Bariatric surgery: surgeon tells experience in book – 07/19/2022 – Equilíbrio e Saúde

Considered a kind of last resort in the fight against obesity, bariatric surgery, even today, is surrounded by myths and stigmas. In his book “Histórias de Peso: A Obesidade como Ela É”, surgeon Felipe Koleski dissects the issue and lays bare the surgical modality, through the stories of patients and his own – he underwent the procedure in 2018.

Cut-and-paste in the gut, which changes the path of food and creates barriers to curb overeating, in addition to messing with hormones and satiety, usually brings good results, especially when associated with changes in eating habits. Repeatedly Koleski emphasizes the importance of monitoring the patient by other professionals, such as a psychologist and nutritionist.

Despite the optimistic bias commonly associated with surgery, there is a not negligible probability of obesity relapse. According to recent studies, this total can exceed 25% and reach more than 60%, depending on the criteria adopted, such as time elapsed until reassessment and the amount of weight regained.

Not to mention the possibility of complications, even lethal, associated with any surgical procedure: thrombosis (when a clot forms and blocks blood flow to some part of the body), allergic reaction, bleeding and infections.

Koleski includes in the book the sad case of a 40-year-old patient who lost her life after bariatric surgery. She had intra-abdominal bleeding, which generated a serious infection. The surgeon says that the most serious complications are usually fistulas, openings between the gastrointestinal tract and the inside of the abdomen, for example caused by the opening of staples that hold the stomach to the intestine.

The patient underwent further surgery, but the fistula was not found. She underwent a series of dialysis processes (filtration of blood by a machine that plays the role of the kidneys), but she could not resist and died. “It was on a Friday night. I still remember her family members, husband and brother, waiting for me at the door of the ICU to know the clinical picture”, she writes.

“Even an episode like this is within the statistics, the pain of a surgeon is immense. The doctor is a human being and suffers like any other”, he says.

According to him, the risk of death today is between 0.2% and 0.3%, that is, 2 to 3 per 1,000. It’s a relatively low risk, but far from zero. Hence the importance of a good indication for surgery — when the potential benefits outweigh the risks.

In any case, the opportunity to have a healthier life, with a decrease or disappearance of problems such as high blood pressure, diabetes, liver fat, sleep apnea, among others, is often a more than sufficient argument for this important choice, in addition to the positive psychological impact and social trust that come with bodily changes.

One of Koleski’s patients became intimately related to other people; another no longer suffered from her husband’s excessive control of her life.

But the story is not always so simple. One patient refused to lose weight because at age 12 she began to be abused by an uncle who was a majority partner in the family business. Afraid of harming her relatives, she subjected herself to abuse. Compulsive eating and gaining weight were the strategy to try to discourage the uncle’s advances. Koleski says cases like this aren’t that rare.

“It is a situation that requires tact and responsibility on the part of the multidisciplinary team, because, although it has a direct relationship with the success or failure of the treatment in the future, it is always the patient’s decision to reveal [esse histórico] or not. After a while of therapy, the patient felt confident and decided to operate.”

The surgeon also reports on what bariatric surgeries were like in the past — they could last up to six hours — with configurations that have now fallen into disuse, such as Scopinaro, with a shorter path of food in the intestine, which resulted in many visits. toilet and smelly stools because of incomplete digestion. Fortunately this has improved with more modern techniques.

The most thought-provoking part of the book, however, is Koleski’s own bariatric saga. He reports all the stages he went through: the desire to operate, when he still did not meet the recommended criteria, the moment of decision, when he already suffered a set of conditions (high cholesterol and blood glucose, reflux, fatty liver, snoring, etc. .), the attempt at discouragement on the part of other people (“It’s just a diet that will do.”) and the H hour, when it went to the table.

Then comes the whole phase of readaptation of the organism to the new diet, perhaps for many one of the biggest challenges. During the pandemic, the doctor sometimes reports having opened the fridge even without hunger. Then he reinforces the mantra: “What’s this for? I’m not hungry”.

“In no way do I want to make an apology for the miraculous cure for obesity. I emphasize that surgery is a stage, perhaps the most difficult and certainly the last resort of continuous treatment against a serious and incurable disease. […] I should stick with the habit changes as they will keep my weight off. The most important thing is not having a weight goal, a number to measure, but how much we gain in quality of life. And for me is the lesson of what it’s like to be on the other side, […] I understand my patients’ doubts, fears and anxieties better”, Koleski writes about his own experience.