Bariatric Surgery Procedures
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Obesity is unfortunately more and more common. Meanwhile, surgical techniques evolve, and their indications must be well laid because they are not deprived of any side effect just like other procedures. The principle of surgery for obesity is the reduction of ingestion and more or less the absorption of food through various operations: gastric banding, sleeve Gastrectomy, bypass and gastric balloon. This is the set of surgical techniques available to treat severe obesity. This type of surgeries is recommended for people with a higher body mass index (BMI: Weight in kg on height in cm squared) of 40 or 35 with co-morbidities such as diabetes, hypertension, difficulty in breathing, etc. People who maintain the same weight even after diets and leading a disciplinary lifestyle are advised to undergo one of these procedures. The eligible age for weight loss surgery should be between 18 and 60 years old and the individual must have a real desire to lose weight and be ready to change their eating habits. Surgery alone is not enough. Surgery is contraindicated for people who suffer from unstable depression, alcoholism, a health problem making general anesthesia risky, or an inflammatory disease of the digestive tract.
A bariatric surgery should be scheduled only after several examinations with different specialties such as gastroenterologist, nutritionist, psychiatrist, a digestive surgeon and an anaesthesiologist. They will each look for contraindications to the surgery, evaluate the patient's motivation and explain the overall intervention.
Duration, hospitalization and nutrition
Depending on the type of intervention and the general condition of the person, the procedures last from one to 3 hours on average and the hospitalization duration varies from 1 to 4 days sometimes outpatient. It can be prolonged if complications occur after the procedure. At least the patient should take about 10 to 15 days off. Like any intervention on the abdomen, the after-effects can be painful. Pain medications are prescribed to reduce any feeling of discomfort. After the procedure the patient can eat foods with a modified consistency: first liquid then in the form of puree. Gradually they resume their solid diet. To avoid unpleasant surprises such as vomiting, pain, etc, it is very important to follow the dietary advice.
Weight Loss techniques
The intervention of Sleeve gastrectomy, also known as vertical gastroplasty, involves removing a large part about 2/3 of the stomach to form a tube. Foods will first be slowed down through the tube and then evacuated very quickly in the small intestine. The Sleeve acts by several mechanisms; the volume and caliber of the stomach are diminished, the passage of food is very slow, but there is no change in the food digestion. A decrease in the rate of ghrelin, which is the hormone of hunger, and thus the individual loses interest in food. The modification of the bacterial flora of the esophagus acts on the food taste and makes patients much less attracted to meat and starchy foods, and much more attracted to fish and green vegetables.
The Gastric banding is a restrictive intervention and lasts about one hour. In fact, it reduces the volume of the stomach and decelerates the food passage but it does not disturb its digestion. The surgeon places a band around the higher section of the stomach in order to create a small pouch. As a result, little quantity of nutriments is sufficient to fill the stomach and the feeling of satiety appears quickly. Food will flow very slowly similar to the sand-glass principle.
The gastric bypass is a restrictive and malabsorptive technique that reduces both the amount of food ingested since the size of the stomach is reduced to a small pouch. Besides, these foods are assimilated by the body, thanks to a short circuit of the part of the stomach and intestine. Nourishment goes directly into the middle part of the small intestine and is therefore digested in smaller quantities. This technique is recommended because it limits the pain and allows you to regain normal activity more quickly.
The intragastric balloon is placed endoscopically by natural means allowing the gastroenterologist to verify the absence of pathology of the digestive tract and the correct positioning in height of the balloon. When the balloon has been inserted in the stomach it is filled either with a sterile saline solution such as bluish methylene or air by means of a catheter attached to the balloon. Once the balloon is filled the doctor pulls on the inner end of the catheter and removes it. The balloon has a closure system that prevents leakage of liquid or air. The ball floats freely in the stomach. This method lasts less than one hour.
Advices after bariatric surgery
After bariatric surgery the patient will lose fat very fast the first month then it slows down. Generally, three months following the surgery they will have lost half of their initial body weight. This process will continue in a slowly manner until 12 months. For example, if you lose 20 kg in three months you will have lost after one year 40 kg in total. Beyond one year a moderate weight regain can occur approximately 10% of the initial total loss. It is essential to be Followed-up by a dietician and respect their dietary advice. Physical activity should be prohibited for six weeks after the gastric surgery in order to avoid a weight regain.
In case of sensations of discomfort with abdominal pain may occur in the form of cramps accompanied by sweating weakness and sometimes diarrhea. Patients are prohibited from fast ingestion of fatty or sweet food or even drinking while eating. As for women pregnancy is possible, however it is recommended to wait 18 to 24 months after the procedure. A close monitoring of your nutritional status before and during pregnancy will be put in place.
Specific dietary supplements and medications must be taken to avoid nutritional deficiencies and serious neurological complications. It is advised to regularly carry out a nutritional and vitamin assessment.