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WEIGHT LOSS SURGERIES

Generalities

It exist multiple types of surgeries for obesity described in medical literature. Some of these have been able to pass the test of time and they are continuously being made at present time.
It is very important that the patient who plans to get the weight loss surgery completely understands that all surgery techniques imply risks and complications, pre and post op. Therefore the patient and his/her family must agree these entire prior to the surgery about the probable necessity of surgical operations according to the needs.

It must be clear that the surgery is not a magical trick as far as results. It´s possible to be waited for bumps with the majority of the used techniques. The patient must be clear that he/she must put a lot of effort, follow suitably the indications of diet and change of nourishing habits and to do exercise. Only with the positive attitude and the aid of our multidisciplinary team, our patients have obtained and maintained a suitable reduction of their weight.

The bariatric surgeries can be divided in RESTRICTIVE, MALABSORPTIVE and MIXED.

The restrictive ones are those in which the aid of some device or surgical stapling is used to limit the gastric capacity and in this way the patient loses weight when ingesting less food, example of these are the intragastric balloon, the gastric band, vertical gastroplasty and the gastric pacemaker.

The malabsorptive techniques tend to diminish the absorption of certain type of nutrients changing by surgical means the passage of biliary and pancreatic secretions and its union with foods. The biliopancreatic derivation and the duodenal switch are examples of these malabsorptive techniques. The gastric by pass, considered by the gold standard in the bariatric surgery uses a restrictive part and another malabsorptive.

At international forums it has been discussed the future of the bariatric surgery and a good number of experts consider that even an ideal procedure has not been devised which frees possible problems and complications.

Bariatric Adjustable Gastric Band

Surgery Type: Restrictive

Description:
The bariatric adjustable gastric band also known as lap band weight loss consists of the placement of a device, using laparoscopic surgery. The device is placed around the stomach and it owns a ball that can be fit through a valve (port) that is located in the abdominal wall of the patient. This is how the device limits the amount of foods producing satiety and even discomfort each time that the patient eats in a not allowed proportion.

Advantages:

a) It does not alter the gastric anatomy in any important form
b) Reversible
c) Technically faster placement

Disadvantages:

It requires adjustments for its appropriate functioning.
Not a weight loss percentage over a 70% of the excess is achieved.

Complications:

  • Sliding
  • Gastric perforation
  • Gastric erosion
  • Vomiting
  • Iimpossibility to produce restriction
  • Impossibility to place it

Laparoscopic gastro yeyunal by pass

Surgery Type: mixed restrictive and malabsorptive

Description:
The laparoscopic gastric Bypass consists of reducing the gastric size with a surgical stapler cutting the stomach and leaving a pouch of approximately 30 ml. Then the small bowel splits to a "y" form and in this way changes the course of the biliopancreatic secretions and also gets together this one "y" to the gastric pouch so that the food continues for a different course.

This technique requires of cuts and gastrointestinal unions that are the places that would be able eventually to produce problems of "leaks". For that reason the risk exists like splits inherent in the procedure.

Once the surgery is done, the patient must be put under specific diets and vitamin C supplements to be able to obtain a proper reduction of weight with suitable nutrition.

Advantages:
a) Does not require of adjustments, but of a periodic control

b) It is considered to be the standard of the bariatric surgeries since very good results are achieved in the descent of weight (approximately 80 % of the excess)

Disadvantages:

  • Posibility of surgical complications (4%)
  • Ocassional vomiting
  • Surgical re interventions may be required
  • Irreversible alteration of the gastrointestinal anatomy
  • It requires of Vitamin supplements for the post surgical

Complications:

  • Bleeding trans and post surgical
  • "Leaks"
  • Internal hernia
  • Obstrucción intestinal
  • Pulmonary embolism
  • Syndrome of respiratory distress of the obese one
  • Death

Bilio pancreatic deviation and duodenal switch

Surgery Type: Malabsorptive

 Description:
A gastric reduction is realized not as important as the by pass. Then the small intestine is cut and united so much of the food as the digestive secretions get together in a common roast of approximately a meter before arriving at the colon. The result is that the bad absorption of nutrients can produce important diarrhea and flatulence in some patients. This type of surgery is used for patients with a very extreme obesity with a IMC over 50 Kg./ m2. It produces a weight reduction over the 90% of the excess. A great majority of patients complain of their frequent diarrhea.

The complications are basically the same as in the Bypass Surgery.

Sleeve gastrectomy

Type of procedure: Restrictive

This type of surgery has become very popular recently. It consists of a gastrectomy using laparoscopic surgery that dries off a big area of the stomach that is in charge of producing a hormone called Ghrelin, Which is the hormone of the appetite. Gastric resection is done with surgical staples making a gastric tubular pouch that produces a restriction for the food passes through.
The results of this technique are compared enough to the results of the gastric by pass and can be used as first step surgery in patients with the highest obesity level. This is a technique that definitely promises a lot as final treatment.

Intragastric balloon

 Type of procedure: restrictive endoscopic

This type of therapy consists of a silicon ball that is placed under endoscopic vision producing a “gastric fullness" sensation so the patient diminishes the amount of ingested food, getting as a result the lost of weight.
It is used as a therapy in patients whose index does not qualify for surgery and also those who must diminish its index to minimize surgical complications. Some patients with Intragastric balloon have intolerance or vomits and it is necessary to retire it.

Gastric pacemaker

Type of procedure: restrictive

It consists in placing an impulse generator in a subcutaneous "bag", which is designed in the abdominal wall in order to connect it to an electrode that enters to the cavity and it is placed in the laparoscopic way into the stomach, so the gastric emptying will be regulated this way. The patient will feel a sensation of satiety that will prevent him/her from keeping on eating.

Review Surgeries

Review surgeries are those made to patients that already have a bariatric procedure that for some reason has failed.

I.E.: the patient who had a lapband placed and then he/she would like the band to be removed and turn into by pass. Or the patient, who has a vertical frustrated gastroplasty, then is necessary to turn his/her to bypass. These cases sometimes are very difficult to do laparoscopically and it can be necessary convert an open surgery.






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