Bariatric Surgery / Obesity

1. Gastric Sleeve (Sleeve Gastrectomy, Gastric Tube)

This procedure involves removing up to 85% of the stomach. It is performed laparoscopically using a video camera introduced into the abdomen through small incisions and special surgical instruments. Candidates for this surgery are patients with a body mass index (BMI) over 40, or those with a BMI over 35 and an associated medical condition.

Pre-surgery Adjustments:

• Stop smoking;
• Avoid alcohol;
• Lose some weight.

The surgery lasts approximately 2 hours, and hospital stay is about 2 days, though it may be longer if needed. Post-surgery pain can be treated with analgesics and usually doesn’t last more than 3 days.

In the first few weeks, patients should consume only liquids to help the stomach adjust. During the first year, patients can lose up to 80% of their excess weight. Cholesterol levels and blood pressure usually normalize within a few months.

The most important complications include bleeding during surgery and leakage of gastric contents due to suture failure. In rare cases, weight regain can occur after a few years if the stomach stretches again.

Cost of Gastric Sleeve:

The cost can exceed €8,000.

2. Gastric Bypass

Gastric bypass is a type of bariatric surgery designed for weight loss. It improves mobility, quality of life, and reduces obesity-related diseases such as diabetes, high blood pressure, and high cholesterol.

Pre-surgery Adjustments:

• Stop smoking;
• Avoid alcohol;
• Lose some weight.

This complex procedure, performed under general anesthesia, takes about 3 to 4 hours, followed by a hospital stay of 2 to 5 days. It is done laparoscopically, resulting in fewer scars and faster recovery compared to traditional open surgery. A small stomach pouch is created, and part of the small intestine is connected to this mini stomach through an anastomosis.

At Clínica Luso Espanhola, we prefer a bypass with a single anastomosis to minimize complications. During the first year, patients can lose up to 80% of their excess weight. Because food bypasses part of the intestine, nutrient absorption is greatly reduced. Post-surgery treatments include a general diet plan and regular exercise. In some cases, vitamin supplements may be necessary.

Cost of Gastric Bypass:

The cost can exceed €10,000.

3. Laparoscopic Gastric Plication

This technique has become very attractive to both patients and doctors for various reasons. It is a newer surgical obesity treatment that does not require cutting the digestive tract or introducing a band around the stomach.

Complications of Stomach Cutting:

• Poor healing of the anastomosis leading to fistulas;
• Bleeding caused by cutting.

In the case of bands, they can sometimes perforate the stomach, especially if they are too tight. Gastric plication uses a different principle, reducing the risks of erosion or fistulas. It is also slightly more affordable due to shorter operation times and the absence of prosthetic materials (bands).

Just like sewing a piece of clothing, the stomach is stitched, reducing its size. The sutures are placed on the gastric wall without cutting it. Even when tied, the stomach remains “closed,” and the innermost layer of the stomach, called the mucosa, is not exposed.

Weight Loss:

Weight loss with gastric plication is similar to that seen in patients who undergo vertical gastroplasty. Plication results in greater weight loss than a gastric band.

Advantages:

• No stomach cutting, reducing the risk of leaks or fistulas;
• No cutting means a reduced risk of bleeding;
• No prostheses (foreign bodies) reduce the risk of gastric perforation;
• No risk of vitamin or iron deficiencies caused by stomach removal;
• The stomach can still be monitored via endoscopy in case of illness;
• The surgery is more easily reversible than other techniques as it is not mutilating;
• No adjustments are needed, unlike with a gastric band;
• Recovery time is much shorter;
• Physical activity can be resumed sooner;
• Lower mortality rate compared to other gastric surgeries;
• If insufficient, a more aggressive surgery can still be performed later.

Disadvantages:

• Less tested procedure;
• Long-term data on maintaining weight loss is still unavailable.