Bariatric Surgery 4.0

Most effective and long-lasting treatment for obesity

Bariatric surgery is the most effective solution to fight obesity in our population, a disease which has had an epidemic growth. This threatening fact has been well documented through the media. It is estimated that in Europe alone there are about 160,000,000 obese patients, where around 1,500,000 are children, reigning in discrimination and where self-esteem is at a very low level, leading to a lack of social fulfillment. In a large part of these patients, both blood pressure and diabetes are altered, as well as other diseases that accompany them, so that more and more family physicians as well as surgeons are subject to greater pressure in an attempt to fight this problem, either non-surgically or surgically, by patients looking for a long and effective weight loss.

Surgical intervention is arguably the most effective and long-lasting treatment of morbid obesity. Bariatric surgery represents a unique discipline for several reasons, the first of which is that bariatric surgery is based on the attempt to change behaviors, as well as physiology, instead of the other reconstructive or resection surgeries. In addition, its success is dependent on the patient’s educational capacity and adherence to the behavioral changes that the surgery imposes. Patients with morbid obesity often have multiple diagnoses because this is a condition that affects almost every system in the body. Surgeons who treat this pathology quickly concluded that it is impossible to carry out this treatment without being through a comprehensive and multidisciplinary program, developed by a diverse and dedicated group of people in the health area, who can evaluate patients, as well as prepare them either mentally or physically for surgery and lifestyle changes that will be asked of them. To this end, there is a need to organize comprehensive programs that require a multidisciplinary approach and a large institutional commitment, leading to the formation of obesity treatment units or bariatric units, capable of having an educational role and developing support strategies for patients.

Patients with a BMI>= 40, or 35 with comorbidities are generally eligible for surgery. Various weight loss attempts must have been made in the past, supervised with diet, exercise or medication. However, we will have to think that some patients with a BMI < 35 may be candidates, but they should be discussed by the whole team.

Although the age between 18 and 60 years is preferable for a surgical treatment, studies show that patients under 18 and above 60 years, after being properly analyzed, may be candidates for surgery. Therefore, age alone is not an objection to surgery.

After surgery, a close follow-up and a multidisciplinary approach are necessary for the success of such a program. The knowledge by the family physicians of the program, the understanding of what bariatric surgery means, how it is performed and what is expected of it is fundamental for these programs to be successful, as they will always be the first to assist the patient and say or give them what they need.

Our bariatric surgeon is the experienced Dr. Luís Sá Vinhas. Surgeries currently being performed can be of various types and performed in several ways:

Obesity surgery using Roux-en-Y Gastric Bypass is the prototype of gastric restriction combined with malabsorption. It is one of the most performed operations in the world. The stomach is divided either with mechanical or manual sutures to obtain a small reservoir (+/- 15 mls), the size of restrictive surgeries. After this complete division of the stomach, the small intestine is divided to connect the gastric reservoir made to the intestine, and the other sectioned part of the intestine rejoins the intestine thus forming a loop in Greek I (Y), starting absorption of food only from this union of the intestine onwards (common loop). Therefore, a large area of ​​crushing and absorption of food (stomach, duodenum and part of the small intestine) is overcome. This malabsorption can be greater or lesser depending on the size of the intestinal loops that are before the union of the two loops, however, the greater the malabsorption instituted, the greater the risks of side effects.


In specific cases, in which there are contraindications related to gastric bypass and gastric sleeve, proceed with the removal of the remaining stomach that would be excluded in the gastric bypass.

For several years it has been thought that, in patients with a high BMI (> 60 kg/m2) or with associated serious diseases, there is an advantage in performing Roux-en-Y gastric bypass surgery or Biliopancreatic shunt with a duodenal switch. As the risk of complications in the postoperative period of this group of patients is particularly high, it led some surgeons to start a surgery that aimed to reduce the weight of these patients and at the same time reduce the risk of complications in the subsequent and definitive surgical procedure. weight loss, thus creating the so-called Vertical Gastrectomy or Gastric Sleeve.

Tubular gastrectomy is a purely restrictive operation, reducing the size of the gastric reservoir to a value between 60 and 100 mls. Another action that is thought to be attributed to it is the plasma reduction of the value of ghrelin (one of the hormones that regulates hunger), which can also be a mechanism involved in weight loss and not just restriction.

Indications for performing only a linear gastrectomy include:

  • Body Mass Index> 60 kg/m2
  • Serious comorbid diseases
  • Advanced age
  • Unfavorable anatomy such as liver cirrhosis, intense abdominal adhesion causing poor exposure.

In almost all existing studies, weight loss is established up to the year, remaining in part in the first 3 years, but with a high disease recurrence rate.

The main complications of surgery are stomach fistula and hemorrhage.

The use of gastric band is probably the simplest surgery that is performed to lose weight. A band, made of synthetic material, usually silicone, is placed around the stomach, next to its upper end creating a small pouch and a more or less narrow passage to the rest of the stomach.

This technique does not alter the normal course of the digestive system for digestion and absorption of food. The only effect here is to decrease the ability to eat food. The small volume of the gastric pouch and the correct diameter of the stoma are very important for the success of the operation.

One of the great advantages of this surgery is that the stomach is not cut, therefore brutally decreasing the risk of infection and the absence of suture line failures. Another great advantage is that the surgery is easy to revisit and completely reversible if necessary.

Some of the bands are adjustable (they are connected to a reservoir that is in the abdomen through a tube) that means that the stoma can be adjusted in its caliber with the injection in the saline solution, thus adjusting the stoma to the patient’s needs to lose weight.

We can conclude that to reduce food intake, restrictive operations depend on a small reservoir and stoma and cause a radical change in eating habits on the part of the patient, that is, a great need to chew food very well, swallow it slowly and ingest small amounts, because if this does not happen, the surgery may become complicated, the bag may dilate, the stoma may stenosize and there is a need for further surgical intervention.


Schedule your appointment now!

Request Information

  • Would you like to know more about this treatment?
  • Would you like to get to know Living Clinic?
  • Would you like our team’s opinion?
  • Would you like to book an appointment?