Dr. Péter Vasas leading surgeon at the Doncaster Royal Infirmary in the UK; general, laparoscopic, upper gastrointestinal tract and bariatric surgeon, founder of Túlsúly Centrum.
After obtaining the surgical exam in 2006, Dr. Vasas got a medical position in the United Kingdom, where he later also have got introduced to different weight loss surgeries.
He was so impressed with these laparoscopic techniques and the surgery’s efficiency in healing diabetes and obesity, that he put great effort into improving his skills to the highest standards. For today, weight loss operations became a main focus for him as a surgeon.
Bringing back the knowledge he gained to Hungary he is operating gastic bypass and sleeve surgeries with great success at the Duna Medical Center since 2016. I am the living example of his work, as he was the one giving me a new life through a successful gastric bypass surgery.
Now, I am asking him about his experiences and thoughts based on the past 400+ surgeries he performed so far.
Dóra Vattay: Doctor Vasas, what is exactly a weight loss surgery?
Dr. Péter Vasas: The practice of surgical healing of morbid obesity is going back for decades in the US and Western Europe. There are various types of weight loss surgeries (WLS), which from I prefer the Roux-en-Y Bastric Bypass if the patient has no contraindications. Yet, I also preform Gastric Sleeve operations and put in Stomach Ballon for weight loss purposes.
From all WLS most people choose the Gastric Bypass. In fact, it is the most comonly performed weight loss operation worldwide.
D. V.: How stressful is this surgery for the patients?
Dr. P. V.: As all surgical procedures, this one has a recovery time as well. In the beginning it was performed with a major open abdominal surgery – which was a huge pressure on the body – but for today the laparoscopic technique allow us to let the patients back home after 2-3 nights spent in the hospital who after a couple of weeks can slowly return to their normal lives.
D. V.: What is the biggest challenge with the patients?
Dr. P. V.: That they understand that is the procedure all about, what are they “buying themselves into.” For example, when the patient comes together with his/her family, I usually invite everyone in to the consultation. I do this especially because I want the whole family to know and talk about that is expected, how the process will work, and also so they can ask me questions. During this conversations I also try to see who wants the operation really, the patient himself/herself or the family. It is a very bad situation when the patient is pushed by the family and he/she does not want to hear about the operation at all. Because in this case it is not the patient’s decision, therefore it can lead to a major conflict of interest with a easily predictable negative outcome. On the other hand it is also not ideal when the patient is the only one wanting the surgery, and everyone in the family is against the idea.
There will be a lot of adjustments and changes after the operation which will also have an effect on the lives of everyone living with or being close to the patient. Therefore these people have to know why things are happening they way they are, and their patience and support will be also necessarily for the long term successful outcome.
D. V.: So, human relations and emotional processes are very important for a WLS, right?
Dr. P. V.: Yes, extremely important. In most cases they are the ones making the difference for a fruitful result at the end. Also, it is scientifically proven that certain mental processes have an effect on the digestive system, and if they are cured through therapy it is possible to avoid the surgery.
The hardest thing is to realize who really profit from the operation, and who won’t. This is a huge challenge to face for us, surgeons.
D. V.: Yes, and I am sure there are great specialist to help you in this, maybe even on a therapeutic level – by providing individual, couple or even family therapy to the patients in order to help the them when creating their new life management for their new lives. Are there any existing cooperations? How helpful are psychologist in this regard?
Dr. P. V.: It would be very important for psychologist to be partners, yet it is unfortunately not very common here. At least my experience shows that most of the expertise they send with the patients are not very helpful or provide and in-depth answer for the mental state of the patient, not giving their opinion for the need or contraindication of the operation from psychological point of view. Of course there are some positive examples too, but I can count them on one hand. For example in the UK there is a seminar before the operation which patients must attend, where bariatric nurses provide all needed information about the surgery. I think this is a great help for them when processing emotions and facing problems/challenges related to the operation.
