What is metabolic surgery?

Question

Hello doctor,

I am 51 years old, and my health is nearing a breaking point. My weight is 392 pounds on a 6'0" frame, generating a cascade of health concerns. I have had diabetes for 12 years and am now insulin-dependent, taking 87 units of Lantus daily with Humalog with meals, and my A1c is still 9.4 %. Despite being on Lisinopril, Amlodipine, and Metoprolol, my blood pressure averages 172/98 mmHg. I was recently diagnosed with severe sleep apnea with an AHI of 67, but I cannot bear the CPAP mask - it feels like I am drowning. Walking became difficult due to painful peripheral neuropathy in my feet, and a cardiologist diagnosed moderate heart failure with an EF of 38 %. My kidneys are beginning to show damage, with microalbuminuria and an eGFR of 58. My mobility is limited, making personal hygiene difficult, and I have chronic skin infections in my folds. The breaking point was when I needed help wiping myself after using the restroom. I tried Ozempic for four months and dropped only 11 pounds before my insurance stopped supporting it. My primary care physician recommended metabolic surgery, but I was concerned about the surgical risks due to my heart condition. Would gastric bypass help reverse some of the damage already done, or is it too late? How risky is surgery for someone with my complications? Are there less invasive surgical options that might work?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am sorry to hear about the challenges you are facing. Given your multiple health issues, it is understandable that you feel overwhelmed. Metabolic surgery, such as gastric bypass, can be a powerful tool for weight loss and may help improve or even reverse some of the complications you are experiencing, including diabetes, hypertension, and sleep apnea.

However, surgery does come with risks, especially for someone with your health profile. The risks include complications related to anesthesia, infections, blood clots, and potential issues with your heart and kidneys. It is crucial to have a thorough evaluation by a multidisciplinary team, including a cardiologist, endocrinologist, and bariatric surgeon, to assess your surgical risk and optimize your health before the procedure.

There are less invasive surgical options, such as gastric sleeve surgery, which may have a lower risk profile but still offer significant weight loss benefits. Additionally, endoscopic procedures like gastric balloon placement might be considered, though they typically result in less weight loss compared to surgical options.

It is essential to have a detailed discussion with your healthcare team to weigh the benefits and risks and determine the best course of action for your specific situation.

Kindly book a consultation with me if you would like more detailed information on any of these points or if you have other questions.

I hope this helps.

Take care.