05 22 25 73 63 drmkohen@gmail.com
Angle Rue Kadi Iass et Rue Ahmed El Mejjati, Maarif, Casablanca
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Obesity surgery in Casablanca

Personalised care: a full assessment, selection of the technique with the most appropriate benefit-risk balance, and long-term medical and nutritional follow-up.

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Techniques

Procedures offered

01 Sleeve gastrectomy Read this section 02 Gastric bypass Read this section 03 Transit bipartition Read this section 04 Intragastric balloon Read this section

Understanding obesity

A chronic disease that requires comprehensive care

Obesity is a complex chronic disease that can have significant consequences for health and quality of life. It can contribute to or worsen type 2 diabetes, high blood pressure, obstructive sleep apnoea, certain cardiovascular diseases, joint pain and a number of other conditions.

Managing it is not simply a matter of wanting to lose weight. Treatment must take account of each patient’s weight history, eating behaviour, metabolism, associated conditions and personal circumstances.

Where medical, nutritional and behavioural treatment does not achieve sufficient and lasting improvement, obesity surgery — also known as bariatric and metabolic surgery — may be considered in selected patients.

In Casablanca, Dr Mohamed Kohen offers a personalised assessment to determine whether surgery is indicated and, if so, which technique offers the most appropriate benefit-risk balance for that patient’s situation.

Your surgeon

Dr Mohamed Kohen, digestive and bariatric surgeon in Casablanca

Dr Mohamed Kohen is a visceral and digestive surgeon in Casablanca. A former chef de clinique at Nantes University Hospital (CHU de Nantes) and former university assistant in Nantes, he has practised digestive surgery for more than thirty years.

His practice covers obesity surgery, cancer surgery and the surgical management of other digestive conditions.

In bariatric surgery his approach rests on one essential principle: there is no single operation that suits every patient. Sleeve gastrectomy, gastric bypass and the other metabolic surgery techniques work through different mechanisms and answer different indications.

Former chef de clinique — CHU de Nantes 30+ years’ experience Casablanca — Maarif

Decision criteria

What the choice of operation must take into account

The choice of operation must take account of:

  • body mass index (BMI)
  • age and general condition
  • how long the obesity has been present
  • previous weight-loss attempts
  • eating habits and behaviour
  • the presence of type 2 diabetes
  • the presence of gastro-oesophageal reflux
  • obstructive sleep apnoea
  • other conditions associated with obesity
  • medical and surgical history
  • the ability to commit to long-term medical and nutritional follow-up

The decision to operate is taken after a full assessment and detailed information on the expected benefits, the constraints, the alternatives and the risks of each technique.

Definition

What is bariatric and metabolic surgery?

Bariatric surgery covers a number of operations used to treat certain forms of obesity.

It does not work through a reduction in stomach volume alone. Depending on the operation performed, several mechanisms may be involved: reduced gastric capacity, altered satiety, altered intestinal transit, and hormonal and metabolic effects.

This is why the term metabolic surgery is also used, particularly where the therapeutic aim includes improving metabolic diseases associated with obesity.

Surgery is nonetheless one stage in an overall treatment pathway. It replaces neither the preoperative preparation nor the postoperative follow-up.

Diet, physical activity, medical and nutritional monitoring and — depending on the technique — vitamin and mineral supplementation remain essential to long-term results.

Indications

Who is obesity surgery for?

The indication for bariatric surgery cannot be based on the patient’s weight alone.

BMI is an important part of the assessment, but the decision also takes account of conditions associated with obesity, treatment already undertaken, the metabolic profile and individual circumstances.

Current international guidelines have broadened the historical indications for metabolic and bariatric surgery. A specialist assessment remains essential to confirm the indication, look for any contraindications and select the appropriate technique.

A consultation with the surgeon allows the medical file, past history, weight history and the patient’s expectations to be reviewed before any decision is made.

Surgical techniques

The main obesity surgery techniques

Four approaches with different mechanisms and different indications. The choice is made after individual assessment.

01

Sleeve gastrectomy

Sleeve gastrectomy, or longitudinal gastrectomy, involves removing a large part of the stomach so that it becomes a gastric tube of smaller capacity.

The operation works through several mechanisms. The reduced gastric volume limits the amount of food consumed, and the anatomical changes also affect some of the hormonal mechanisms involved in hunger and satiety.

Sleeve gastrectomy is generally performed as minimally invasive laparoscopic surgery.

The indication must be individualised. In particular, significant gastro-oesophageal reflux must be carefully assessed before this technique is chosen.

Discuss sleeve gastrectomy at a consultation
02

Gastric bypass

Gastric bypass combines the creation of a small gastric pouch with a modification of the intestinal circuit.

It works through several combined mechanisms: a reduction in the amount of food consumed, a change in how food passes through the digestive tract, and hormonal and metabolic effects.

This operation may be of particular value in certain patients depending on their metabolic profile, eating habits, past history and any gastro-oesophageal reflux.

Gastric bypass requires regular medical and nutritional follow-up, long-term blood monitoring and appropriate supplementation.

Discuss gastric bypass at a consultation
03

Transit bipartition

Transit bipartition is a metabolic surgery technique that combines a gastric procedure with a modification of the intestinal circuit.

It creates a second pathway allowing part of the food to reach the distal intestine more quickly, while maintaining passage through the usual digestive circuit.

