When is bariatric surgery reversal necessary? Understand

A bariatric surgery is one of the treatment options for obesity, being indicated for patients with a BMI (Body Mass Index) above or equal to 30, according to the current guidelines of the SBCBM (Brazilian Society of Bariatric and Metabolic Surgery). In most cases, surgery is successful. However, in rare situations, it can cause serious complications, requiring bariatric surgery reversal .

According to Fábio de Oliveira Rodrigues, specialist in bariatric surgery and holder of SBCBM, among the rare and serious complications that bariatric surgery malnutrition and the hypoglycemia severe (low blood glucose level).

AND In these cases, reversal of bariatric surgery becomes indicated. . “At recent congresses, we have seen some patients who are asking to reverse bariatric surgery and the big discussion is this: when does this reversal become necessary. In this case, it may be indicated in more severe cases of malnutrition and hypoglycemia”, says Rodrigues.

The reversal of bariatric surgery is performed using the reestablishment of the patient's intestinal transit . “In bariatric surgery, food no longer passes through the duodenum [tubo oco que se liga ao estômago e o jejuno e onde ocorre a maior parte do processo digestivo]. In the reversal, we will make the food pass back into the duodenum”, explains Rodrigues.

How does bariatric surgery work and when can it pose health risks?

Bariatric surgery is one of the treatments for severe obesity. She is also known as “stomach reduction ” because it reduces the organ's ability to receive food, making it difficult to absorb a high number of calories. She is recommended for patients with grade I to grade III obesity in accordance with the following SBCBM guidelines:

• BMI from 30 to 34.9 (Grade I Obesity) : To be eligible for metabolic surgery, the patient must have type 2 diabetes. In this case, the procedure is called metabolic surgery, with a focus on treating diabetes;
• BMI from 35 to 39.9 (Grade II Obesity) : The patient must have at least one comorbidity associated with obesity, such as hypertension, diabetes, hepatic steatosis (fatty liver), dyslipidemia, sleep apnea, among others;
• BMI greater than 40 (Grade III Obesity) : In these cases, proof of comorbidities is not necessary. Obesity itself, regardless of associated diseases, is an indication for surgery.

Currently, there are four main techniques for bariatric surgery, which are:

• Gastric Bypass : Creation of a small stomach pouch connected to the small intestine, reducing food intake and absorption;
• Gastric Sleeve : Removal of about 75% of the stomach, limiting the amount of food that can be eaten;
• Adjustable Gastric Band : Placing a band around the upper part of the stomach to restrict food intake, but has lost popularity due to less long-term effectiveness;
• duodenal switch : Removal of a large part of the stomach with changes in the intestine to reduce the absorption of nutrients, being reserved for specific cases due to their complexity.

“It is important to highlight that, in addition to BMI and comorbidities, the SBCBM emphasizes the need for a rigorous multidisciplinary assessment before surgery. This assessment includes physical, psychological and nutritional examinations to ensure that the patient is fit for the procedure and for post-operative monitoring, which is essential for the success of the treatment”, explains the specialist.

When the preoperative assessment is well conducted and monitored by a multidisciplinary team, it is possible to identify the profiles of patients at risk of developing serious complications from bariatric surgery and make the necessary adjustments before surgery or, in specific cases, contraindicate the procedure. procedure, according to Rodrigues.

According to SBCBM statistics, the rate of serious complications after bariatric surgery is relatively low , ranging from 0.1% to 0.5% for death and from 4% to 6% for severe complications. “Adequate patient preparation and the choice of a specialized center and qualified team are essential to minimize risks and promote a successful surgical outcome”, he adds.

Furthermore, bariatric surgery can cause immediate complications related to the surgical procedure and which generally occur within the first 15 days after surgery, as explained by the specialist. “The main immediate complications include bleeding and fistulas, which often require clinical readmissions or even a new surgical procedure to control the damage.”