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Bariatric Surgery: Which Procedure is Right for Me?

Bariatric-Surgery

Nearly 2/3 of Australians are overweight or obese. Many factors contribute to obesity, and a large number of other health problems are linked to obesity such as diabetes, sleep apnoea, and cardiovascular disease.

There are a multitude of diets, lifestyle changes and medical treatments which are used to aid in weight-loss, but bariatric (weight-loss) surgery is the only one to show a long-term durable weight loss compared to the other methods. It also has a beneficial effect on obesity-related health conditions – for example, diabetics may reduce or cease their medications/insulin requirements following bariatric surgery.

The number of patients undergoing bariatric surgery is becoming increasingly common with more than 22,000 procedures performed in the country in 2014-2015.

Weight is commonly measured via the Body Mass Index (BMI). This is a simple calculation which takes into account a person’s height and weight.

Calculate your BMI here

  • Find out your BMI and gain an understanding of what it means
  • Find out the health consequences
  • Get practice weight loss information

Start

BMI

BMI Classification
< 18.5 underweight
18.5–24.9 normal weight
25.0–29.9 overweight
30.0–34.9 class I obesity
35.0–39.9 class II obesity
≥ 40.0 class III obesity

Speak to your GP about surgery if:

  • Your BMI is more than 30
  • You have health problems linked to weight such as sleep apnoea, asthma, high blood pressure, high cholesterol and arthritis
  • Your BMI or waist circumference is increasing in between GP visits
  • You have a waist size of 80cm or more for women and 94cm or more for men
  • You have diabetes related to obesity. In more than 80 per cent of cases this can be resolved or reduced post-surgery
  1. Adjustable gastric band – a hollow band is placed around the top of the stomach to create a small pouch. The tightness of this is adjusted via a small port under the skin to increase or decrease the feeling of satiety (fullness) after eating.
  2. Sleeve gastrectomy – approximately 2/3 of stomach is removed, leaving behind a narrow tube of stomach which decreases the amount of food one can eat before they feel full. This is the most commonly performed procedure in Australia as it has been shown to offer good long term results with minimal complications.
  3. Laparoscopic Roux-en-Y gastric bypass – the stomach is divided to create a small pouch (which causes fullness), and the small intestine is joined up in such a way that the food which is eaten ‘skips’ or bypasses a portion of the stomach and bowel (which reduces the amount of nutrients and calories absorbed by the body).
  4. Revisional Surgery – some people may have undergone previous obesity surgery such as gastric band, or gastric stapling, and have had unsatisfactory long term results. They may have not been able to maintain their weight-loss goals, or they may have adverse symptoms such as severe reflux or swallowing difficulties. Revision surgery to convert the current procedure to another procedure may be performed. This is done in most instances laparoscopically (key-hole), however there is a higher risk than a primary (first-time) procedure. The decision to revise therefore requires a very careful assessment and consultation beforehand.

Weight loss - you will lose a significant amount of weight – usually 50-80% of excess body weight

Other health conditions – obesity-related conditions such as diabetes, sleep apnoea and osteo-arthritis may be significantly improved or in some cases resolved completely.

Risk of premature death and obesity-related illness will be reduced

You will have improved self-confidence and it will be the opportunity for a fresh start with an improved, healthier lifestyle.

Over the last 2 decades, the world-wide prevalence of obesity has risen dramatically. In Australia, 52% of women are overweight or obese, including 35% of women of child-bearing age (25 to 35 years of age).

Body Mass Index (BMI) is a calculation based on a person’s height and weight, and is a commonly used and simple way to quantify obesity. A person with a BMI of 25-30 is classified as overweight, and >30 is classified as obese.

Fertility rates are reduced in obese women, with a 2x longer time to achieve pregnancy compared to non-obese women. This is partly due to the reduction in normal ovulation which occurs with obesity. The success rate of fertility treatments such as IVF procedures is also reduced in obesity.

Obese individuals are also prone to polycystic ovary syndrome (PCOS), a well-recognised condition which affects ovulation and thus fertility. This is also associated with hormonal disturbances which also impact fertility. Weight loss of as little as 5% has been shown to have a beneficial effect on ovulatory function in patients with PCOS.

Pregnancy in obese women is associated with a higher risk of prolonged labour and higher rates of needing medical intervention around labour, such as induction or caesarean section.

Weight loss has been shown to be linked to improved fertility and reduced risk of pregnancy-related complications. A multitude of weight loss interventions are available, ranging from lifestyle changes to medical management to weight-loss surgery. Of these, surgery has been shown to achieve the most durable and effective long-term weight loss.

Weight-loss surgery and its effect on fertility has been studied and has been shown to lead to improved ovulatory function and fertility, as well as reducing adverse maternal outcomes.

In one published study of women with PCOS undergoing weight-loss surgery, all patients resumed normal menstrual cycles an average of 3.4 months after surgery.

Another review of a large number of studies found that in patients who had weight-loss surgery, the incidence of PCOS decreased from 45.6% to 6.8% after 12 months, and infertility decreased from 18.2 to 4.3%.

What about the effect of surgery on IVF treatment specifically? There is limited data regarding the effect of non-surgical weight-loss on fertility treatment, but a number of studies have demonstrated a positive effect. A study examining patients who had IVF before and after weight-loss surgery showed that after surgery there was a significant decrease in the total number of gonadotropin ampoules required during the IVF cycle (which also meant reduced cost and improved patient comfort from fewer injections. There was also no detrimental effect on the number of follicles or eggs retrieved.

Another study reported 5 patients who underwent bariatric surgery who conceived after their first or second IVF cycle with no complications.

It should be noted however that pregnancy in the initial 12-24 months following weight-loss surgery is not advised, as this is the period of rapid weight-loss. A pregnant woman (and her unborn child) require a relatively higher intake of nutrients which is not possible to achieve during this time. Therefore it is imperative that appropriate contraception is discussed during this period.

References

  1. Effective treatment of polycystic ovarian syndrome with Roux-en-Y gastric bypass. Eid GM et al. Surg Obes Relat Dis. 2005;1(2):77
  2. Does bariatric surgery improve ovarian stimulation characteristics, Oocyte yield, or embryo quality? Tsur A et al. J Ovarian Res 2014;7:116
  3. The impact of bariatric surgery on polycystic ovary syndrome: a systematic review and meta-analysis. Skubleny D et al. Obes Surg 2016;26(1):169-76
  4. In Vitro fertilization after bariatric surgery. TsurA, et al. FertilSteril2010;94(7):2812–4.
  5. Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Moran LJ et al. Fertil Steril 2009:92(6):1966-82
  6. Reproductive outcome after bariatric surgery: a critical review. Guelinckx I et al. Hum Reprod Update 2009;15 (2):189–201.

Mr Ben Keong MBBS FRACS

As you can see, it can be difficult to decide which, if any, procedure to choose. Every individual is different and it is important to have an in-depth discussion with your surgeon regarding the pros and cons of each procedure and to tailor it to your unique circumstances.
Mr Ben Keong, MBBS FRACS

Specialists

See our list of Bariatric Surgeons.