bariatric surgery (weight loss surgery) includes various procedures performed on obese people. Weight loss is achieved by reducing the size of the stomach with a gastric band or through partial removal of the stomach (gastrectomy of the arm or biliopancreatic transfer by duodenal switch) or by rearranging and re-route the small intestine into the small abdominal sac (gastric bypass surgery).
Long-term studies show procedures for causing long-term weight loss, recovery from diabetes, increased cardiovascular risk factors, and reduced mortality from 40% to 23%. The US National Institutes of Health recommends bariatric surgery for obese individuals with a minimum body mass index (BMI) of 40, and for people with a minimum BMI of 35 and serious joint medical conditions such as diabetes. However, emerging studies suggest that bariatric surgery may be appropriate for those with a BMI of 35-40 without comorbidity or BMI 30 to 35 with significant comorbidities. American Society for Metabolic & amp; Bariatric Surgery Guidelines suggest position statements on consensus for BMIs as an indication for bariatric surgery. Recent guidelines show that any patient with a BMI of more than 30 with comorbidity is a candidate for bariatric surgery.
Video Bariatric surgery
Indication
A medical guide by the American College of Physicians concludes:
- "Surgery should be considered as a treatment option for patients with a 40 kg/m 2 or greater mass instituted but fails with adequate exercise and diet programs (with or without adjunctive drug therapy ) and those present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. Doctor-patient discussions about surgical options should include long-term side effects, such as the possibility of re-surgery, gallbladder disease, and malabsorption. "
- "Patients should be referred to a high-volume center with experienced surgeons in bariatric surgery."
Surgery is contraindicated in patients with end-stage disease and also in patients who are not committed to making lifestyle changes that are considered ideal for surgery.
In 2011, the International Diabetes Federation issued a position statement indicating "In some circumstances, people with BMI 30-35 must be eligible for surgery." When determining eligibility for bariatric surgery for very obese patients, psychiatric examination is essential; it is also important to determine postoperative success. Patients with a body mass index of 40 kg/m 2 or greater had a fivefold risk of depression, and half of bariatric candidate candidates were depressed.
Maps Bariatric surgery
Classification of surgical procedures
Procedures can be grouped into three main categories: blocking, limiting, and mixing. The standard of care in the United States and most of the industrial world in 2009 was for laparoscopy as opposed to open procedures. Future trends seek to achieve the same or better results through endoscopic procedures.
Blocking procedure
Some procedures preclude the absorption of food, although they also reduce the size of the stomach.
Biliopancreatic redirects
This operation is called biliopancreatic redirection (BPD) or Scopinaro procedure . The original form of this procedure is now rarely done due to problems with. It has been replaced with a modification known as duodenal switch (BPD/DS). The abdomen is resected, making the stomach smaller (but the patient can eat free food because there are no restrictive components). The distal portion of the small intestine is then connected to the pouch, passing through the duodenum and jejunum.
Approximately 2% of patients experience severe malabsorption and nutritional deficiencies requiring normal absorption recovery. The malabsorptive effects of BPD are so strong that, as in the most rigorous procedure, those undergoing the procedure must take vitamins and minerals of food above and beyond that of the normal population. Without these supplements, there is a risk of serious deficiency diseases such as anemia and osteoporosis.
Since gallstones are a common complication of rapid weight loss after all types of bariatric surgery, some surgeons lift the gallbladder as a precautionary measure during BPD. Others prefer prescribing medications to reduce the risk of postoperative gallstones.
Fewer surgeons perform BPD compared to other weight-loss surgeries, partly because of the need for long-term nutritional follow-up and monitoring of BPD patients.
Jejunoileal Cutting
This procedure is no longer done. This is a weight-loss procedure undertaken to remove morbid obesity from the 1950s through the 1970s in which all except 30 cm (12 inches) to 45 cm (18 inches) of the small intestine is dislodged and set to the side.
The endoluminal arm
A human study was conducted in Chile using the same technique but the results were not conclusive and the device had problems with migration and slipping. A recent study conducted in the Netherlands found a decrease of 5.5 BMI points in 3 months with the endoluminal arm.
Restricting procedures
Procedures that limit the size of the stomach or take up space in the stomach, make people feel fuller when they eat less.
Vertical banded gastroplasti
In a vertical stubborn gastroplasty, also called a Masonic procedure or staple of the abdomen, the abdomen is permanently clamped to make a smaller pre-gastric sac, which functions as a new stomach.
