Bariatric surgery is a technically challenging surgical approach, which demands comprehensive knowledge in abdominal surgery, proficiency in laparoscopic techniques and understanding of obesity causes and mechanisms. Technical equipment of the healthcare institution and coordinated work of specialists` team are important, as well. All these measures provide effective weight loss with prolonged and stable result.
Bariatric Surgery centre of the Hospital Sachsenhausen - Academic Hospital of the University of Frankfurt am Main is specially ranked among worldwide known bariatric centers. Professor, MD Plamen Staikov, Head of the centre, has completely devoted his practical experience and scientific research to the bariatric surgery. Today professor performs more than 650 specialized interventions per year and provides educational courses for practicing surgeons.
Booking Health offers the following obesity treatment programs:
- Obesity diagnosis and consultation
- Endoluminal bariatric surgery with POST
- Laparoscopic or open biliopancreatic bypass surgery for weight loss
- Laparoscopic or open gastric bypass surgery for weight loss
- Laparoscopic or open stomach band for weight loss
- Laparoscopic or open surgery sleeve gastroplasty for weight loss
- Setting of the gastric balloon for weight loss
Is obesity an aesthetic or health problem?
In the modern society image of a successful person is tightly connected with physical health and impressive appearance. Slender and harmonious figure makes both men and women feel more attractive and self-confident. The same time, the problem of excessive body mass draws close attention of the World Health Organization during last 30-40 years.
According to the results of a number of clinical trials, excessive body mass or obesity are linked with certain health problems, namely:
- Higher risk of cardiovascular diseases, particularly this concerns myocardial infarction and stroke
- Extremely high risk of developing diabetes mellitus type 2 and all severe complications of the disease
- Pathology of the musculoskeletal system, particularly this concerns degenerative joint diseases
- Oncological disorders, namely, breast cancer, prostate cancer, cancer of liver and colon
- Deterioration of general well-being – fatigue, memory impairment, lower intellectual activity
In the global scope, number of people with obesity has almost doubled during last 40 years. According to the up-to-date World Health Organization data, more than 50% of people in the European region have excessive body mass and more than 20% are diagnosed with obesity.
Main causes, underlying this threatening situation, are the following:
- Giving preference to high-energy foods – sweets, bakery, and “snacks”. These products tempt people with attractive taste and possibility to have a bite during the working day.
- Lower physical activity due to extremely widespread now work at the computer, using public transport rather than walking or riding bicycle, and avoiding active rest options.
- Presence of concomitant diseases and metabolic disorders, like disorders of the thyroid gland and adrenal glands, constant intake of certain drugs for the treatment of autoimmune diseases, and chronic problems with cardiovascular system.
High prevalence rate of obesity in the world`s scope, including obesity in children and adolescents, promotes thorough scientific research of this problem and development of the most favorable solutions.
Particularly, bariatric surgery, or “obesity surgery” is the most effective treatment technique for patients with morbid obesity, especially in zero result in all other treatment options administration.
When should I consider bariatric surgery?
First of all, we should clearly understand the difference between bariatric surgery and usual plastic surgery, which is pointed at removing excessive adipose tissue. Plastic surgery influences only the external aspect of the problem and doesn`t affect its causes. Unfortunately, excessive body mass often returns back after performing liposuction or abdominoplasty (techniques of the direct body correction) bringing to nought effectiveness of the intervention.
Bariatric surgery modifies the main pathological mechanism of the obesity – redundant intake of nutrients, especially high-energy ones. In this case body mass reduction is more natural and smooth, doesn`t cause any health problems and remains stable over the time.
