For a gastric band
On the basis of a serious preoperative assessment and a strict selection (psychological, dietetic, gastroenterological,…) gastric banding was considered in our experience (more than 1500 cases) and in the medical literature as the method of choice for the surgical treatment of obesity in patients under 20 years of age with a BMI of less than 32 and with a low sweet tooth.
Today the ring remains a limited indication. We reserve it for certain adolescents and low BMIs between 28 and 32. In this situation, we propose a gastric plication (not yet recognised by the HAS)
For a sleeve gastrectomy
Sleeve gastrectomy is an excellent operation for the super-obese (BMI over 50), and an excellent operation for patients over 18 years of age with a BMI over 35 and little sweet tooth. It clearly improves diabetics.
For a gastric plication
From time to time we perform gastric banding, which is a sleeve without cutting the stomach, and reserve it for certain patients with a BMI of less than 35 and comorbidities.
For a bypass
Bypass is considered the gold standard of obesity surgery: it is aimed at regular sweet eaters, patients with a BMI above 40. It is an excellent operation for recent diabetics of less than 5 years whose BMI is less than 35 and even more than 35. In this case, the diabetes goes into long-term remission.
Which surgical techniques to choose?
The choice of surgical technique depends on the patient’s age, BMI and eating behaviour. That is why today we prefer to propose :
- A gastric plication in a young obese person who does not eat sweets and whose BMI varies between 28 and 35
- A Gastric Bypass to an obese person over 18 years old, sweet-eater with a BMI over 35 and why not diabetic, even if the BMI is under 35
A sleeve gastrectomy to a super-obese or non-sugar-eating obese person over 18 years of age with a BMI over 35 or over 50.
Long-term follow-up (24 to 60 months) of 500 consecutively operated patients shows confirmed positive responses for arterial hypertension (96%), sleep apnoea syndrome (91%), diabetes (85%), gastro-oesophageal reflux (76%), orthopaedic problems (74%) and cardio-respiratory failure (74%).