Adjustable gastric band
Gastric restriction can also be made using silicone bands, which can be adjusted by the addition or removal of saline through ports placed just below the skin. This operation can be done laparoscopically, and is commonly referred to as a "lap band". Weight loss is mainly due to the restriction of nutrient intake created by small gastric pockets and narrow outlets. This is considered one of the safest procedures currently performed with a 0.05% mortality rate.
Gastrectomy arm
Gastrectomy of the arm, or arm of the stomach, is a weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of most of the stomach, following the main curve. The open edges are then affixed together (usually with surgical staples, stitches, or both) to leave the stomach shaped more like a tube, or arm, with a banana shape. This procedure permanently reduces the size of the stomach. This procedure is performed laparoscopically and can not be reversed. It has been shown to be comparable in effectiveness to the Roux-en-Y gastric bypass.
Intracrific balloons (gastric bubble)
An intravastric balloon involves placing a deflated balloon into the abdomen, and then filling it to reduce the amount of stomach space. Balloons can be left in the abdomen for a maximum of 6 months and produce an average weight loss of 5-9 BMI for half a year. Intragastric balloons are approved in Australia, Canada, Mexico, India, United States (received FDA approval by 2015) and some European and South American countries. Intragastric balloons can be used before other bariatric surgeries to help patients achieve the appropriate weight for surgery, furthermore it can also be used on several occasions if needed.
There are three categories of costs for intragastric balloons: preoperative (eg professional costs, lab work and testing), the procedure itself (eg surgeon, surgical assistant, anesthesia and hospital costs) and postoperative (eg visiting follow-up doctor, vitamins and supplements).
Quoted charges for intragastric balloons are special surgeons and vary by region. The average cost quoted by region is as follows (provided in United States Dollar for comparison): Australia: $ 4,178 USD; Canada: $ 8,250 USD; Mexico: $ 5,800 USD; United Kingdom: $ 6,195 USD; United States: $ 8,150 USD).
Abdominal stomach
Basically, this procedure can be understood as a gastric surgery version or a more popular gastrectomy operation in which the arm is made with sutures rather than lifting the abdominal tissue thus retaining its natural nutrient absorption ability. Gastric provision significantly reduces the patient's stomach volume, so the smaller amount of food provides a sense of satiety. This procedure produced some significant results published in a recent study at Bariatric Times and was based on postoperative outcomes for 66 patients (44 women) who underwent an arm gastric plaque procedure between January 2007 and March 2010. The patient age was flat average 34 years, with an average BMI of 35. Follow-up visits for safety assessment and weight loss are scheduled periodically in the postoperative period. No major complications were reported among 66 patients. The weight loss results are proportional to the gastric bypass.
This study describes the hull of the plication arm (also referred to as laparoscopic plaque hull or lapar plaque) as a restrictive technique that removes the complications associated with adjustable stomach and vertical arm gastrectomy - this is by creating restrictions without the use of implants and without gastric resection (cutting) and staples.
Mixed procedure
The mixed procedure implements blocking and limiting at the same time.
Stomach bypass operation
The general form of gastric bypass surgery is the Roux-en-Y gastric bypass, which is designed to reduce the amount of food a person can eat by cutting off the abdomen. Gastric bypass is a permanent procedure that helps the patient by altering how the stomach and small intestine handle the food eaten to achieve and maintain the goal of weight loss. After surgery, the stomach will become smaller. A patient will feel full with less food.
Gastric-bypass surgery is the most commonly performed surgery for weight loss in the United States, and about 140,000 gastric-bypass procedures were performed in 2005. Its market share has declined since then and in 2011, the frequency of gastric bypass is considered to be less than 50% of the market weight loss surgery.
One factor in the success of bariatric surgery is strict post-surgical adherence to a healthy diet.
There are certain patients who can not tolerate the malabsorption syndrome and the discharges associated with gastric bypass. In such patients, although previously regarded as an irreversible procedure, there are cases where gastric-bypass procedures may be partially reversed.
