficiencies (vitamins A, B6, B9, B12, D; iron; calcium; zinc) requiring oral substitution.

Low risk of ulcer from the anastomosis (suture) between stomach and intestine (0.3 to 3%).

For which patients?

Patients with gastroesophageal reflux disease.

In case of snacking and sugary foods.

The sleeve:

What Is The Sleeve?

Your surgeon will make 2 to 5 small incisions in your abdomen. The surgeon will pass the laparoscope through one of these openings. The camera will be connected with a video monitor in the operating room. Your surgeon will look at the monitor to see inside your belly. Your surgeon will insert thin surgical instruments through the other openings.

Your surgeon will remove most (about 80% to 85%) of your stomach. The remaining portions of your stomach are connected using surgical staples. This creates a long vertical tube. The new stomach will be shaped like a banana.

The surgery does not involve cutting or changing the sphincter muscles that allow food to enter or leave the stomach.

Your sleeve gastrectomy operation may take as little as 30 to 60 minutes if your surgeon has already performed a lot of these procedures.

The advantages of Sleeve Gastrectomy are numerous:

Intervention generally done completely under laparoscopy (laparoscopy).

Safety level comparable to the ring with a low conversion rate (even in super-obese, male patients).

There is no placement of foreign body, unlike the gastric band.

The staples used are generally well integrated after a few months: they are identical to those used in any other abdominal surgery.

Sleeve gastrectomy does not cause any malabsorption.

It is a very physiological intervention.

There is no change in the rest of the digestive tract, nor in digestion.

Sleeve Gastrectomy does not generate vitamin deficiency.

There is no impact on the effectiveness and dosage of your treatments (whether you are taking medicines or the contraceptive pill).

The digestive tract remains accessible to any endoscopic investigation.

There is no early * or late * dumping syndrome.

Food comfort is better compared to the gastric band

because there is no feeling of blockage with frequent vomiting.

In sleeve gastrectomy, the size (volume) of the stomach is reduced regularly along the tube: an almost normal diet, although in small quantities, is possible.

There are no risks associated with digestive sutures (anastomoses)

no anastomotic fistulas and late strictures, unlike the By-Pass.

There is no risk of long-term internal hernia surgery

Unlike the By-Pass.

Sleeve gastrectomy is used to treat co-morbidities linked to obesity

Disappearance and / or control of diabetes, hypertension, sleep apnea syndrome and dyslipidemia with efficacy comparable to Gastric By-Pass.

The results in terms of weight loss appear superior to those that can be achieved by fitting a gastric band and are comparable to those of a more sophisticated operation such as the Gastric By-Pass.

The Sleeve Gastrectomy is an evolving operation at least as much as the ring: in the event of weight regain or insufficient weight loss we can add a Gastric By-Pass or a bilio-pancreatic bypass.

The Sleeve, An Efficient And Safe Operation:

  • When you eat after the operation, the small pouch will fill up quickly. You will feel full after eating only a very small amount of food.

  • Sleeve gastrectomy is an option if you are very obese and cannot lose weight thanks to a balanced diet and an exercise program.

  • The operation is performed laparoscopically, significantly reducing the risk of infection.

  • This surgery will require you to make a major lifestyle change since it is not a quick fix to obesity. You will be forced to adopt a specific diet and exercise after having a gastric sleeve to avoid post-operative complications or poor weight loss. So this surgery kind of puts you "on the right track" from a nutritional and physical point of view.

  • Losing enough weight after the sleeve can improve or even treat many conditions that you may suffer from. Diseases that can be improved or even cured are asthma, type 2 diabetes, hypertension, obstructive sleep apnea, high cholesterol, gastroesophageal reflux disease (GERD).

  • Losing weight after a gastric sleeve should also make your travel and daily activities easier.

  • This operation does not require the introduction and maintenance of a foreign body (as is the case with the gastric band).

  • Vomiting (when the capacity of the new stomach pouch is exceeded) is less likely than with gastroplasty.

  • The sleeve reduces the level of ghrelin, and consequently the feeling of hunger (just like the gastric bypass would).

Disadvantages and risks:

  • This surgery is not reversible.

  • Patients with a very high BMI may need a second operation to keep losing weight.

  • The risk of gallstones may increase after a gastric sleeve. Your surgeon may recommend a cholecystectomy (surgery to remove the gallbladder) before your surgery.

  • Injury to your stomach, intestines or other organs during surgery.

  • Leakage of the line where the stomach parts were stapled together.

  • Scar inside your stomach. This can cause an obstruction (blockage) in your intestine in the future.

  • Gastritis (inflammatory disease of the stomach lining), gastric reflux, stomach ulcers.

  • Poor nutrition or even undernutrition, although less serious than with a gastric bypass.

  • Vomiting if you eat more than your new stomach pouch can hold.

Who is this operation intended for?

1.The gastric sleeve procedure may be considered if you have:

BMI of 40 or more: Someone with a BMI over 40 is at least 45 kilograms over their recommended weight. A normal BMI is between 18.5 and 25.

2.A BMI between 35 and 39.9 is a serious condition, the symptoms of which may improve with weight loss. Some of these diseases are sleep apnea, type 2 diabetes, heart disease.

Post-operative outlook and prognosis:

  • The final weight loss may not be as great as with a gastric bypass. However, weight loss may be sufficient for many patients. Because gastric sleeve surgery is a newer procedure, there is less data on the long-term benefits and risks. Talk to your doctor about this procedure is recommended.

  • Weight comes off more slowly than with a gastric bypass. You normally continue to lose weight for 2 to 3 years after the operation

  • Despite the lack of scientific perspective on the benefits and risks after a sleeve, experts estimate that after 5 years, weight loss is equivalent to about 60-80% of the initial excess weight.

  • Patients who wish to undergo this operation should think carefully about its consequences because this anti-obesity surgery cannot be reversed once completed. Sleeve gastrectomy is an irreversible surgery.

Gastric Plicature:

The gastric plicature is one of the emerging interventions, even if the first interventions go back more than 10 years, this intervention knows a strong diffusion in the world and a weak diffusion in Europe. In fact, it was originally described in countries where the cost of sleeve gastrectomy, particularly in mechanical sutures, made the intervention impractical in terms of volume, as in our countries. The results published with 12 years of hindsight prompted us to carry out this intervention with some technical modifications which seem interesting to us. The first results are encouraging with a low rate of complications, and especially no severe complications as can be seen after sleeve gastrectomy.

It can cause nausea and vomiting which can last about 8 days.

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