D. V.: What do you think what is the reason for this attitude and how it could be solved?
Dr. P. V.: I do not know the reason, but I can tell you a story which might provide some answer. Once, a dietitian called me regarding a patient. She was quite uncomfortable and started to say how much she would not like to get in conflict with the with the surgical plans, but she thinks that this certain patient might not be the right candidate for the operation. I could not be happier for such a phone call, so I told her how thankful I am, because everyone’s interest is to find the right and long-lasting method for each patient. I told her that our goal is not to have the operation in 2-3 weeks, but to do it for the right people. Also, I truly think, that if it is the good path for someone, it will still be in a couple of month time as well.
D. V.: What do you think, how long is the ideal waiting time between the decision and the surgery?
Dr. P. V.: I think 3 to 4 months is perfect. Patients often came and say to me „Doctor Vasas, I am so prepared that I would jump on the surgical table tomorrow.” – then when our manager call then in 3 weeks about an opening for the operation in our calendar they say that they changed their minds.
Well, the ones who are coming with such elan, usually the vehemence disappears with the same speed.
This is one of the reasons why I think that a couple of months is ideal for the waiting. During there is enough time to make all tests, check what the surgery and the life post-operation is all about, and the thoughts can also settle. And it is a reasonable and foreseeable time for those who are truly determined.
D. V.: What are the risks of this operation?
Dr. P. V.: I had a change to learn in the UK, that it is necessarily to inform patients about all risks a way before the operation. Therefore I made a system here too, in which I send the Consent Statement to the patients two weeks before the surgery. Besides the risks this statement also includes the recovery process, and if there are any questions I am there to ask until the day of the operation. This seemed to be useful for more reasons: first, instead of facing the facts right before the surgery – when there is no room for extra stress – this way the patients have the time to prepare and process the information in advance. Plus, it also serves as a final filter.
D. V.: Until now, we have talked about pre-surgery happenings. What happens after the surgery? My experience is that the big work comes afterwards and not only in a physical, but also an emotional level. This is the time when support is needed the most. And I know, that you also find it important, because the medical follow-up is part of your package.
Dr. P. V.: Yes, since the beginning it was our goal to offer not only the surgery, but a sort of package deal which include the conversation before the operation and our attention post-surgery as well. We are accessible to our patients, which is very important to us, because we are the ones with the knowledge to help when they face challenges on their journey with the new stomach.
I could never imagine to “sell” the surgery only.
For instance, two ladies visited me today. They had the operation somewhere else and they came to me to ask if I could be their point of contact, and make their aftercare. Of course, I took on the role happily. We had a talk, I suggested them a couple of things to change, and they left with peace in their soul. They did not have any serious issues, they only needed someone to be able to turn to if they have questions in the future.
D. V.: I am sure you also gather statistics.
Dr. P. V.: Yes, the test results sent back by the patients are all put into our statistics, which we analyze. The outcomes give us numbers to present, and we also try to use them for improvement.
D. V.: By the way, what improvements or maybe even regression can be seen based on the patient feedbacks?
Dr. P. V.: Thankfully, there are not a lot of negative feedbacks. What comes up are more in a form of questions and mainly in the first period, when the new lifestyle is established. I see the patients to be more relaxed, proud of themselves and coming with a huge smile on their face. They are very thankful which makes me/us also happy.
D. V.: Last but not least, to who would you suggest to go under WLS?
Dr. P. V.: I suggest the weight loss operation to people who are morbidly obese and could not loose weight any other way or gained back all what they have lost. The most important is to know what this operations is only a help, a crutch, not magic! So, only the ones will be successful who think of it was part of a longer process and change their lifestyle forever. Those who do not do it can gain the weight back, and more than likely will gain it back.
We are here to give all the help in our power for this process to be successful. Yet, at the end of the day, we are not the real warranty for success, but the patient him/herself and his/her persistence till the end.