Discussing New Developments with Dr. Sherif Hakky
Over the years, diabetes has come to be known as one of the most challenging chronic diseases, not only in Egypt, but also all over the world. Cairo West Magazine was fortunate to have the opportunity to chat with Dr. Sherif Hakky, a leading surgeon in the field of bariatric surgery. He gives our readers an insight into the latest developments in tackling this endemic condition.
CWM: What is the prevalence of diabetes and obesity worldwide, and in Egypt?
SH: Unfortunately, Egypt currently ranks the 11th in worldwide obesity, with more than 55 million people considered overweight, this has risen alarmingly over the last few years. Obesity leads to Type 2 diabetes, which in Egypt affects a monumental 15.6% of all adults aged 20 to 79. The International Diabetes Federation (IDF) has identified Egypt as the ninth leading country in the world for the number of patients with Type 2 diabetes, a major cause of kidney failure, blindness, nerve damage, amputations, heart attack and stroke. It has almost tripled over the last two decades due to the fact that we are carrying more weight and eating the wrong things.
What has research come up with regarding metabolism-changing surgical procedures for Type 2 diabetes?
Only just recently a groundbreaking development has occurred in the field of diabetes management. Guidelines published by the American Diabetes Association in May 2016 have proposed that weight-loss surgery is the standard treatment option for obese patients.
Those new guidelines have been endorsed by 45 professional societies around the world. This has to be one of the most exciting developments in the field of medicine in decades, because only twenty years back if someone came out and said that an operation will be the solution to one of the most challenging chronic diseases, people would have called him crazy. The new guidelines advise that such procedures be considered specifically for patients whose Body Mass Index (BMI) is greater than 30 (or 27.5 for people of Asian descent). BMI is calculated as the height/weight2.
Commonly the most common treatment given by doctors to help regulate the blood glucose levels in one’s body is insulin. However, this differs depending whether the patient is diagnosed with Type 1 or Type 2 diabetes. Also, the latter type requires one to commit to a relatively good nutritional program and a suitable workout routine on almost a daily basis. With the current medical breakthroughs and after expansive research, the alternative treatment has been discovered to alleviate the ongoing struggles of marginalized obese diabetics.
How long has this been under study?
You would be surprised to know that the first observation about this was nearly a hundred years ago. It was actually by pure coincidence, where a scientist described the improvement of diabetes as a “side effect “ of peptic ulcer surgery. All the credit goes to Dr. Francesco Rubino, Chair of Metabolic and Bariatric Surgery at King’s College London, who led the scientific breakthrough in the 1990’s, then spent almost two decades researching this to the letter until the guidelines came out and got endorsed.
How is the operation carried out?
It is done by key hole (laparoscopic) surgery and can be done by either making the stomach smaller (sleeve gastrectomy) or by connecting the intestines directly to the smaller stomach (gastric bypass).
How long does the operation take?
It varies in time, but it takes about an hour to do most cases. But cases can differ and you can never really give an exact time.
What is the recovery period?
The operation is done by keyhole surgery and the patient leaves the hospital the next day. They are back to work during the same week.>>
What level of weight loss can be expected? And over what period?
The level of weight loss that can be expected is roughly 33% of the total body weight, over a year. The weight loss is maintained thereafter, and that is the key benefit. I still remember a patient who dropped from 150 Kg to 100 Kg, he came to his one-year follow-up and told me that he had been walking around for the last 15 years of his life “carrying a sack of cement” (shayel shekaret asmant).
What are the possible side effects or risks?
These operations require a lot of technical skill that is acquired through performing thousands of cases in a high volume center, and when one achieves that level of performance, the complication rate is at its lowest. The potential side effects occur in no more than 1.8% of the cases when this level of performance is achieved, and includes poor healing of the surgical staple line that might lead to leakage of the stomach juices. This is very manageable when diagnosed early. Just to put this number into perspective, this complication rate is similar to that of a gallbladder surgery, a standard every-day procedure.
Is the procedure suitable for everyone?
Absolutely not, is the simple answer. There are strict international guidelines. It is only suitable for patients with uncontrolled diabetes and a BMI of more than 30. Or those with a BMI of more than 35 and a health problem related to obesity.
Does it impact nutrition and food assimilation? And do you need to take supplements after the procedure?
There is a common misconception about this. The food is digested and the nutrients are absorbed. The multivitamins and minerals that the patients are prescribed after the surgery are to complement, rather than supplement, the diet. The surgery needs to be done expertly in a specific way for one to achieve this outcome.
What other lifestyle adjustments are recommended as an adjunct to surgery? And can a person with an active lifestyle work out and exercise normally when they have had the procedure?
Great question! This surgery needs to be seen as a lifestyle change, rather than an easy way out. One has to start being more active and have a completely different outlook on life and health. If one sits back and relies on the fact that they have had weight loss surgery, they will not achieve the best outcome; we encourage exercise. I have had a patient who ran a marathon and another who is now a regular tri-athlete. We ask all the patients to walk for half an hour starting day two after the surgery, and most patients will go on to develop a much more active lifestyle once they have shed the kilograms. They find themselves lighter and able to do a lot more and are finally able to enjoy playing sports again.