There are several types of bariatric surgery. Some of them limit the amount of food intake, while others help to reduce the absorption of nutrients in the gut, reducing the caloric content.
Laparoscopic sleeve gastrectomy (sleeve gastrectomy, plums resection, sleeve gastrectomy) is an operation to reduce the size of the body and, accordingly, the volume of food consumed.
What diagnostic tests precede the surgery?
Before resection prescribed tests, a number of studies. Some of them:
- Physical examination.
- Blood and urine tests, ultrasound of the gall bladder and other tests, studying the general state of health, to determine the feasibility of the operation.
- A chest radiograph.
- Consultations bariatric surgery, endocrinologist, nutritionist, psychologist.
How is the sleeve gastrectomy?
The clinic Assuta surgeons prefer the laparoscopic approach. General anesthesia is used. 5 or 6 is performed small incisions in the abdominal cavity, through which is introduced into the special tools. During operation is performed removing about 75% of the stomach, leaving only a small segment of a tube which is connected by means of surgical staples. He reminded vertical tube of banana or stomach. During the operation, are not affected by the sphincter muscle that allows food to enter or exit the body. The duration of surgery is between sixty to ninety minutes. A relatively short operative time is an advantage for patients with severe heart or lung disease.
Bariatric surgery can increase the risk of developing gallstones. Therefore, a doctor can recommend perform cholecystectomy (surgery to remove the gall bladder) to reduce gastric or simultaneously.
The period of stay in Israel after the surgery is about two weeks. This operation in the clinic Assuta be able to perform a leading bariatric surgeon in Israel - Dr. Khan Feigin.
How drain resection promotes weight loss?
This restrictive or restrictive operation significantly reduces body size and limiting the amount of food that can be eaten at one time. This resection does not reduce the absorption of nutrients and does not create a detour around the intestines. After drinking a small amount of food a person very quickly feel satiety while maintaining a feeling of satiety for a couple hours.
Sleeve gastrectomy can cause loss of appetite. Reduced production of the body "hunger hormone" that will promote weight loss. Information on this matter are insufficient, but in most patients the feeling of hunger is significantly reduced after surgery.
In some cases, the proposed laparoscopic sleeve gastrectomy?
Sleeve resection was successfully performed in different types of obesity. Since this is a fairly new operation, there is no information about weight loss, complications and return of body weight for 3 years.
Laparoscopic gastrectomy is mainly used as part of a phased approach to surgical weight loss. It is recommended if there is a very high body mass index; an increased risk due to anesthesia or severe heart or lung disease. Sometimes the decision to hold a two-step approach is taken before the operation in connection with the above risk factors. In other patients, the decision on the implementation of sleeve gastrectomy instead of gastric bypass surgery is taken during surgery due to an excessively large or extensive liver scar tissue as bypass procedure may be too long and unsafe.
In patients who underwent tubular resection as a first step, the second (gastric bypass) plan after 12-18 months after significant weight loss, when the risk of anesthesia is significantly lower, and liver decreased in size. Although this approach involves two procedures for the individual patient it is safe and effective.
Laparoscopic sleeve gastrectomy can also be used as the primary procedure. There is relatively little information about the application of this surgery in patients with a lower BMI, therefore, in this group of patients should be seen within the framework of clinical trials. Sleeve gastrectomy, so it is recommended in the clinic Assuta diabetics with a BMI between 30 and 40, which will more accurately identify the short and long term benefits of surgery in these patients.
Sleeve gastrectomy can be performed for the following reasons:
- A body mass index greater than 60.
- Severe concomitant disease (heart, lung or liver).
- Advanced age.
- Inflammatory bowel disease.
- The need for reception of specific drugs - anti-inflammatory drugs, immunosuppressive drugs.
- Greatly enlarged liver.
- Scarring in the intestine, observed during the operation.
- Any combination of the above factors that increase risk.
What are the weight loss after a laparoscopic sleeve gastrectomy?
At high BMI after surgery as the first stage of treatment, patients lost an average of 40-50% of the overweight in the first two years - 56.7 kg is body mass index of more than 60.
Patients with lower BMI to lose most of the weight of 60-80% for three years after gastrectomy.
What are the risks laparokospicheskoy drain-resection?
There are risks inherent in any laparoscopic procedure - bleeding, infection, breathing problems, deep vein thrombosis or pulmonary embolism, allergic reactions to medications or the need to switch to open surgery. These problems are rare.
Possible side effects of sleeve gastrectomy include - gastritis, heartburn, stomach ulcers; gastric damage during surgery, bowel or other organs; poor nutrition, the leak of the corrected body; adhesions, which can lead to intestinal blockage.
Serious complications noted in 5-10% of cases - less than with gastric bypass with duodenal switch. This is due to the fact that the small intestine is connected again to the digestion process.
In general, several risks higher than the regulated laparoscopic banding and lower than the gastric bypass.
What are the advantages of laparoscopic sleeve gastrectomy?
Depending on the pre-operative patients may lose weight from 40 to 70% of excess body weight after surgery.
Many obesity-related diseases are weakened or completely disappear after bariatric surgery - more than 75% of patients. This applies to type 2 diabetes, arthritis, asthma, gastroesophageal disease, hypertension, sleep apnea, abnormal cholesterol levels.
Although long-term studies yet, weight loss, which is observed after the drain-resection leads to significant improvements in the above-mentioned violations within the first year after surgery.
When laparoscopic sleeve gastrectomy is a good choice?
The surgeon will offer this operation as an embodiment, a BMI of 60 or above there are significant health problems which increase the risk of anesthesia or gastric bypass. Also resection may be recommended in clinical trials for lower body mass index and diabetes.
All of the available surgical procedures are discussed with the doctor, and determined the best option. The patient must know the risks and benefits of the tubular gastrectomy, bypass and banding procedures before making a decision.
So, we can make the following brief conclusions and highlight the main advantages of the sleeve gastrectomy:
- To a large extent it is applied with a BMI over 60, and serious health problems.
- In addition to reducing the amount of food consumed, there is a decreased appetite after surgery.
- Indicator serious complications is only 5-10% - higher compared with laparoscopic banding adjustable and lower than at gastric bypass.
- Weight loss on average 40-50% (56.7 kg) during the first two years with a body mass index of more than 60.
- After gastrectomy improved in general health status in 75% of patients. Diminish or disappear entirely diseases such as asthma, type 2 diabetes, hypertension, arthritis, obstructive sleep apnea syndrome, and others.
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