Surgical intervention may be necessary for a proportion of patients who are not be able to lose weight through medical, dietary, exercise and lifestyle interventions alone. Surgical intervention for obesity, also referred to as bariatric (from the Greek ‘baros’, meaning ‘weight’) surgery, effects weight loss by modifying gastro-intestinal anatomy. The Ministry of Health Obesity Clinical Practice Guidelines published in 2004 endorses the role of surgery once patients fulfill specific criteria related to weight and co-morbid conditions.
Surgery is medically indicated if a patient’s body mass index (BMI) is higher than 37.5 without any co-morbidities (Class III obesity), or above 32.5 (Class II obesity) with co-morbidities such as diabetes, hypertensions, hyperlipidaemia and obstructive sleep apnoea (OSA). Weight control can lead to significant improvement in these metabolic disorders. It must be emphasized that surgery is most effective in achieving weight loss when performed in the setting of a multi-disciplinary programme.
At the SGH LIFE Centre, we have a team approach to the management of obesity. Patients will be assessed by specialists in obesity, endocrinology, exercise and dietetics as necessary, before surgery is contemplated. Our surgeons are specially trained in advanced laparoscopic and bariatric surgery.
We offer 4 minimally invasive weight-loss interventions:
Gastric balloon
This is a silicone balloon, placed in the stomach by endoscopy and filled with a saline solution to give patients a sense of fullness, thereby reducing their food intake. Although it is an effective method of weight loss, the balloon must be removed after 6 months because of degradation by gastric acid.
Laparoscopic adjustable gastric banding (LAGB)
LAGB is a restrictive procedure used as a solution for morbid obesity. An adjustable silicone band is placed around the upper part of the stomach to reduce the size of the stomach so that a person feels full faster, thus eating less and ultimately losing weight. The pouch and the outlet should be small enough to restrict intake adequately yet not too small to cause obstruction. The band is deemed adjustable because a port implanted under the skin allows for fine adjustment of the outlet diameter.
Laparoscopic sleeve gastrectomy (LSG)
This is a restrictive procedure where the stomach is tubularised and the excess part is removed. About 75% of the stomach can be removed in this way. Although this is a relatively new procedure, early results show that weight loss after LSG is comparable to LAGB. Unlike the LAGB, this procedure is performed once only and no adjustments are required thereafter.
Laparoscopic Roux-en-Y gastric bypass (LRYGB)
This is the most complex bariatric surgery available at SGH. Utilizing 6 trocars ranging from 5 to 12mm, a small gastric pouch is first created and then a bypass to the small intestine (jejunum) is performed. LRYGB effects weight loss in 2 ways. It reduces caloric intake and shunts food into the mid-jejunum, thus altering the mechanism of digestion. Evidence from large cohort studies and meta-analyses show that bypass procedures have a profound effect on gastro-intestinal physiology and are remarkably effective in correcting metabolic disorders such as type II diabetes mellitus and hyperlipidaemia.
Preparing for Surgery
As there are risks involved, patients will be thoroughly assessed first to determine their suitability for bariatric surgery. Pre-operative endoscopy, respiratory and cardiac assessment may be necessary. A special low calorie diet and vitamins are commenced 2 weeks before surgery to improve patients’ surgical fitness. Breathing and physical exercises are also better started pre-operatively.
Surgical Admission
All procedures are performed using minimally invasive (MIS) techniques. Endoscopic gastric balloon placement can be done as a day case procedure, while after laparoscopic surgery patients can expect to stay in hospital for about 3 to 5 days. Before discharge from hospital, a special x-ray may be performed to confirm that it is safe to resume oral intake.
After Surgery – Now The New Life Begins!
Surgery helps patients learn a completely new lifestyle. Food intake may be limited to fluids for the first 2 weeks. After this period, soft food and then solids can be gradually re-introduced under the guidance of our specialists. In addition to superior weight loss compared to medical and lifestyle intervention alone, bariatric surgery can also improve co-morbidities such as type II diabetes mellitus, hyperlipidaemia, hypertension and obstructive sleep apnoea (OSA).
In order to achieve the best results, patients will continue to be monitored for life by a multidisciplinary team comprising of a surgeon, physician, obesity clinical coordinator, physiotherapist and dietitian.
For further enquiries on programme and services offered for bariatric surgery, please call 6326 6697 or email us at sgh.lifeobesity@sgh.com.sg
Bariatric Surgery Support Group
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