When is weight loss sleeve surgery recommended?

Question

Hello doctor,

I am 38 years old and cannot lose weight no matter what I try. My current weight is 311 pounds at 5 feet 4 inches, and I have been obese since my teens. I have tried every diet program, exercise routine, and even prescription weight loss drugs like Qsymia and Contrave without success.

My health is deteriorating rapidly. I was diagnosed with polycystic ovary syndrome (PCOS), also known as polyendocrine metabolic ovarian syndrome(PMOS), years ago. I developed insulin resistance with an A1c now at 6.7, and my fertility specialist says my weight is the main reason why in vitro fertilization (IVF) has not worked after three expensive cycles. My knees hurt so badly that I can barely climb stairs in my own house, and I recently developed sleep apnea, requiring a continuous positive airway pressure (CPAP) machine with an ApneaHypopnea Index (AHI) of 32.

My cholesterol is through the roof, with low-density lipoprotein (LDL) at 192, despite taking Atorvastatin 40mg (milligrams). My blood pressure averages 152/94 on Lisinopril and Hydrochlorothiazide. I have been researching metabolic surgery, but I am terrified of the complications I read about online. My mom had gastric bypass surgery 10 years ago and suffered from dumping syndrome so severely that she regrets it.

Would gastric sleeve surgery be a better option for someone with my condition? How would the surgery affect my fertility treatments and PCOS or PMOS? I am worried about loose skin afterward and whether my insurance will cover plastic surgery later.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am sorry to hear about your struggles. Given your health conditions, metabolic surgery could be a beneficial option. The sleeve gastrectomy is often preferred for individuals with PCOS (polycystic ovary syndrome), now known as PMOS (polyendocrine metabolic ovarian syndrome), and insulin resistance, as it can improve both conditions and aid in weight loss. It typically has a lower risk of complications like dumping syndrome compared to gastric bypass.

Weight loss surgery can positively impact fertility and PCOS or PMOS by improving hormonal balance and increasing the chances of successful IVF (in vitro fertilization). However, it is essential to work closely with your fertility specialist and surgeon to coordinate your treatment plan.

Loose skin is a common concern post-surgery. Some insurance plans may cover reconstructive surgery, but it is best to check with your provider.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.