Indications for bariatric intervention performing include the following:
- Body mass index (BMI, it determines the ratio of weight to height) over 40 kg/m2
- BMI from 35 to 40 kg/m2 in presence of the complications of obesity – persistent arterial hypertension, diabetes mellitus type 2, osteoarthritis and other pathology of joints, ischemic heart disease or myocardial infarction, sleep apnea
- BMI from 30 to 35 kg/m2 in presence of decompensated diabetes mellitus type 2 with multiple complications
- Presence of excessive weight during 5 years and more in combination with absence of significant beneficial results from conservative treatment during 6 months and more
- Willingness of the patient to fulfill all the recommendations of the treating physician and maintain a healthy lifestyle in the future
The surgeon chooses the most appropriate kind of bariatric intervention for each patient in terms of the individual clinical situation – body mass, age and gender, presence of concomitant disorders.
There are several basic types of bariatric interventions depending on surgical technique and principle of further body mass lowering:
- Restrictive method. Surgical interventions from this group substantially decrease the volume of stomach and thus the volume of food one can eat per meal. In addition, feeling of satiety arises earlier after the meal and lasts longer. Surgeries from this group include sleeve gastrectomy or sleeve resection, intragastric balloon technique and gastric banding.
- Malabsorptive method reduces uptake of food without changes in the diet. Main mechanisms of such changes include deterioration of food digestion and lower absorption of digested food. Biliopancreatic diversion is an example of intervention from this group.
- Complex surgical techniques possess benefits of both methods – lower volume of food and less intensive intestinal absorption of nutrients. Gastric bypass is the most effective complex surgical technique.
Bariatric surgeon should have practical experience in performing all types of operations, including laparoscopic ones. Technical equipment of the healthcare institution is of the same importance. This allows performing the most beneficial for the patient intervention, without any technical or professional restrictions.
Contribution of professor Staikov to the development of bariatric surgery conception
Professor, MD Plamen Staikov is now the Executive medical director of the Sachsenhausen Clinic in Frankfurt am Main, Germany, and Head of the Department of Surgery, Endocrine Surgery, Bariatric Surgery. Since 1995 the Sachsenhausen Clinic has received a reputation of leading bariatric clinic in the Europe. It is quite natural that professor Staikov is also a head of the Obesity centre, which is a specialized part of the Sachsenhausen Clinic.
Speaking of earlier experience, after graduating from the Otto von Guericke University in Magdeburg, Germany, in 1994 professor Staikov has devoted his entire career to the field of surgery. The doctor began his work at the Surgical Department of Pirogov Hospital in Sofia, where he gained priceless practical experience and the ability to make the most beneficial for the patient decisions quickly. After that professor Staikov shifted to the field of abdominal and oncologic surgery, in particular, using laparoscopic techniques. The doctor held a post of the Head of the Metabolic surgery center and simultaneously worked as a practical abdominal surgeon, introducing the latest technologies into practice.
In subsequent years bariatric surgery became the main specialization of professor Staikov. In 2005 he defended M.D. thesis “Gastric-banding as a surgical procedure for the gastroesophageal reflux in the treatment of morbid obesity". In addition to practical work, professor continues performing trainings for students and fellow surgeons.
Moving to Germany and employment in the Sachsenhausen Clinic in Frankfurt am Main with excellent technical base allowed professor Staikov to practice more complex bariatric interventions. Currently professor performs more than 650 bariatric interventions a year, having excellent effectiveness of treatment and minimum complications rates. Taking into consideration importance of esthetic aspects, professor gives preference to less traumatic minimally invasive interventions. The total number of laparoscopic surgeries performed by him reaches 9,000. In addition, professor Staikov is competent in work with da Vinci Surgical System, which is a robotic surgical system for more precise laparoscopic interventions.
As the outstanding abdominal surgeon with special competence in the field of bariatric surgery, professor Staikov aims to achieve a long-term positive result for each patient and appreciates an integrated approach to treatment. Combination of surgical treatment with conservative methods, working with a psychologist and communicating with other patients in self-help groups is the distinctive feature of the Sachsenhausen Clinic.
Long-term experience and recognition of the clinic`s competence in the global scape allow the Obesity centre of the Sachsenhausen Clinic to provide medical help not only to German citizens, but to international patients, as well. The clinic often admits patients from Europe, USA, Russia, etc.
