Bariatric surgery is a solution to treat obesity . It works by reducing the stomach’s ability to absorb food, which limits the amount of food ingested and allows for significant weight loss. The process of human digestion begins in the mouth where food is chewed and mixed with enzymes found in saliva. Once it arrives in the stomach, it is broken down by digestive juices into nutrients and calories which will be absorbed by the body. Digestion continues in the duodenum, where food is mixed with bile and pancreatic juice. Bariatric surgery intervenes to alter this process by modifying the normal circuit of digestion. This helps reduce the amount of food digested and absorbed, thereby helping to lose weight and reduce the risk of diseases associated with obesity. There are several bariatric surgery techniques , such as gastric bypass , mini-bypass and sleeve gastrectomy .

Is bariatric surgery right for you?

To consider bariatric surgery , several criteria must be met:

• A body mass index (BMI) greater than 40 kg/m², or greater than 35 kg/m² with medical
• complications such as type 2 diabetes or hypertension.
• Be aged between 18 and 60.
• Have no psychological contraindications.
• Have no specific surgical history that would pose a problem.

It is also important that the patient has tried more conventional weight loss methods without success, including medical diets, dietary monitoring, physical exercise and psychological care. The decision to resort to bariatric surgery must be taken after consultation between different specialists such as the treating physician, the surgeon, the endocrinologist, the nutritionist and a psychologist or psychiatrist.

Calculate your Body Mass Index (BMI)

BMI is an indicator used to assess body size and detect problems related to being overweight . It is calculated by dividing weight by height squared. This indicator is recommended by the World Health Organization (WHO) for adults aged 18 to 65, but it is not suitable for pregnant women, athletes or people with highly developed muscles. Here is the interpretation of BMI results according to WHO standards:

• Less than 16.5: Underweight
• 16.5 to 18.5: Underweight
• 18.5 to 25: Normal weight
• 25 to 30: Overweight
• 30 to 35: Moderate obesity
• 35 to 40: Severe obesity
• Over 40: Morbid or massive obesity

The different techniques of bariatric surgery in Tunisia

Sleeve gastrectomy

Sleeve gastrectomy involves removing a large portion of the stomach to reduce its size and thus limit the amount of food the patient can eat. This procedure is indicated for people with a BMI greater than 40 kg/m², or greater than 35 kg/m² with complications such as diabetes or hypertension. The procedure lasts approximately 2 hours and requires hospitalization for 4 to 5 days. Patients generally lose between 45 and 65% of their excess weight after two years, provided they follow post-operative recommendations. The sleeve offers benefits such as regular weight loss and remission of certain diseases, but can lead to vitamin deficiencies or rare postoperative complications.

Gastric bypass

Gastric bypass is a surgical technique that involves reducing the size of the stomach and bypassing part of the small intestine, thereby changing the route of food. This procedure lasts between 1.5 and 3 hours, with a one-day hospitalization. The bypass allows you to lose around 60% of excess weight after two years, but requires regular medical monitoring to avoid vitamin and mineral deficiencies, such as vitamin B12 and iron.

The mini-bypass

The mini-bypass is a simplified version of the classic bypass. It involves the creation of a small stomach pouch and the diversion of part of the intestine, which limits the absorption of nutrients. This operation lasts between 45 minutes and 1.5 hours and requires hospitalization for 24 to 48 hours. Patients generally lose between 70 and 75% of their excess weight in two years, provided they follow strict medical monitoring. Mini-bypass has benefits like rapid recovery and significant results.

The gastric balloon

The gastric balloon is a non-surgical solution to help patients lose weight. A balloon is inserted into the stomach to take up space and limit the amount of food absorbed. This treatment is indicated for people with a BMI between 30 and 40, and for those who have failed to lose weight using traditional methods. The balloon placement lasts between 15 and 30 minutes, with a 24-hour hospitalization. Weight loss is usually 20 to 50% of excess weight within four months following the procedure.

