Patient's Query
Hello doctor, My wife is struggling badly with her weight and all the complications that come with it. She is 39 years old and weighs 290 pounds. She has had high blood pressure and borderline diabetes. Her knees hurt constantly, and she cannot walk without getting winded. She has tried following every diet out there, such as keto, low carb, and meal delivery. But nothing sticks longer than a few weeks. We recently heard about metabolic surgery from a coworker who had great results. But we are nervous about how risky this is for someone like her with hypertension. Also, she is taking medicines like Lisinopril and Metformin. Would these interfere? She is scared of general anesthesia, too. How would her recovery be? How soon can she get back to normal routines? Are there any options that do not involve bypass? Please suggest. Thank you.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
As you mentioned, she is 39 years old and weighs 290 pounds, which falls into class 3 obesity with uncontrolled diabetes and hypertension, so you are a strong candidate for bariatric or metabolic surgery. In such cases, the risk of not opting for surgery, continued progression of diabetes, cardiovascular disease, and kidney damage, can outweigh the risks of surgery itself, especially if medications and lifestyle changes have not been effective. Metabolic surgery can really help to improve both blood sugar and hypertension, depending on the type of surgical procedure, with around 60 to 70% inducing remission for diabetes and HTN (hypertension). There are different types of bariatric surgeries.
1. Sleeve gastrectomy (up to 80% of the stomach is removed) is very effective for weight loss and diabetes improvement.
2. Roux-en-y- gastric bypass (RYGB) - It creates a small stomach pouch and reroutes the small intestine to bypass part of the stomach and duodenum. It is most effective for type 2 diabetes remission.
3. Mini gastric bypass (one anastomosis bypass) - It has a shorter surgery and fewer complications. It is effective for weight loss and diabetes.
4. Adjustable gastric banding - It has a high rate of long-term complications and reoperations.
5. Biliopancreatic diversion with duodenal switch (BPD-DS) - This causes the highest weight loss and diabetes remission rates. It creates a high risk of malnutrition and requires lifelong strict vitamin and protein supplementation.
The main difference between sleeve gastrectomy and Roux-en-Y gastric bypass is,
1. Sleeve gastrectomy:
About 75 to 80 per cent of the stomach is removed, leaving a narrow gastric "sleeve." There is no intestinal bypass, only a restrictive one. It reduces stomach volume and decreases ghrelin (hunger hormone). There is minimal malabsorption, which lowers the risk of deficiencies. Weight loss is around 60 to 70 per cent.
2. Roux-en-Y gastric bypass (RYGB):
A small stomach pouch is created and connected directly to the jejunum. It bypasses the duodenum and part of the jejunum. It is both restrictive and malabsorptive. It reduces intake and nutrient absorption and also alters gut hormones. There is a significant malabsorption with a higher risk of developing deficiencies in iron, B12, and calcium. The weight loss is around 65 to 80%, slightly more than sleeve gastrectomy. The complications include bleeding, infections, and anastomosis leakage.
Recovery period - Usually, hospital stay is one to three days. Full activity can be done within four to six weeks. You will follow a structured plan starting with liquids, then soft foods, and then regular meals over a few weeks. Most patients lose 60 to 80% of excess weight and maintain long-term improvements in blood sugar and pressure. You will need to commit to regular follow-up, nutritional counseling, and possibly vitamin supplements for life.
For more doubts, you can consult a bariatric surgeon, who can guide you to the best option for you.
I hope this answers your query.
Let me know if I need to assist you further.
Thank you.
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Answered byDr. Mohamed Abdirahman Ali
Medically reviewed byDr. K. Shobana
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