Bariatric surgery is an effective, if not the best, treatment for very severe and morbid obesity. It allows you to lose up to 50 kg in one year and up to 40% of the initial weight in the long term. It immediately and significantly reduces associated pathologies such as diabetes, hypertension, or cardiovascular risks. Finally, it improves the quality of life by increasing the possibilities of physical activity, social relations, self-esteem, and sexuality.

The waiting period for bariatric surgery can be up to 4 years. During this time, you could benefit from a healthy weight management program.

Use this time to plan for the life changes you will need to make and to think about the implications of the surgery in your daily life.

A demanding path…

But beware! The surgical approach alone is not sufficient to guarantee and preserve long-term weight loss. It will only be effective if it is accompanied by preparation and, above all, serious follow-up. It will be necessary to return to the fundamentals of a healthy lifestyle: regular and appropriate physical activity, stabilization of eating habits and psychological support in order to maintain morale and avoid the return of the initial toxic behaviors.

Steps related to bariatric surgery

Step 1: Join the waiting list

Step 2: Nursing appointment

Step 3: Appointment with the surgeon

Step 4: Preoperative assessment

Step 5: Bariatric surgery

Step 6: Post-surgery follow-ups

Step 7: Nutrition follow-ups

Step 8: Nursing and medical follow-ups

… and full of pitfalls!

Any surgery has its share of risks. The risks associated with a bariatric procedure depend on its nature and that of the patient — weight, age, medical history, and related problems, such as coronary artery disease, diabetes or taking certain medications. In any case, the surgical team is responsible for informing the patient about all these risks.

Thus, difficulties can arise on a daily basis, and several months after the operation. For example:

  • Postoperative complications such as slipping of a gastric band or leaking stomach or intestinal suture requiring further intervention
  • Nutritional deficiencies which must be compensated by a better variety and/or supplements of vitamins, minerals, and trace elements

A modified body envelope that may require plastic surgery interventions as well as an adjustment of self-perception and relationship to others

A "Thinker"

Finally, we must not hide the fact that the risk of mortality associated with bariatric surgery, although very low, is not zero. Estimated at about 1% of cases, it is half as high as that of coronary bypasses, but twice as high as for the removal of the gallbladder. In short, it’s a “Think about it”.

Success Factors

The good news is that success often follows. Thus, it is important to note the “Success Factors” observed in people who lose a lot of weight and enjoy better health following bariatric surgery:

  1. Education
    They learned about the risks, requirements and benefits specific to each type of intervention.
  2. Support
    They surround themselves with a network of people eager to see them succeed.
  3. Attendance
    They begin as early as possible, before surgery, to adopt new habits with regard to diet and exercise.
  4. Healing
    They give their body time to recover by following the plan prepared by the team of health professionals.
  5. Nutrition
    They are completely rethinking the way they eat and drink, favoring small portions and healthy foods.
  6. Exercise
    They couldn’t achieve their goals without exercise.
  7. Listen
    They listen to their body and are on the lookout for the signals it sends them.
  8. Tracking
    They meet their team of health professionals and thus benefit from adequate follow-up.

1 Source: Chirurgie de l’obésité: Ce qu’il faut savoir avant de se décider, Haute autorité de santé, France, 2009 (PDF, 480 Ko). FRENCH ONLY

2 Source: Chirurgie bariatrique – Comment choisir la procédure la mieux adaptée à vos besoins (PDF, 10,4 Mo), Ethicon Endo-Surgery, recommandé sur le site du Centre de chirurgie bariatrique de Montréal.  FRENCH ONLY

Bariatric surgery is a heavy intervention technique and a last resort that is only offered to people who meet three criteria:

  • Suffer from either morbid obesity (BMI greater than 40 kg/m2) or severe obesity (BMI greater than 35 kg/m2) associated with complications justifying surgery.
  • Have tried to lose weight by conventional methods without this improving their condition in a satisfactory way.
  • Be in a state of health that allows surgery and, in particular, general anesthesia to be tolerated.

Your doctor can help you deal with the excess weight. Consult your doctor to see what options are available to you.

To consult a surgeon, you can register on the waiting list at: www.chirurgiebariatrique.com/fr/questionnaire

Patients operated on thanks to the logistical and financial support put in place by the Ronald-Denis Foundation must go through or have already gone through the preparatory phase in effect at the Bariatric Surgery Center (BSC) of the Hôpital du Sacré-Coeur de Montréal. The whole process can take a few months. You have to be motivated… and patient.

A complete assessment and appropriate treatments

The objective of the preparatory phase is to carry out a complete assessment of the state of obesity and, if necessary, to set up the environment and the conditions necessary for the success of the operation. This requires real commitment from patients. They are therefore taken care of by a multidisciplinary team of health professionals: surgeon, of course, but also doctor, nutritionist, psychiatrist or psychologist, anesthesiologist, etc. This care is necessary so that patients are well prepared and informed about all aspects of the operation.

Medical examinations (blood tests, endoscopies, X-rays, cardiac and respiratory function tests, oral evaluation, even pregnancy test in women) make it possible to detect and treat any nutritional or vitamin deficiencies as well as any pathology associated with obesity (diabetes, hypertension, cholesterol, heart problems, sleep apnea, respiratory problems, etc.).

Nutrition, exercise, and psychotherapy

Several nutritional consultations aim to assess physical activity and eating habits to improve, if necessary, the patient’s lifestyle before the operation. A diet protocol aimed at weight loss (5 to 10%) and reduction in the size of the liver is implemented in order to limit the risk of complications related to surgery. We also take the opportunity to identify a physical activity compatible with the patient’s state of health, desires, rhythm of life and physical possibilities. Finally, if necessary, the psychological assessment leads to psychotherapeutic treatment.

