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Interview with Dr Kowalski,

Why is it important to choose a specialist for bariatric surgery?

Choosing the right Bariatric Surgeon – golden rule: experience reigns supreme. The more experienced your surgeon, the greater your operation’s chance of success. When examining different bariatric surgeons, I recommend you look at the following:

- Number of years in the field of bariatrics

- Number of bariatric operations performed

- Variety of bariatric operations performed

Most data suggest that the complication rate (including mortality) is directly related to the number of bariatric operations performed by individual surgeons and the number performed at a given hospital or medical center.

Patients must make sure their bariatric surgeon has the appropriate medical credentials. He or she should be state licensed and board certified. Certification by the Board of Surgery demonstrates that a surgeon has completed training in a program accredited by the Board of Surgery. The mother of all institutions is The Society for Metabolic and Bariatric Surgery.

It’s extremely important that the hospital or medical facility where your surgery is completed is supportive of a bariatric program.

What should someone look for in a bariatric surgeon? What makes someone an expert in this field?

Once patient has decided to have bariatric surgery, change bad habits and live a healthier lifestyle, the choice of bariatric surgeon might be the most important factor for successful weight loss:

- Is the bariatric surgeon is the doctor someone that you trust?
- Will your surgeon continue to provide excellent care weight loss surgery?
- Does the Clinic offer regular support groups?
- Does the surgeon listen to your needs and understand your lifestyle?
- Your doctor should have experience with your chosen procedure.
- The resources and support staff to provide quality after-care are available.
- The surgeon should participate in groups such as the Society for Metabolic and Bariatric Surgeons - The surgeon should be board certified in general surgery.
- A fellowship trained Bariatric Surgeon has more training experience in that specific focus area

- If the surgeon performs all weight loss procedures, does he have a preference? The final criteria is based on the physical location where your surgery takes place.

The best bariatric center typically has:

- Performed a minimum number of bariatric procedures the prior year.

- Has achieved excellent quality outcomes.

- The staff has undergone extra training specific to weight loss surgery and the treatment of bariatric patients.

- They will have a Bariatric Coordinator that helps things run smoothly and this person is also often the main point of contact for patients.

Who is the best candidate for bariatric surgery?

Qualifications for bariatric surgery in most areas include: - BMI ≥ 40, or more than 100 pounds overweight.

- BMI ≥ 30-35 and at least two obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.

- Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.

What's the most important things you wish patients understood about bariatric surgery?

Patients who lose weight while getting ready for bariatric surgery: - Tend to lose more weight after surgery
- Are less likely to experience complications during surgery

The patients with pre-op weight loss in excess of 5% had a 36 minute shorter operating time on average. In other words, lower weight made it easier for the surgeons to perform the procedure. Less operating time means lower risk of complications. The gastric bypass patients and sleeve gastrectomy patients found a direct correlation between pre-op weight loss and complication rates. The more weight patients lost while preparing for gastric bypass surgery, the less likely they were to experience complications. The other big reason for preparing for weight loss surgery early is reversing poor habits. Habits take time to change, and weight loss surgery will not work over the long term if you don’t change your habits. Your weight loss surgery will not work over the long term if you do not change your habits.

- If you go back to your old ways following surgery, you will gain the weight back and you will experience a relapse in your obesity-related health problems.

- Just as a runner would never attempt a marathon without months of conditioning, a bariatric surgery patient should not go into surgery without significant preparation.

The sooner you start preparing for bariatric surgery, the more likely you will be to establish the habits required to achieve the long-term weight loss and health improvement goals you set ahead of time.

