Seeking Surgical Options for High-Risk Obesity: A Daughter's Plea

I have a very big question?

Hello Doctor: My mother found an article in a newspaper about Dr.
Tsai Chinhong from Taichung City Hospital performing laparoscopic surgery (gastric sleeve surgery) on a patient who successfully lost weight.
It also mentioned coverage by the National Health Insurance.
However, this is not related to my inquiry.
My mother is 147 cm tall and weighs 145 kg.
She has hypertension, cardiomegaly, ischemic heart disease, and lipomas (three to four in her abdomen).
She has consulted many hospitals, including Linkou Chang Gung Memorial Hospital, Hsinchu En Chu Kong Hospital, Taoyuan Provincial Hospital, and 804 Hospital.
Almost no doctor is willing to treat her.
I would like to know if there is anyone at your hospital who is willing to treat my mother.
Please do not keep passing us around.

Lanqi, 20~29 year old female. Ask Date: 2004/09/20

Dr. Huang Zhihui reply Surgery

After reviewing your concerns, I believe you may have unrealistic expectations regarding "gastric partition surgery." Gastric partition surgery involves surgically dividing the stomach, which normally can hold one to two liters of food, into a much smaller pouch with a capacity of only a few tens of cc.
This procedure limits the amount of food the patient can consume, thereby reducing caloric intake and achieving weight loss.
However, as with any surgical procedure, there are inherent risks, including anesthesia complications, infection, and even death.
Patients with severe obesity may face heightened anesthesia risks due to compromised cardiopulmonary function.
Additionally, altering the normal physiological structure can lead to adverse side effects.
Complications may include gastroesophageal reflux disease, pneumonia, ulcers, bleeding, malnutrition, peripheral neuropathy, strictures, obstructions, and venous thromboembolism.
Many patients struggle to change their eating habits post-surgery, leading to rapid weight regain.
Consequently, most surgeons adopt a conservative stance regarding this procedure.
Currently, there is a consensus on the indications for surgery, which include meeting the following five criteria: being under 55 years of age, having an ideal body weight exceeding 85% of the recommended weight, having attempted dietary control for over six months, being mentally stable with a psychiatric evaluation confirming no abnormalities, and not having morbid obesity due to metabolic or endocrine disorders.
Given that your mother is over 55 years old and has hypertension and heart disease (making her a high-risk candidate for anesthesia), she is not a suitable candidate for this surgery.
Therefore, I strongly advise her to consider safer, non-invasive weight loss methods and to avoid having overly high expectations regarding surgical weight loss.

Reply Date: 2004/09/20

More Info

When considering surgical options for patients with severe obesity, especially those with multiple comorbidities like your mother, it is crucial to assess the risks and benefits thoroughly. Your mother's situation is complex due to her height of 147 cm and weight of 145 kg, which places her in the category of severe obesity (BMI of approximately 67.5). Additionally, her existing health conditions—hypertension, cardiomyopathy, and the presence of lipomas—significantly increase her surgical risk.

Bariatric surgery, such as laparoscopic gastric sleeve surgery, is often considered for patients with a BMI over 40 or over 35 with obesity-related health issues. However, the eligibility for such procedures is not solely based on BMI. Surgeons typically evaluate several factors, including the patient's overall health, the presence of comorbidities, and the potential for postoperative complications.

In your mother's case, her high blood pressure and heart conditions classify her as a high-risk surgical candidate. The risks associated with anesthesia and surgery are elevated in patients with compromised cardiovascular health. Potential complications from surgery can include infections, blood clots, and even cardiac events, which are particularly concerning given her medical history.

Most bariatric surgeons adhere to specific criteria when determining if a patient is suitable for surgery. Generally, the following criteria are considered:
1. Age: Patients under 55 years old are often preferred, as older patients may have higher risks of complications.

2. BMI: A BMI over 40 or over 35 with obesity-related health issues is typically required.

3. Psychological Evaluation: Patients should have a stable mental health status, often confirmed through a psychiatric evaluation.

4. Commitment to Lifestyle Changes: Patients must demonstrate a willingness to adhere to dietary and lifestyle changes post-surgery.

5. Absence of Other Medical Conditions: Patients should not have other significant metabolic or endocrine disorders contributing to obesity.

Given your mother's age and existing health issues, many surgeons may recommend against surgical intervention, opting instead for non-surgical weight loss methods. These can include lifestyle modifications, dietary changes, and possibly pharmacotherapy for weight management.
It is essential to have an open dialogue with healthcare providers about your mother's condition. If she has not yet consulted with a specialized bariatric surgeon, it may be beneficial to seek a second opinion from a center that specializes in high-risk bariatric surgery. Some centers have multidisciplinary teams that include cardiologists, endocrinologists, and dietitians who can provide comprehensive care tailored to high-risk patients.

In conclusion, while your mother may be seeking surgical options for weight loss, her current health status poses significant risks that need to be carefully weighed against the potential benefits of surgery. Non-surgical interventions may be safer and more appropriate given her circumstances. It is crucial to work closely with her healthcare team to explore all available options and develop a personalized plan that prioritizes her health and safety.

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