Gastric band

Gastric banding is a technique that involves placing a band around the upper part of the stomach to reduce its size. This operation limits the amount of food that the patient can consume. However, this technique can cause complications, such as frequent vomiting or displacement of the ring. Additionally, weight regain after band removal is common.

Endo-sleeve

Endo-sleeve is a non-surgical technique that reduces the size of the stomach using endoscopic sutures. This method is less invasive and does not require an incision, but offers results comparable to the classic sleeve, with significant weight loss. The procedure lasts between 60 and 90 minutes and requires hospitalization for 1 to 3 days. Patients can lose up to 20 kg in six months, provided they follow post-operative recommendations.

Revisional Bariatric Surgery: A Second Wind for Weight Loss

Revisional bariatric surgery is an option for people whose initial post-surgery weight loss was insufficient or who regained weight after their procedure. In some cases, it may also be necessary in cases of excessive weight loss. The causes of failure of a first bariatric surgery can be varied, ranging from mechanical factors to inappropriate eating behaviors. Among the revision options, we find the Sleeve after gastric band, the Bypass after gastric band or the Bypass after Sleeve. Primary reasons for considering revision surgery include gastroesophageal reflux disease (GERD), failure to lose weight or regain weight, and nutritional deficiencies that may occur after an initial procedure. Before any reoperation, it is crucial to fully understand the reasons for the failure and to undergo a complete medical evaluation. These revision operations offer encouraging results, both for weight loss and for improvement of obesity-related comorbidities.

What are the benefits of bariatric surgery?

Bariatric surgery offers many benefits for people suffering from severe obesity:

• Type 2 diabetes remission: Whether through a Bypass, mini-Bypass or Sleeve, this surgery promotes lasting improvement in type 2 diabetes. Many patients are even able to stop taking their medication after the operation.
• Improved cardiovascular health: By reducing the risk of stroke and heart attack, bariatric surgery allows indicators such as blood pressure and cholesterol to return to normal levels.
• Positive psychological impact: Weight loss boosts self-esteem and helps combat the depression often associated with obesity. One study showed a 32.7% reduction in depressive symptoms in patients who underwent this surgery.
• Disappearance of sleep apnoea: Thanks to surgery, many patients are able to get rid of their CPAP machine and regain a better quality of sleep.
• Reduced joint pain: By reducing the weight on the joints, patients experience less chronic pain and can reduce or even stop taking painkillers.
• Improved sexual health: Weight loss improves fertility and helps regulate menstrual cycles in women with ovulation problems.
  Cure for metabolic syndrome: Bariatric surgery helps to treat metabolic syndrome and certain complications such as those linked to pregnancy or gall bladder disease.
• Healing Metabolic Syndrome: Bariatric surgery helps treat metabolic syndrome and certain complications such as those related to pregnancy or gallbladder diseases.

What are the risks associated with bariatric surgery?

Like any surgical procedure, bariatric surgery carries certain risks, including:

• Haemorrhage
• Complications associated with anaesthesia
• Deep vein thrombosis
• Dehiscence (separation of sutures)
  Infections
• Staple leaks
• Marginal ulcers
• Pulmonary complications
• Pulmonary complications
• Spleen damage
• Stenosis (abnormal narrowing of the gastric pouch after a Bypass)

If complications arise during laparoscopic surgery, it may be necessary to move on to open surgery.

Price of bariatric surgery in Tunisia

Bariatric surgery allows patients to return to a healthier lifestyle by reducing the size of their stomach and, therefore, their food consumption. From the operation, they feel satiety more quickly, making it easier to manage their hunger and weight. With a multidisciplinary team of experienced professionals, Bonjour Assistance Médicale supports its local and international patients in their obesity surgery journey, while offering very competitive prices compared to those practiced in Europe. Here are the indicative prices:

How do you choose the right bariatric surgeon in Tunisia?

Obesity, a true global scourge, affects millions of people across the globe, causing serious health consequences. Faced with this reality, several treatments are offered, including bariatric surgery (Sleeve, Bypass, Mini-Bypass). However, before taking the step of the operation, it is crucial to choose the right bariatric surgeon. Here are the main criteria to take into account to ensure you make the right choice.

