Weight Loss Surgery

Understand your problem

Obesity is a disease where excess body fat has accumulated to the extent that health may be adversely affected.

 

The Body Mass Index (BMI), calculated as weight (in kg) divided by the square of height (in metres), is the recommended index to define obesity.

 

Classification of BMI in Asian adults

 

Category BMI Risk of co-morbidities
Underweight <18.5 Low
Normal weight 18.5 to 22.9 Average
Pre-obese 23 to 27.4 Increased
Obese Class I 27.5 to 32.4 Moderate
Obese Class II 32.5 to 37.4 Severe
Obese Class III >37.5 Very severe

 

Patients who are morbidly obese (obese class III) have a much reduced life expectancy compared to people of normal weight.

 

Seek for Treatment

Weight Management Strategy

 

Weight reduction can be achieved by various measures such as:

 

  • Diet therapy
  • Physical activity
  • Behaviour therapy
  • Pharmacotherapy
  • Bariatric (weight loss) surgery.

 

However, conservative treatment fails in more than 95% of morbidly obese patients.

 

Bariatric surgery, as part of a multi-disciplinary approach, is the most effective method that

helps the severely obese patients to reduce weight. Patients with a Body mass index (BMI) of > 37.5 kg/m2 and BMI > 32.5 kg/m2 (for Asians) with significant obesity related co-morbidities. They have failed non-surgical treatment (such as diet, exercise and drug treatment), are fit for surgery and agree to lifelong follow up and lifestyle changes.

 

The various surgical options can be classified into the following categories: restrictive procedures, malabsorptive procedures and combined restrictive/malabsorptive procedures. Restrictive procedures limit the patient’s ability to take in food whereas malabsorptive procedures interrupt the digestive process.

 

Weight loss surgery is performed under general anaesthesia. They include adjustable gastric banding, sleeve gastrectomy and roux-en-Y gastric bypass.

Adjustable gastric banding (AGB)
  • The most frequently performed restrictive operation.
  • A collar of silicone containing an inflatable bladder is placed around the upper stomach.
  • Inflation is carried out by introducing saline via a special needle into a subcutaneous reservoir (port). It induces an early satiety and thereby decreases food intake.
  • It also slows the passage of food from the upper pouch to the lower part of the stomach.
  • Patients who undergo adjustable gastric banding can lose 50-60% of their excess body weight.

 

Sleeve gastrectomy
  • The stomach is reduced to about 15% of its original size.
  • It is a purely restrictive operation and it eliminates the need of having to insert a foreign body.
  • However, this procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. It is also not reversible.

 

Gastric bypass
  • It is a combined restrictive-malabsorptive procedure.
  • The operation includes forming a small stomach pouch and a small bowel bypass.
  • It has excellent and durable results with low morbidity and mortality rates.

 

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