Gastrectomy of the arm with duodenal switch
Variations of the biliopancreatic diversion include the duodenal switch. The stomach along the larger curve is resected. The belly is "tubulized" with a residual volume of about 150 ml. This volume reduction provides a restriction component of food intake from this operation. Anatomical and functional resection types can not be changed. The abdomen is then disconnected from the duodenum and connected to the distal part of the small intestine. The duodenum and the top of the small intestine are connected to the rest about 75-100 cm from the large intestine. Steps of Gastric & amp; Procedure
Implant stomach stimulation
This procedure in which a device similar to a pacemaker is implanted by a surgeon, with electrical instructions stimulating the outer surface of the stomach, is being studied in the United States. Electrical stimulation is thought to alter the activity of the enteric nervous system, which is interpreted by the brain to provide satiety or fullness. Preliminary evidence suggests that it is less effective than other forms of bariatric surgery.
Eat after bariatric surgery
Immediately after bariatric surgery, the patient is limited to a diet of clear liquid, which includes foods such as clear broth, diluted fruit juice or sugar-free beverages and gelatin dessert. This diet is continued until the gastrointestinal tract has recovered slightly from surgery. The next stage provides a sugar-free diet mixed or pulp for at least two weeks. It may consist of high protein, liquid or soft foods such as protein shakes, soft meats, and dairy products. High carbohydrate foods are usually avoided when possible during periods of early weight loss.
Postoperatively, overeating is curbed because it exceeds the capacity of the stomach causing nausea and vomiting. Dietary restrictions after recovery from surgery partly depend on the type of surgery. Many patients will need to take multivitamin pills daily for life to compensate for the reduced absorption of essential nutrients. Because patients can not eat large amounts of food, doctors usually recommend a diet that is relatively high in protein and low in fat and alcohol.
Recommended fluid
This is very common, in the first postoperative month, for the patient to experience volume depletion and dehydration. Patients have difficulty drinking the right amount of fluids because they adapt to their new stomach volume. Limitations of oral fluid intake, reduced calorie intake, and higher incidence of vomiting and diarrhea are all factors that contribute significantly to dehydration. To prevent depletion of fluid volume and dehydration, at least 48-64 fl oz (1.4-1.9 L) should be consumed with small repeated gulps throughout the day.
Operating effectiveness
Weight
In general, malabsorptive procedures lead to more weight loss than restrictive procedures; However, they have a higher risk profile. A meta-analysis from the University of California, Los Angeles, reported the following weight loss in 36 months:
- Biliopancreatic redirection - 117 Lbs/53Ã, kg
- Roux-en-Y hull shortcut (RYGB) - 90 Lbs/41Ã, kg
- Open - 95 Lbs/43Ã, kg
- Laparoscopy - 84 Lbs/38Ã, kg
- Sticky vertebral Gastroplasti - 71 Lbs/32 kg
A 2017 meta-analysis showed bariatric surgery to be effective for weight loss in adolescents, as assessed 36 months after the intervention. The same meta-analysis noted that additional data are needed to determine whether it is also effective for long-term weight loss in adolescents. According to the Canadian Agency for Drugs and Technologies in Health, the comparative evidence base for bariatric surgery in adolescents and young adults is "... limited to some narrow studies in scope and with relatively small sample sizes."
Another 2017 meta-analysis reported that it is effective for weight loss among unhealthy obese adults in China.
Decrease in mortality and morbidity
In the short term, weight loss from bariatric surgery is associated with a decrease in some obese comorbidities, such as diabetes, metabolic syndrome and sleep apnea, but the benefits for hypertension are uncertain. It is uncertain whether a given bariatric procedure is more effective than other procedures in controlling comorbidities. There is no high quality evidence of long-term effects compared to conventional treatment of comorbidities.
Bariatric surgery in older patients has also been the subject of debate, centering on concerns for safety in this population; the relative benefits and risks in this population are unknown.
Given the remarkable rate of diabetic remission with bariatric surgery, there is considerable interest in offering this intervention for people with type 2 diabetes who have lower BMI than is usually required for bariatric surgery, but evidence of high quality is lacking and time optimal of uncertain procedures.
Laparoscopic bariatric surgery requires hospitalization for only one or two days. Short-term complications of laparoscopically adjusted gastric abnormalities are reported to be lower than for Roux-en-Y laparoscopic surgery, and complications from laparoscopic Roux-en-Y surgery are lower than conventional (open) Roux-en-Y surgery.
Fertility
The position of the American Society for Metabolic and Bariatric Surgery in 2017 is that it is not clearly understood whether medical weight-loss treatments or bariatric surgery have a responsive effect on subsequent treatments for infertility in both men and women. Psychiatric.2 Psychiatric Psychiatry/Psychological
Several studies have shown that psychological health may increase after bariatric surgery.
