The Karen Hospital

Won’t lose, Can’t lose

Are you aware that there are people who are obese and cannot lose excess weight? This could be due to health conditions such as diabetes, arthritis and heart disease. One is termed as obese when their body mass index (BMI) is above 30. Body mass index is a measure of fats in the body against the weight and height of the individual. It is usually calculated using the formula weight (Kgs.)/height (m ² ) .A BMI of 18-25 is considered healthy.

There is hope though, in form of bariatric surgical procedures. These are surgical interventions used in the management of morbid obesity. Morbid obesity is characterized by an extremely high body mass index of over 40. It is often accompanied by conditions such as diabetes and heart disease.

There are two types of bariatric surgeries; restrictive and malabsorbtive procedures. Restrictive operations involve reducing the stomach capacity; this will result in satiety after minimal food intake. They include laparoscopic sleeve gastrectomy, gastric band and balloon procedures.

Malabsorbtive procedures interfere with the nutrients absorption capacity. This means that the amount of nutrients absorbed in the body is greatly reduced to only what the body needs. They include gastric bypass and duodenal switch.

Dr. Joshua Mwangi, a gastrointestinal surgeon, recently performed a laparoscopic sleeve gastrectomy (L.S.G) at The Karen Hospital. The intricate procedure is a restrictive surgical operation and involves removal of part of the stomach. Its main objective is to help patients lose excess weight.

 As the name suggests, it is a laparoscopy procedure. This means that it is carried out through insertion of narrow, lighted tubes into the abdomen through keyhole incisions. A video camera is inserted in one keyhole just above the navel. This will allow the surgeon to see what he’s doing since it is not an intrusive open surgery. Carbon dioxide gas is then pumped into the abdominal cavity. This is to lift the stomach and separate it from other internal organs such as the small intestines. Next, a tube is inserted though the mouth down to the stomach to help in mapping out how much of the stomach should be removed. Two other keyholes give access to surgical instruments that will help with the cutting and simultaneous stapling of the stomach walls.

According to Dr. Mwangi, the advantages of having the procedure done are numerous. It will definitely reduce complications such as diabetes. It is a cheaper procedure since patients spend very little time in hospital post operation. There is very little bleeding hence there will be no transfusions necessary. There will be very little scarring. It is also easier for the surgeon to carry out as compared to other intrusive methods.

Good news is one can notice the difference around two weeks after the procedure. It is expected that 50% of the excess weight will be lost within one year and one can be of a healthy weight within two years.

It is important to note that the decision to operate requires a multidisciplinary assessment. A panel comprising of a surgeon, a nutritionist, a psychologist, an anesthesiologist and a physician will evaluate the patient before a decision is reached on whether operation is the solution or not. Each one of them has an important role. The nutritionist tries to find out if the excess weight can be shed through diet management or exercises before opting for surgery. The physician ensures that the patient is not suffering from a thyroid condition any other illness that would result in complications during and after the surgery. He or she also ensures that the patient is not taking any form of medication whose side effects include weight gain. The anesthesiologist checks to see that the patient will be able to handle the anesthesia administered during the procedure and the psychologist ensures that the patient is of sound mind and is ready for the changes that come with having the procedure done.

How much does it cost? According to Dr. Mwangi, there are a number of factors that will determine how much it will cost. “Choice of equipment to be used, the size of the surgical team and the hospital where the surgery will take place are the main determinant of the operation cost,” he said.

Post operation care is very important if the objectives of the procedure are to be achieved. The patient is always advised to follow a soft diet as the wounds heal. Vitamin supplements are prescribed to ensure that the patient does not lack any nutrients as a result of the procedure. The patient will be evaluated to ensure that they are adapting well to the changes in their body. Most importantly their weight and any other medical condition such as diabetes is closely monitored.

Dr. Mwangi winds up by saying,” Our main concern is usually the excess weight, beauty is miscellaneous.” The tremendous weight loss will come with another less risky problem; excess skin. Not to worry though, one will be referred to a cosmetic surgeon for the much needed nips and tacks.