More and more obese patients on the operating table. Doctors: Sometimes it’s the only way out

About morbid obesity, i.e. morbid obesity is said to be when a patient’s BMI (body mass index) exceeds 40 units. With a slightly lower BMI, above 35, the patient struggles with second-degree obesity. Obesity is diagnosed when BMI exceeds 30 kg/m2. The World Health Organization (WHO) has no doubt that obesity has become a disease, and to prove this, it is listed in the International Classification of Diseases (ICD-10) under the number E66.

The experts emphasize that Obesity is a chronic disease that does not go away on its own. Especially the giant version can have very serious consequences such as asthma, hypoxia, hypertension, coronary heart disease, venous thrombosis or obstructive sleep apnea.. Not to mention mental disorders and often exclusion from public life.

Who Can Get Bariatric Surgery?

In Poland, they noticed the problem of morbid obesity. In 2021, the KOS-BAR pilot program was launched. It includes 4,000 patients who are taken to the operating table.

“The pilot project is intended for patients over 18 years of age with a diagnosis of ICD-10: E66.0. This name hides obesity caused by excessive energy supply. Patients admitted to the program undergo surgical treatmentexplains Andrzej Troszyński, representative of the National Health Fund.

The KOS-BAR program is only available to adult patients with a BMI greater than 40 kg/m2 or 30 kg/m2, for whom surgery can help manage type 2 diabetes, high blood pressure, cardiovascular disease, sleep apnea, joint disease requiring surgical treatment, non-alcoholic steatohepatitis, hyperlipidemia and female infertility, including polycystic ovary syndrome.

Admission to the procedure occurs after assessing the patient’s health status, conducting diagnostic studies and consulting specialists. The patient does not immediately lie down on the operating table. Before this happens, he must go through a series of meetings with specialists: a surgeon, an internist or diabetologist, an anesthesiologist, a nutritionist, a psychologist, an endocrinologist, a medical physiotherapist.

The task of the bariatric team is to prepare the patient for the procedure – clinically and psychologically, and this process usually takes 3 to 6 months. Then carried out bariatric surgery. A few days later, the patient returns home with an individual therapeutic rehabilitation plan to prevent complications, improve physical performance and reduce body weight. The patient’s condition is monitored for a year after the procedure.

Where are bariatric operations carried out under the KOS-BAR program?

At the beginning of the pilot project, the Ministry of Health selected 14 medical organizations for its implementation, but due to high demand, the list was expanded by another five centers. carried out in them bariatric procedures are performed under a contract with the National Health Fund, which means that they are paid by the patient.

Within the framework of KOS-BAR, treatment takes place in such institutions as:

• Independent Public Health Center University Hospital in Krakow,

• University Clinical Hospital in Bialystok,

• Independent Public Health Center in Hajnowka,

• University Clinical Center in Gdansk,

• Limited Liability Company Szpitale Pomorskie in Gdynia,

• Municipal United Hospital in Olsztyn,

• Independent Public Health Center in Lenchn,

• Limited Liability Company Chernyakovsky Hospital,

• Independent State Clinical Hospital. prof. Witold Orlowski Center for Postgraduate Medical Education in Warsaw,

• Military Medical Institute in Warsaw,

• SP ZOH University Clinical Hospital No. 1 named after. N. Barlitsky in Lodz,

• Specialized Medical Center. st. John Paul II Spółka Akcyjna,

• Regional Health Center Sp. z oo in Lubin,

• Provincial Integrated Hospital. L. Rydyger in Torun,

• Regional Specialized Hospital. doctor Vladislav Begansky in Grudziadz,

• University Hospital No. 2 Dr. Jan Biziel in Bydgoszcz,

• General Hospital in Jaworzno,

• Regional Specialized Hospital. Janusz Korczak in Słupsk

• Autonomous State Clinical Hospital No. 1 named after prof. Tadeusz Sokolowski from the Pomeranian Medical University in Szczecin.

Various bariatric methods – sleeve gastrectomy and gastric bypass

Bariatric procedures are also carried out in other institutions that did not join the pilot. Just like the Independent Public Provincial United Hospital in Szczecin. Surgical treatment of obesity is carried out there according to the standard technique and is funded by the National Health Fund. Since the beginning of the year, the institution has already performed 139 bariatric surgeries (and only five months have passed). In total, 160 of them were completed last year, so there is a significant upward trend. Among the operations, sleeve gastrectomy prevailed – 117 patients out of 139 were operated on using this method. In the remaining patients (22), gastric bypass was performed. The procedures differ from each other, although they give a similar effect when it comes to weight loss.

Sleeve gastrectomy is a restrictive operation., involving the removal of part of the stomach and, as a result, leading to its reduction. As a result, the patient feels full after eating less food. Whereas gastric bypass – a more complex procedure that has a greater effect on metabolism, therefore it is recommended for patients with type 2 diabetes, hypertension or dyslipidemia. Food is sent directly to the small intestine, bypassing the duodenum and approximately 150 cm of the jejunum, which shortens the effective time for digestion and absorption. As a result, the patient loses weight.

“The type of operation is always selected individually for the patient, taking into account, among other things, the initial body weight, the presence of concomitant diseases, the patient’s lifestyle – said the surgeon – bariatric medicine. Bartosz Kowalewski, during the “Day of Bariatrics”, organized by the Szczecin Hospital,

Is bariatric surgery safe?

Many patients are afraid of bariatric surgery.

We hear from our patients that they are afraid of the operation itself, but I want to emphasize that bariatric surgery is safe, comparable to the risk of the most commonly performed procedure in the world, i.e. cholecystectomy. The hospitalization time after the operation is 3-4 days, and our patients can move independently along the hospital corridors even a few hours after the operation.– explained Dr. Bartosz Kowalewski, a bariatric surgeon.

On the initiative of the bariatric surgeons of the Regional Hospital in Szczecin, a patient support group has been created on Facebook, where you can share your experiences and concerns. There are a lot of stories with happy endings. Among them is the story of Mrs. Eva, who two years ago weighed 118 kg, and thanks to the procedure she lost 46 kg and can climb to the fourth floor without out of breath. Not only did her appearance improve, but most of all her health improved. Just like Mr. Mateusz, who underwent bariatric surgery 6 years ago, as a result of which he lost 50 kg. He emphasizes that the effect of the treatment is permanent, and its results are better. And he has no problem with what used to be a problem for him, like putting on shoes.

The new trend is also visible at the facility in Szczecin. More and more people are getting abdominoplasty. i.e. a tummy tuck.

Bariatric surgery in children

The problem of morbid obesity is increasingly affecting children. Some have indications for bariatric surgery. In our country, few centers perform them in children, and if they do, then by the method of sleeve gastrectomy. Doctors of the Upper Silesian Children’s Health Center in Katowice have been carrying out such operations since 2016 under an agreement with the National Health Fund. The qualification rules are the same as for adults – a BMI greater than 40 or 35 units (if the patient has diseases caused by obesity). In addition, a small patient, regardless of the opinion of the guardians, must give conscious consent to the operation.

In Katowice, the first step towards the procedure is a consultation at the GCZD Childhood and Adolescent Obesity Clinic. You need a referral from your family doctor or pediatrician. So far, 40 children have undergone bariatric surgery at the hospital in Katowice, and many more are waiting for their turn. In February of this year, the doctors of the GKZD for the first time applied the gastric bypass method in a pediatric patient – in a patient who in 2018 at the age of 13 years old underwent a gastric bypass operation using the sleeve resection method for the first time. Before the procedure, the girl weighed 135 kg. She lost 40 kg, but returned to bad eating habits and neglected the results of the control. Why did you decide to have a second operation?

“The effect of the previous operation was preserved. Before the first operation, the patient had arterial hypertension and diabetes mellitus. And these diseases went away without cardio or diabetic drugs. This is the undoubted success of that operation, despite the returned kilograms.explains Dr. Dominika Krakowczyk. In making the decision to undergo gastric bypass, the bariatric team stepped up dietary and psychological support. Several months have passed since the operation, the patient is losing weight and her results are improving.

Experts emphasize that bariatric surgery is not a shortcut. Sometimes this is a necessity. According to prof. Tomasz Koszucki, head of the Department of Surgery and Urology of the SCCH, if the patient’s BMI exceeds 40 kg/m2, the best treatment is surgery, of course, combined with a change in the psyche and lifestyle modification.