Bariatric surgery is a major event in a patient’s weight-loss journey, but the event is best seen as a new beginning. Obesity is a lifelong disease and there is no operation, diet or medication that can by itself offer a permanent cure. Surgery with good aftercare and moderate lifestyle changes can give wonderful long-term results for health and weight. In the weeks after surgery, patient will have a plan for you to follow, including instructions for nutrition and activity. This may include a liquid diet for a period of time followed by a progression to soft or pureed foods, and eventually more regular food. While you are healing in the first few months, it is extra hard to get enough fluid. Most surgeons advise a of more of fluids daily to avoid dehydration, constipation, and kidney stones. Patient will also need a lifelong habit with daily supplements, usually including: Multi-vitamins, Vitamin D, Calcium, Iron, Vitamin B12. Healthy lifestyle choices give the best results for health and Quality of Life after surgery. Protein-rich foods are important, with patients advised to take in 60-100g of protein daily, depending on their medical conditions, type of operation and activity level. We warns patients to avoid excessive carbohydrate intake, such as starchy foods (breads, pastas, crackers, refined cereals) and sweetened foods (cookies, cakes, candy, or other sweets). Limiting carbohydrates to 50 grams per day or less helps avoid rebound hunger problems which can lead to weight regain.

No surgery is without risk and so having weight loss surgery does carry risks. Very occasionally, some people die during surgery. Complications after surgery are possible. The risks vary according to your age, sex and your BMI. Also, in some people, the operation may not always be successful in helping them lose weight.


What advancements in technology have improved the success of this procedure?

Weight loss surgery is a relatively new procedure. Weight loss surgery began back in the 1950’s with open procedures that often resulted in severe complications. Advances in technology, instrumentation and research have led to the evolution of modern bariatric surgery. Today, there are many bariatric surgeons, more procedures to choose from, and most often insurance covers weight loss surgery. Many of us know someone who has had either gastric sleeve surgery, gastric bypass or Lap Band. Times have definitely changed.

One of the best newest and most advanced technology improvement that further increased our Clinical results at KCM Clinic is using the 3D endoscope from Olympus.
KCM Clinic is the only specialized weight loss Hospital in East-Central Europe that uses an 3D endoscope from Olympus during the weight loss surgery. Using the newest 3D imaging solution provides depth perception and a precise spatial view of anatomy that cannot be achieved with traditional 2D systems. The Patient benefits from a much higher accuracy and significantly quicker recovery.

What are the latest methodologies?

There are some other procedures that are being carried out to help with weight loss which are not strictly surgical operations. Such procedures include:

An intragastric balloon. A special telescope (called an endoscope) is passed through your mouth, down your oesophagus and into your stomach. This allows a special silicone balloon to be inserted into your stomach. The balloon is filled with liquid so that is fills an area of your stomach. With the balloon in place, it can make you feel full more easily and so reduces the amount of food that you are able to eat. However, this is only a short-term option, as the balloon needs to be removed after a maximum of six months. At KCM Clinic we use 6-months Orbera balloons.

Intragastric stimulation. Two electrodes are planted into the wall of your stomach, using keyhole surgery. These are joined to a special stimulator that sits under the surface of your skin. The stimulator sends out electrical impulses to the electrodes in your stomach. It is thought that this then sends messages to your brain, telling your brain that you are full and therefore reducing the amount of food that you eat.

What are the benefits of weight loss surgery?

As mentioned above, in general, weight loss surgery has been shown to be very effective at helping to achieve long-term weight loss. When compared with diet, or with treatment with tablets to help weight loss, weight loss surgery has been shown to produce greater degrees of weight loss in obese people. In fact, for people who are very obese, weight loss surgery may be the most effective treatment.The more general leaflet about obesity and overweight in adults discusses the health risks of being overweight or obese. So, it stands to reason that losing a lot of weight after surgery for weight loss may have a dramatic effect on improving your health. For example:

Type 2 diabetes may be completely reversed in many people who have had weight loss surgery, or, in others, the control of their diabetes may be greatly improved.

Studies have shown that, in seriously obese people, having weight loss surgery means they are likely to live longer. There is less risk of stroke, heart attacks, some types of cancer and liver disease not connected with alcohol.

Studies have also shown that people who have had surgery for weight loss are less likely to develop high blood pressure in the future than those having conventional treatment for their weight loss.

Some of the different types of weight loss surgery (discussed below) may enable more weight loss in the long term than others. However, these operations may be more complex and may carry more in the way of risks than some of the more straightforward ones.