Technical equipment of the clinic and practical experience of doctors make it possible to treat patients with the most complicated cases of morbid obesity. Actually, the Sachsenhausen Clinic in Frankfurt am Main offers all types of bariatric surgeries with the highest level of each intervention.
Which type of bariatric surgery is the best exactly for me?
In each case type of the surgery is chosen individually, based on the results of obligatory preoperative examination:
- Physical examination, blood pressure measurement
- Advanced laboratory testing
- Consultation of the surgeon
- Consultation of the anesthesiologist
Professor Staikov carefully investigates the results of laboratory and instrumental examinations and discusses possible personal treatment options with the patient. The patient's preferences are always considered when choosing a surgical technique.
The most effective types of bariatric surgeries, each of which is excellently performed by the professor, are listed below.
- Intragastric balloon technique is one of the least invasive techniques that does not require surgical intervention and is performed during simple gastroscopy. This operation is suitable for patients with a slight increase in body mass (BMI from 28 to 35 kg/m2) and for patients who intend to lose 15-20 kg prior to further more extensive bariatric intervention. During the procedure a liquid-filled balloon is placed in the patient's stomach. The balloon occupies a certain volume of the stomach and thus limits the amount of food, contributing to a faster saturation. The balloon fulfills its function in the stomach for up to 6 months, after this it is removed during repeated gastroscopy or under general anesthesia, during the planned more extensive bariatric intervention.
- Gastric banding involves laparoscopic placement on the stomach of a special cuff (bandage) made of silicone. In this case the cuff divides the stomach into two parts, reducing its volume. The size of the opening between the parts of the stomach is regulated by a special device placed under the skin, so the patient can control the amount of food and the rate of weight loss on his own. On the one hand, gastric banding is a minimally invasive intervention that preserves the natural movement of food through all parts of the gastrointestinal tract. On the other hand, gastric banding is connected with high risk of complications – displacement of the cuff, functional disorders of the stomach, inflammatory processes. Patients with complications are often referred to professor Staikov, as such situation requires technically complicated removal of the cuff and shunting or resection of the stomach. Professor Staikov himself gives preference to other methods of treatment.
- Sleeve gastrectomy or sleeve gastric resection is a restrictive technique, which involves removing almost all body of the stomach and formation of a smaller stomach in the form of a sleeve. During the operation the part of the stomach that produces the hormones responsible for the feeling hunger and saturation is removed. Thus, sleeve gastric resection has two mechanisms of body weight decrease – reducing the size of the stomach and reducing the feeling of hunger. Unlike previous techniques, resection of the stomach is irreversible, its effect persists lifelong.
- Biliopancreatic diversion is a more comprehensive complex surgery, which involves removing part of the stomach and special reconstruction of the small intestine to reduce fat absorption. This type of bypass is extremely effective in type 2 diabetes mellitus and high blood cholesterol levels. The body weight decrease after the operation is significant and, which is even more important, long-term. It should be noted that the result of the surgery doesn`t depend on the patient`s diet, as after the reconstruction of the small intestine absorption of edible fats substantially decreases.
- Gastric bypass implies anatomical reconstruction of the stomach and small intestine, as well. During this surgery part of the stomach and rich in digestive enzymes initial parts of the small intestine are cut off from the process of food digestion. A surgeon creates new path for dietary masses movement, so they come from the upper part of the stomach immediately into the middle part of the small intestine. This is called “bypass”. Bypass is similar to biliopancreatic diversion by the mechanism of weight loss – after this type of surgery the size of the working stomach decreases and activity of digestion and absorption of nutrients in the small intestine lowers, as well.
- Professor Staikov performs revision weight loss surgeries after previous bariatric interventions, as well. Such procedures are considered to be more complicated, as the surgeon needs to reveal the complication of the previous intervention (often performed by another doctor) and correct it as effectively as possible. In addition, the Sachsenhausen Clinic offers plastic surgery options – abdominoplasty, correction of hips and shoulders shape, mammoplasty. No more than 25% of patients require plastic surgery interventions; it is usually associated with insufficient elastic properties of the skin and formation of excess skin folds.
