Surgeon Dr César Carvalho began his medical journey in Coimbra before relocating to the Algarve to serve at HPA Gambelas and HPA Alvor. Specialised in Bariatric Surgery, the doctor assured, “It is very rewarding when we are dealing with an overweight patient and we are able to change their lives, Bariatric Surgery is the type of surgery where you can definitely see the results”.


Bariatric Surgery

Concisely, “Bariatric surgery is the last step in the multidisciplinary attempt for a patient to lose weight”, Dr César defended. Although there are several types of obesity, morbid obesity when the body mass index (BMI) exceeds 40 kg/m2 is when Bariatric Surgery emerges as an option. As stated by Dr César Carvalho, Bariatric Surgery is the final step because more conservative measures are taken first. "We would argue that it is the most effective and efficient method, but it is the last resource after all other options have been exhausted." Moreover, the doctor added that Bariatric Surgery can also be considered if the BMI of a patient is over 35kg/m2, but comorbidity with all the related conditions, such as diabetes, high blood pressure, and sleep apnoea.

It has been shown that treating obesity itself results in several alterations. “It was only by accident that it was found that some of the Bariatric Surgery procedures could be employed in the weight-loss process, being in the current days one of the most conducted procedures in the area”, the doctor shared. Bariatric surgery was in the past restricted to patients between 18 and 65 years old, but the age range has massively extended and is nowadays accessible to almost everyone, with under 18’s requiring special attention.

First approaches to the weight-loss process

Contrary to popular belief, obesity is not solely caused by an individual's overeating habits. It is caused by several factors, including the reward system itself through the influence of dopamine, as well as hormones that increase/decrease the urge to eat (such as ghrelin, leptin, and GLP-1). Dietary monitoring and, most of the time, exercise are the first steps in the weight reduction process.

However, when diet plans and exercise are unlikely to produce positive results, there are several combinations that can also aid the weight loss process. Pharmacological approaches, such as medications, can be used as a following treatment, before a possible Bariatric Surgery. Still, the goal and success of weight loss are always adjustments in daily routines. As Dr César defended, “Bariatric surgery itself is a crutch, it doesn't perform miracles, it will help a lot but there are other alterations which should be made”.

Gastric sleeve and gastric bypass

There are different types of Bariatric Surgeries, the calibrated vertical gastrectomy known as gastric sleeve, and the gastric bypass are the most common ones. Both surgeries are conducted through laparoscopy, with the sleeve providing a restrictive effect and the bypass a combination of restrictive and hypo-absorptive effects. “There are patients who, with a higher level of body mass, bypass is the only solution we can offer. On the other hand, the sleeve is a technique that has more benefits for the people who eat a lot of food during a meal, but who do not have reflux”, the doctor stated, emphasising that “each case is different, and we always have to hear what the patient would prefer”.

In the gastric sleeve a tube with a specific diameter that reaches the oesophagus and the stomach, will be used to calibrate the stomach. According to the doctor, “We will cut the stomach longitudinally, it will become a tube, and this tube will have several effects – one of the most important is restriction, which makes the person feel full early. Then it will have another effect, since the hormones that make us want to eat are reduced and removed in the gastric sleeve, implying a decrease in appetite”.

In the bypass, a pouch will be created, which will be right at the exit of the oesophagus. To this pouch, part of the small intestine will be attached. As Dr César explained, “The food enters this pouch, indicating that the patient will consume less food and become satiated. The food will pass through this section of the small intestine without being absorbed until it joins the other section that brings the bile and pancreatic secretions, at which point it will permit absorption to take place in the remaining small intestine”. There are other Bariatric Surgery techniques, more complex and aggressive in weight loss, but which are reserved for patients with super obesity (BMI>50kg/m2).

High-quality devices and practices

The bypass procedure is a little more laborious than the sleeve, but in both techniques, complications are infrequent, with the most common one being leakage through the staple lines that have to be conducted. That's why HPA chooses to use the best devices on the market. Those devices are more expensive, which increases the price of surgeries, but provides the professionals with a completely different level of confidence. Dr César Carvalho, alongside Dr Filipe Guerra, oversees the Bariatric Surgeries at HPA Alvor and HPA Gambelas, where all procedures that are carried out are done in the same way and with the help of the same clinical equipment. “This systematisation helps to avoid complications”, the doctor assured.

In addition to the metabolic part which implies an analysis of all associated diseases, an anaesthesia consultation, a nutrition evaluation (since the patient must begin a diet prior to surgery), and a psychology consultation to determine whether the patient is a good candidate for this type of surgery, are always conducted in advance. Regarding the post-operatory, the patient is discharged after two days and after a week the patient is re-evaluated, implementing a liquid-only diet throughout that time.

For more information please contact Grupo HPA Saude on (+351) 282 420 400.

Author

After studying Journalism for five years in the UK and Malta, Sara Durães moved back to Portugal to pursue her passion for writing and connecting with people. A ‘wanderluster’, Sara loves the beach, long walks, and sports. 

Sara J. Durães