Essential criteria for choosing a bariatric surgeon

Specialization of the surgeon : It is essential to contact a surgeon specializing in bariatric surgery . Make sure that the latter has proven expertise in this area, rather than a general practitioner or a visceral surgeon. Specific expertise in bariatrics guarantees better mastery of surgical techniques and the risks associated with the intervention. Experience and case volume: The number of bariatric operations performed each year by the surgeon is an indicator of competence. A practitioner who regularly uses these interventions is better prepared to manage possible complications and personalize treatment according to the patient’s profile. Training and qualifications: Consult the surgeon’s academic and professional background. Check their diplomas, certifications, and continuing education. A strong CV in the field of obesity surgery is a guarantee of seriousness and competence. Professional Experience: A surgeon’s experience plays a major role in the success of a procedure. An experienced practitioner, with several years of practice in bariatric surgery, will have acquired expertise and skills that beginners have not yet developed. Testimonials and recommendations: Word of mouth is a reliable source of information. Former patients can share their experiences with the surgeon, which allows you to have a more precise idea of ​​the quality of his interventions and his post-operative follow-up.

The first pre-operative consultation

Once the choice of surgeon has been made, the initial consultation with the latter is a decisive step. This appointment allows us to discuss in detail the different surgical options adapted to the patient’s profile and to ask all the necessary questions. A good relationship of trust with the practitioner is essential to calmly approach the intervention.

Avoid the proximity criterion

It is important not to prioritize geographic proximity when choosing a bariatric surgeon. Choosing the practitioner closest to you may seem convenient, but it is not always the best choice. It is better to travel the extra miles to benefit from the expertise of an experienced surgeon, rather than limiting yourself to proximity.

What to do before bariatric surgery

Preparing for bariatric surgery is a crucial phase that takes place over several months. The patient must be actively involved in this process and meet a multidisciplinary team including doctors, nutritionists, psychologists, and dieticians. This preoperative step ensures that the patient is ready to undergo major surgery. The stages of the preoperative phase:

• Complete health check-up: Before the operation, an exhaustive check-up is carried out to assess the nature of the patient’s obesity and detect any co-morbidities (diabetes, hypertension, sleep apnoea, etc.).
• Nutritional and psychological assessment: A nutritional and psychological assessment is necessary to determine whether the patient can make the lifestyle changes that are essential after the operation. The support of a psychologist may prove useful in dealing with any eating disorders and self-image issues.
• Physical fitness: Patients must also undergo a physical fitness assessment to check whether they are fit to undergo surgery. Light physical preparation is often recommended before the operation.

Post-operative follow-up of bariatric surgery

Once the operation is completed, post-operative follow-up is just as important as preparation. Here are the essential steps to recovery:

• Recovery phase and pain management: After the operation, the patient is transferred to the recovery room, where a medical team monitors his or her condition. A nurse is responsible for pain management and for guiding the patient out of bed for the first time.
• Going home: On the day they leave the clinic, patients must be accompanied by a relative to ensure their well-being. Post-operative recommendations include careful monitoring for signs of complications, good hydration and a suitable diet.
• Gradual resumption of activities: A return to light physical activity, such as walking, is encouraged to stimulate blood circulation and facilitate recovery. Driving is only authorised after medical assessment, particularly if no painkillers likely to cause drowsiness have been taken.

Restorative surgery after weight loss After significant weight loss, it is common for excess skin or sagging skin to appear. Reconstructive surgery can correct these imperfections. However, it can only be considered at least one year after the bariatric procedure and requires a prior consultation to assess the patient’s state of health.

Would you like to have bariatric surgery in Tunisia?

Whether for a sleeve, a bypass, a mini-bypass or any other bariatric surgery treatment, Bonjour Assistance Médicale offers complete care at affordable prices, guaranteeing personalized medical monitoring and multidisciplinary support throughout the process weight loss. For more information, do not hesitate to contact us via our website or digital channels.