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Operating costs
The cost of bariatric surgery depends on the type of procedure performed and the method of payment along with site-specific factors including geographical area, surgical practice and hospital where the operation is performed.
The four types of prescribed procedures (hull Roux-en-Y, gastric appeal, vertical arm gastrectomy (stomach arm) and duodenal switch) carry an average cost in the United States of $ 24,000, $ 15,000, $ 19,000 and $ 27,000 respectively -something. However, costs may vary significantly based on location. Quoted costs generally include fees for hospitals, surgeons, surgical assistants, anesthesia and embedded devices (if any). Depending on surgical practices, costs may include or ignore pre-operative, post-op or long-term visits.
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Adverse effects
Surgical weight loss surgery in adults is associated with relatively high risk and complications, compared with other treatments for obesity.
The likelihood of major complications from weight loss surgery is 4%. "Gastrectomy of the arm has the lowest complication and re-operative rate of the three procedures (major weight loss surgery)..... Percentage of procedures requiring repeat surgery due to complications is 15.3 percent for gastric bands, 7.7 percent for gastric and 1.5 percent for arm gastrectomy "- American Society for Metabolic and Bariatric Surgery
Because the rate of complications appears to be reduced when the procedure is performed by an experienced surgeon, the guidelines recommend that the surgery be performed in a dedicated or experienced unit. It has been observed that leakage rates are greater at low volume centers whereas high volume centers indicate lower leakage rates. Leakage rates are now globally dropping to an average of 1-5%.
Metabolic bone disease manifests as osteopenia and secondary hyperparathyroidism has been reported after the Roux-en-Y gastric bypass surgery because of reduced calcium absorption. The highest concentration of calcium transporter is in the duodenum. Because the digested food will not pass through the duodenum after a shortcut procedure, the levels of calcium in the blood may decrease, leading to secondary hyperparathyroidism, increased bone turnover, and decreased bone mass. An increased risk of fracture has also been associated with bariatric surgery.
Rapid weight loss after obesity surgery may contribute to the development of gallstones as well by increasing bile litogeneity. Adverse effects on the kidneys have been studied. Hyperoxaluria which has the potential to cause oxalate nephropathy and irreversible renal failure is the most significant abnormality seen in urine chemistry studies. Rhabdomyolysis causes acute renal injury, and impaired treatment of renal acid and base has been reported after bypass surgery.
Nutritional disorders due to micronutrient deficiencies such as iron, vitamin B12, fat soluble vitamins, thiamine, and folate are very common after malarial motor malarial procedures. Seizures due to hyperinsulinemic hypoglycemia have been reported. Inappropriate secretion of insulin due to islet cell hyperplasia, called pancreatic nedidioblastosis, may explain this syndrome.
A study completed in 2011 and published in JAMA-Surgery reported that self-harm and suicidal behaviors increased in patients with mental health problems within 5 years after bariatric surgery was performed.
src: www.mybariatriclife.org
Bariatric surgery in youth
Since childhood obesity has more than doubled in recent years and more than tripled in adolescents (according to the CDC), bariatric surgery for teenagers is becoming increasingly common. Some worry that a decrease in life expectancy may occur from an increased rate of obesity, so providing youth with the right care can help prevent serious medical complications caused by obesity and related illness. Difficulties and ethical problems arise when making decisions related to obesity care for those who are too young or unable to give consent without adult guidance.
Children and adolescents are still developing, both physically and mentally. This makes it difficult for them to make informed decisions and give consent to move forward with care. These patients may also experience severe depression or other psychological disorders related to their obesity which makes the understanding of information extremely difficult.
src: spectrum.diabetesjournals.org
History
Open weight loss surgery began slowly in the 1950s with intestinal bypass. It involves upper and lower bowel anastomosis, which passes through a large number of absorption circuits, leading to pure weight loss by food malabsorption. Later Drs. J. Howard Payne, Lorent T. DeWind and Robert R. Commons were developed in 1963 with Shunt Jejuno-colic, which connects the upper small intestine to the large intestine. Laboratory studies leading to gastric bypass did not begin until 1965 when Dr. Edward E. Mason (b.1920) and Dr. Chikashi Ito (1930-2013) at the University of Iowa developed a genuine gastric bypass to lose weight which causes fewer complications than intestinal bypass and for this reason Mason is known as "the father of obesity surgery".
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See also
- Revision of weight loss surgery
![Revision Bariatric Surgery â€]()
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References
Source of the article : Wikipedia
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