At the end of this process, together with meetings with patients who have already undergone the operation and the mobilization of adequate resources at the community and social level, we come to the critical point – decision-making.

Decision making

Only the multidisciplinary medical and professional team can initiate the surgical process. At the end of the pre-operative phase, this team makes one of these three decisions:

1.      Surgery is not an option for reasons that are explained to the patient. In this case, the team offers another non-surgical mode of weight management.

2.      Surgery is possible, but patient preparation is insufficient. In this case, the patient must engage in a new preparatory period at the end of which the case will be reassessed.

3.      Surgery is possible and the patient is deemed physically and mentally ready to undergo it. In this case, it is clearly explained to the patient the type of intervention that has been identified as the best for him and he is informed of the risks and side effects associated with it.

At this time, it is up to the patient and him alone to make the final decision. The date of the intervention is then determined according to the availability of the facilities and the surgical team.

1 Source consultée pour la phase préparatoire: Chirurgie de l’obésité: Ce qu’il faut savoir avant de se décider, Haute autorité de santé, France, 2009 (PDF, 480 Ko).

Bariatric surgery brings together a set of techniques aimed at mechanically reducing energy intake by modifying the anatomy of the digestive system. It makes it possible to obtain a weight reduction of up to 40% of the initial weight and its effectiveness is almost constant. This weight reduction significantly reduces mortality and cardiovascular risks, reduces arterial hypertension, improves lipid balance and glycaemia, allows the cure of pre-existing diabetes in more than three-quarters of cases, and even prevents the onset of type II diabetes.

Bariatric techniques are based on two principles: reducing the amount of food consumed (principle of restriction) and reducing the assimilation of food by the body (principle of malabsorption). The surgeons collaborating with the Ronald-Denis Foundation mainly perform four types of intervention:

Vertical Gastrectomy

Vertical gastrectomy is a restrictive operation. It is easily done by laparoscopy and with very little risk. It involves removing the outer part of the stomach leaving a thin vertical gastric tube that can only hold a small portion of food. In addition, by removing the fundus, also called the large gastric tuberosity, we are removing a source of secretion of hormones controlling hunger.

Adjustable Gastric Band

It is an adjustable gastric band that is placed around the stomach laparoscopically and which decreases the capacity of the stomach. As the stomach accepts less food, less food is consumed, and the body draws on its own fat reserves in order to obtain the energy it needs. This technique carries a low risk of postoperative complications.

Gastric Bypass

It is a major bariatric operation of the mixed type: the volume of the stomach is reduced, and a bypass is added to the small intestine in order to transport food further into the digestive tract. This malabsorption of food leads to a decrease in the amount of nutrients absorbed as well as weight loss.

Bilio-pancreatic Diversion

Initially, the 50 to 60% stomach resection aims to reduce acidity and not to prevent people from eating, which does not make it a restrictive surgery strictly speaking.

Subsequently, the operation consists of performing a diversion of secretions from the bile and the pancreas to cause malabsorption. The success rate reaches 85%.

Download the document  Chirurgie bariatrique – Comment choisir la procédure la mieux adaptée à vos besoins (PDF, 10.4 Mo), by Ethicon Endo-Surgery, recommended on the website Centre de chirurgie bariatrique de Montréal.

Once back home, the patient receives the medical and professional follow-up required by his operation. This is to ensure that his evolution is going well, that there are no severe complications and to ensure that he does not find himself in a situation of relapse.

Surgical follow-up

One or more appointments with the surgeon are thus planned in the months following the intervention and basic examinations, such as blood tests, are carried out in order to follow the evolution of his state of health. If everything is normal after four to six months, the follow-up is entrusted to the nurse who will follow up by telephone three times a year, initially, then twice and finally, only once a year thereafter.

Of course, the patient can contact the bariatric team at any time (see below). If complications arise, he will be immediately taken care of again and directed to the appropriate resources.

Nutrition monitoring

The patient must follow a special diet, called “postoperative”, during the first five weeks following his operation. He is then prescribed a so-called “normal” but precise diet, which he must follow assiduously and for as long as necessary – even throughout his life.

•       The capacity of the stomach having diminished, it is necessary to reduce the quantity of food for each meal while making them more regular and complementing them with vitamin supplements if necessary.

•       Food quality and variety, as recommended by Canada’s Food Guide, are essential. Of course, the professional team guides the patient by providing the necessary advice and documentation.

Each case being unique, it is important that the patient listens to his body and adapts his diet to what suits him best

Psychological Follow-Up

When bariatric surgery fails, it is often because of insufficient consideration of psychological factors before the operation and, subsequently, of a deficient quality of psychological follow-up. The operation must indeed be the starting point for a redefining of oneself. It is by succeeding in controlling his impulses and by thinking healthily about strategies to eat less that the patient becomes the main actor of his healing and not a passive spectator, fragile and threatened by failure.

Thus, the psychological and psychiatric evaluation which is recommended before the operation must be extended by a postoperative follow-up. This is particularly important when eating disorders or psychiatric illnesses have been identified before the operation. Otherwise, this type of follow-up will be offered on a case-by-case basis.

In the case of a systematic and quality follow-up, the psychiatrist who carried out the preoperative evaluation will see the patient two to four times during the first year, then will carry out two follow-up visits during the second year. It is a question of providing the patient with the necessary listening and help to face the possible psychological difficulties that he could feel due to the surgery, its side effects and the changes in perception and behavior that accompany it.

Follow-Up Clinic

People who have undergone bariatric surgery supported by the Ronald-Denis Foundation have access to follow-up clinics at the Hôpital du Sacré-Coeur de Montréal. They can meet with one of the surgeons from the Bariatric Surgery Center to receive postoperative information and support.

TO GO FURTHER