What will my life after the surgery be like?
Up to 3 days after the surgery the patient stays in clinic, under the supervision of qualified specialists and professor Staikov himself. During the first 24 hours after the intervention state of the patient is monitored the most thoroughly – the patient stays in the special Intermediate Care unit, which is located near the intensive care unit and operating room. The next day the patient is transferred to a usual ward. The same time training begins – the patient receives information about important aspects of future life and special recommendations for early postoperative period.
Recommendations for the period of adaptation during the first weeks after the bariatric surgery include the following:
- Having meal each 4-6 hours, which is approximately 4-5 meals a day
- Chewing food thoroughly and taking food slowly, paying attention to the feeling of satiety
- Separate taking food and drinks, the gap between them should be at least 30 minutes
- Intake of the sufficient quantity of liquid (non-carbonated drinks without sugar and alcohol) – 1,5-2,0 liters a day
- Giving preference to whole-grain products, vegetables and fruits; having sufficient amount of protein in the diet
- Keeping a food diary in written or electronic form
- Satisfactory level of physical activity – not less than 30 minutes of fast walking a day, swimming, aerobic sports
The scheme of long-term follow-up significantly depends on the chosen bariatric intervention, but always includes the following aspects:
- Consultation on healthy nutrition, elaboration of an individual diet with a nutritionist, training in independent making menu for the day and week
- Development of an individual physical activity plan depending on the general condition of the patient and the desired rate of weight loss
- Consultation of the therapist and laboratory control in three months, six months and a year after surgery; after this routine check-up is performed once a year in absence of complaints
- Consultation of the endocrinologist and medicinal treatment of diabetes mellitus, if necessary
- Working with a psychologist, attending self-help groups meetings – this motivates the patient to reach his goal and supports him along the way
Pictorial and motivating for further work way is keeping a photo diary with comments on the process of reducing body weight, achievements and plans for the future. Some patients make such diaries available in the Internet, so that many people with similar problems can follow them and get inspired. A number of professor Staikov`s patients` photo diaries are publicly available. In the diaries patients demonstrate impressive results, share new achievements and thank the professor for help.
How can I get an appointment with the professor and plan surgery?
High standards of work and excellent qualification of the specialists of the Sachsenhausen Clinic in Frankfurt am Main make it possible to provide medical help to international patients, as well. As a rule, Bariatric Surgery centre leaves limited number of places for international patients, so it is important to make an appointment timely. The competence of the clinic`s staff is restricted to providing medical services.
Administrative work and organizational aspects of the trip are provided by an official partner of the Sachsenhausen Clinic – certified medical tourism company Booking Health, which annually helps hundreds of patients with morbid obesity in receiving effective treatment in the most specialized healthcare institutions. International quality control ISO certificate ensures company`s reliability and correspondence to the highest international standards.
To receive a consultation on the possibility of coming for the treatment, basic examination program and planning further surgery, as well as receiving help in preparing necessary documents, you should leave a request on the website of the Booking Health company. After this our patient case manager will contact you to clarify all the details and help you with preparing for the trip.
Booking Health company helps patients in such important aspects as:
- Getting an invitation for treatment from the clinic for faster medical visa receiving
- Getting an appointment on the convenient date and time
- Preliminary organization of comprehensive preoperative examination
- Providing transfer from the airport to clinic and back to the airport
- Assistance of interpreter and personal medical coordinator
- Assistance in further surgical treatment organization, if necessary
- Providing medical insurance in case of complications (up to 200 000 euros)
- Preparation and translation of medical documents and recommendations from clinic
- Help in further communication with your treating physician, if necessary
Our aim is to help you in saving and improving your health, don`t hesitate to contact us.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova