Bariatric surgery

The number of people suffering from obesity and related health problems has increased considerably in Finland and Europe in the recent years. This has also resulted in a rapid development of the treatment modalities of obesity, including surgical treatment methods. The speciality in surgery dealing with obesity is called bariatric surgery.

It has been clearly demonstrated that people with obesity have an increased mortality rate (Lew EA, Garfinkel L., “Variations in mortality by weight among 750,000 men and women.” J Chronic Dis 1979; 32:563-576.) and morbidity (obesity has several co-morbidities including cardiovascular diseases, hypertension, diabetes, atherosclerosis, orthopedic and dermatological problems).

Medicinal therapy of obesity is expensive and of limited efficiency in many cases. Nevertheless, it is still recommended that the patients should try conservative weight reduction methods (e.g. weigh reduction program, physical exercise) before they opt for surgical treatment. Radical treatment is only used after all other weight reduction methods have been proven ineffective. In principle, endoscopic and surgical treatment methods are most popular for surgically dealing with obesity.

The two main elements that apply in the surgical treatment of obesity are:

Gastric restriction or reduction of gastric volume: Such methods include intragastric balloon, adjustable gastric banding, vertical gastroplasty, longitudinal gastrectomy.

In case of intestinal malabsorption operations the volume of stomach is reduced. One of the most frequently used surgical methods is called gastric bypass surgery, where both of these elements mechanism apply. There are several techniques used for bypass operations. In addition, bypass operations also induce hormonal changes that contribute to the weight reduction, e.g. reduced secretion of the hormones that are associated with the feeling of hunger (ghrelin) (Cummings et al, 2002).

Also, regression (sometimes even complete resolution) of Type II diabetes that is very often associated with obesity, is frequently seen after bariatric surgery. The underlying cause for this is not completely understood, but it is thought to be associated with hormonal changes (e.g. leptin, adiponectin, etc. – i.e. hormones that participate in the metabolism of insulin) induced by bariatric surgery (W.J. Pories et al, 2007).

In principle all bariatric surgery methods can be performed laparoscopically, but due to individual needs, open surgery (laparatomy) may be necessary in some cases.

Roux-Y bypass – food is directed to bypass the stomach – this is the most frequent bariatric operation.

Biliopancreatic diversion (BPD) – food is directed to bypass stomach and jejunum (upper part of the small intestine). This induces more pronounced malabsorption than Roux-Y method and therefore it is also used in cases of more severe forms of obesity.

Duodenal switch + BPD – food is directed to bypass stomach and jejunum + gastric resection with preservation of the pylorus. This reduces the risk of dumping syndrome and marginal ulcer, but is technically more complicated and the research on long term outcome is rather limited.

Mini Gastric Bypass (MGB) is a weight loss surgery that combines restriction and malabsorption.

Complications of bypass surgery:

Early complications include wound infection, thrombophlebitis, anastomosis leakage, marginal ulcer, and complications during the operation (bleeding, technical problems).

Late-stage complications include dumping syndrome, vitamin deficiency (most of the vitamins are absorbed in the jejunum), anaemia (vitamin B12 deficiency anaemia since food does not come into contact with intrinsic factor (IF) produced in the stomach and iron deficiency anaemia since the acidic environment of the stomach cannot convert ionised iron into an easily absorbable form any more). This can cause a life-long need for substitution therapy with multivitamins, and vitamin B12, iron and calcium preparations.

This procedure is technically simpler than bypass surgery. The volume of the stomach is reduced with the help of a special “band”. Differently from bypass surgery, the continuity of the gastrointestinal tract is not disrupted and therefore the risk of complications is also much smaller. Gastric banding causes a feeling of satiety after eating small portions of food. This method is not associated with malabsorption (decreased absorption of food from the gastrointestinal tract) problem. The diameter of the “band” can be adjusted later since it contains a balloon filled with fluid. Usually this adjustment is performed three times during the first year after the surgery.

Sleeve resection of the stomach is an operation where a large sleeve-like part of the stomach is removed. The remaining stomach resembles a tube with significantly reduced volume. Therefore, the normal route of food will not be changed, but the amount of food that can be filled into the stomach is considerably reduced.

This operation belongs in the group of so-called restrictive operations and it is suitable for patients who tend to eat large portions of food and in whom increased weight is associated with limited physical activity.

This method is not the best choice for those who tend to eat or drink too many sugary foods.

Initially this operation was mainly used as a first stage for an extensive gastric bypass operation (the second operation was performed after about 6 months), but nowadays “sleeve” resection of the stomach is frequently used as a sufficient individual method for the treatment of obesity.

We will discuss the procedure in detail with you during your consultation. The consultation includes a presentation of the surgical procedure, risk and possible complications associated with the surgery, and what to expect after surgery such as possible post-operative side effects and pain management. The consultation helps you to determine the best possible treatment that will guarantee you the best method to control your weight, based on your personal goals for surgery, and a thorough and realistic review of your expectations.

All the Bariatric surgeries (weight loss surgeries) take place in Tallinn, Estonia. The newly-renovated ward is fully equipped with high-tech treatment and diagnostics equipment. Andre Trudnikov perform all the bariatric surgeries. We offer our customers a complete package. We arrange the round-trip ticket between Helsinki and Tallinn, and transport from the ferry port to the hospital and back. The price also includes 2-3 nights at the hospital (depending on the surgery of your choice), complete care, anesthesia, surgery, medications and aftercare services performed by our co-operation partners, such as counseling and follow-up.

The surgeon will examine you, take blood tests and X-rays and also explain which surgical technique is most appropriate for you. The operation takes place shortly after your discussion with the surgeon. It is very important not to eat or drink anything (not even water, gum or mints) prior to surgery. Please follow the pre and postoperative instructions you will be given in written. The surgery is performed under general anesthesia. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Postoperatively you will be provided with effective medication for postoperative discomfort and pain. An average patients spend 2-3 nights at the hospital under observation depending on the surgery performed. During your stay in the hospital you will have daily check ups by the surgeon (everyone heals differently). Some pain, discoloration and swelling will occur initially, but most discomfort will resolve within a month.

After bariatric surgery, it is often possible to return to work within 14 days, depending on your job. You cannot exercise for 4 weeks after surgery. Please follow the postoperative eating instructions you will be given in written. You are allowed to eat only liquid food for the first 6 weeks.

Our co-operation partners offer our patients safe postoperative care, such as counseling and follow-up appointments.

As with any surgery weight loss surgery does have some risks and complications associated with it. The complications are rare, but for safety reasons, all our patients get a mobile phone number, from where you can reach us anytime.

Gastric banding: 5 800 €

Sleeve: 6 500 €

Gastric bypass surgery: 6 500 €

The price includes everything.