This technique may be discussed in certain specific situations, depending in particular on the degree of obesity, the metabolic profile and the presence of associated conditions.

Like all bariatric and metabolic surgery, it requires careful patient selection, full information and prolonged medical and nutritional follow-up.

Discuss transit bipartition at a consultation
04

Intragastric balloon

The intragastric balloon is a temporary endoscopic technique.

A balloon is placed in the stomach to occupy part of its volume and encourage earlier satiety.

It is not a surgical procedure, and its indications differ from those of sleeve gastrectomy, gastric bypass or other metabolic surgery procedures.

Results depend in particular on patient selection and on the quality of nutritional and behavioural support.

Discuss the gastric balloon at a consultation

Sleeve or bypass

How to choose between them

The question “sleeve or bypass?” comes up often in consultation. There is, however, no universal answer.

Sleeve gastrectomy and gastric bypass are two different operations in their anatomy, their mechanisms, their potential benefits and their constraints.

The choice depends on BMI, eating behaviour, the presence of type 2 diabetes or gastro-oesophageal reflux, digestive and surgical history, and the patient’s expectations.

The best operation is therefore not necessarily the newest or the most talked about. It is the one with the most appropriate benefit-risk balance for that patient, following individual assessment.

Before surgery

The pathway before bariatric surgery

Obesity surgery requires preparation.

The preoperative workup has several aims: to assess general condition, to look for the consequences of obesity, to identify associated conditions, to examine eating behaviour and to identify factors that may influence the choice of operation.

Depending on the clinical situation, the assessment may involve several professionals: surgeon, anaesthetist, nutritionist or dietitian, gastroenterologist, endocrinologist and, where necessary, other specialists.

The workup may also include blood tests, digestive investigation and further tests appropriate to the patient’s profile.

This period of preparation allows the patient to understand the operation, its expected benefits, its risks, the dietary changes required and the importance of long-term follow-up.

The operation

What does the operation involve?

Most bariatric procedures are now performed using minimally invasive surgery.

The operative technique, the length of hospital stay and recovery all vary according to the operation performed and the patient’s situation.

After the operation, eating is resumed gradually according to an appropriate protocol. Early mobilisation and the prevention of thromboembolic complications form part of postoperative care.

Discharge instructions and the follow-up schedule are explained to the patient before they return home.

After surgery

What follow-up after a sleeve or a bypass?

Follow-up after bariatric surgery is an essential component of treatment.

During the first few weeks, monitoring mainly concerns postoperative recovery, wound healing, hydration and the gradual resumption of eating.

In the medium and long term, follow-up allows monitoring of:

  • changes in weight and body composition
  • the quality of the diet
  • digestive tolerance
  • the course of diabetes and other associated conditions
  • blood and nutritional results
  • any vitamin and mineral deficiencies
  • adjustment of medical treatment
  • maintaining or resuming appropriate physical activity
  • overall quality of life

Surgery is an effective treatment for severe obesity in properly selected patients, but the quality of follow-up contributes directly to the safety and durability of the results.

Consultation

A personalised decision

A first consultation for obesity does not mean that surgery will necessarily be proposed.

It allows the history of the condition to be understood, the treatment already undertaken to be assessed, and whether surgery may be appropriate to be determined.

Dr Mohamed Kohen sees patients in Casablanca seeking an assessment for obesity surgery and performs a range of techniques, including sleeve gastrectomy, gastric bypass and, where indicated, other metabolic procedures such as transit bipartition.

Every indication is discussed individually. The aim of the consultation is to propose a strategy suited to the patient’s situation and to give clear information on the expected results, the treatment alternatives, the demands of follow-up and the potential risks.

Frequently asked questions

Frequently asked questions about obesity surgery

What BMI do you need to be considered for obesity surgery?
BMI is an important factor but is not, on its own, enough to decide on surgery. Current international guidelines also take account of metabolic disease and conditions associated with obesity. A definitive indication requires specialist medical assessment.
Which is the best operation for losing weight?
There is no single operation that is best for every patient. The choice depends on the individual profile, BMI, associated conditions, eating behaviour, any reflux, and medical and surgical history.
What is the difference between a sleeve and a bypass?
The sleeve reduces the volume of the stomach without altering the intestinal circuit. The bypass combines a small gastric pouch with a modification of the intestinal route. The two techniques have different mechanisms, benefits, risks and follow-up requirements.
Can you regain weight after bariatric surgery?
Weight regain is possible after any bariatric technique. Long-term follow-up, diet, physical activity, eating behaviour and certain anatomical or metabolic factors can all influence how weight develops.
Can diabetes improve after bariatric surgery?
In some patients with type 2 diabetes and obesity, metabolic surgery can lead to a significant improvement in blood glucose control and sometimes to remission. The result varies with how long the diabetes has been present, its severity and the individual patient profile.
How long is the hospital stay?
The length depends on the operation performed, the patient’s general condition and the postoperative course. It is specified case by case by the surgical team.
Is follow-up compulsory after a sleeve or a bypass?
Long-term medical and nutritional follow-up is strongly recommended after any bariatric surgery. It allows monitoring of weight, digestive tolerance, associated conditions and the risk of nutritional deficiencies.

Consultation

Book an obesity consultation in Casablanca

Would you like to know whether obesity surgery might suit your situation? A consultation allows your medical file, your weight history and your goals to be assessed, and the different treatment options to be identified.

Book an appointment with Dr Mohamed Kohen
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