Restrictive gastric surgery - Bariatric surgery
Gastric banding
The gastric banding surgery is preferably performed laparoscopically due to significant advantages of this method, major of which is a reduced chance of complications.
The operation procedure
Banding is an application of a silicone ring (band) on the stomach, which is then attached to the wall of the stomach with a few surgical sutures, thus, forming a so-called "small stomach" above the bandage. There is an opening for the passage of food approx. 12 mm in diameter. The volume of the newly formed stomach is no bigger than 15-20 ml.
A small tube is connected to the ring-bandage. A special device (port) is attached to the tube at its end, which is used to fill with liquid or remove excessive of it from the system. This device allows to adjust the diameter of the inner lumen of the bandage according to the rate of the patient’s weight loss and health.
Approximately a month after the surgery, the patient is getting used to the new restrictions and at this time the assessment, based on the results of X-ray, as well as of weight loss and well-being of the patient, is carried out, upon which the doctor will decide the need to adjust (increase or decrease) a diameter of the ring opening.
The advantages of laparoscopic gastric banding
The advantage of laparoscopic techniques is reduced likelihood of complications, such as wound infection or the appearance of hernial protrusion of wound (this eliminates the need for another surgery). In addition, this method significantly reduces pain in the post-operative period, eliminates the scar on the stomach and ensures a faster and easier recovery.
It is important to note that after this operation it is possible to remove the ring at any time at the patient’s request.
Preparation for surgery
As usually, before any other surgical procedure, the patient undergoes various tests according to the doctor's referral/request. Among them are:
- laboratory tests of liver function;
- laboratory tests of thyroid function and adrenal gland;
- spirometry;
- X-ray of the esophagus;
- X-ray of stomach and duodenum;
- ultrasonography of the gallbladder;
- consultation with a psychiatrist.
In an interview with the doctor, the patient receives a detailed explanation of the surgery procedures and rules for post-operative period regarding eating and physical activity, which should be followed rigorously.
The hospitalization course and recovery period after laparoscopic gastric banding
The duration of hospital stay after surgery is usually 1-2 days. During this time, the patient receives fluids intravenously and a radiograph evaluation of the stomach condition. Gradually, the patient begins to take small amounts of liquid in a normal way. If there are no complications, the patient is discharged from the Department maximum two days after the surgery.
Sleeve resection of the stomach (sleeve gastroplasty)
Sleeve resection of the stomach is one of the types of bariatric operations performed to treat obesity. This operation is usually performed by laparoscopic method, similar to the stomach banding surgery. Other types of bariatric operations are gastric and duodenum bypasses. In contrast to gastric banding, a sleeve resection procedure is a restrictive operation, in which the volume of the stomach is decreased to approximately 50 ml, without the use of the ring. With this type of operation other parts of digestive system are not affected. Thus, this operation does not reduce absorption of nutrients in the intestine, as the opposite to the aforementioned gastric or duodenum bypasses.?During sleeve resection surgery, approximately 75% of the stomach is removed and then along the lesser curvature, a new tube-shaped stomach is formed. It was found out that as a result of this operation, the level of the hormone ghrelin in the organism sharply decreases. This hormone is produced in the stomach and is responsible for hunger. The patients, who have undergone this operation, point out a completely new feeling of satiety, even at the first postoperative day, which is, apparently, the result of the reduction in the gastric volume. After the surgery, the stomach is not able to accommodate more than 50 ml of food at one time, which consequently leads to a significant reduction in weight.
Sleeve resection of the stomach allows to reduce the body weight by approximately 60% of the previous weight. In the past, this operation was used as the first stage of surgical treatment for patients with the body mass index over 50 and obesity-related diseases. As the second stage, gastric or duodenal bypass were planned a year after. But in some cases, sleeve resection had such a pronounced positive effect, that the necessity for the second stage was no longer relevant. Thus, this type of bariatric surgery has gradually turned into an independent method for the treatment of obesity.
At the same time, as this type of operation has been applied since fairly recently, the information accumulated to date is based only on a three-year postoperative follow-up. Therefore, it is extremely important to determine the long-term results of this type of operation by carrying out a continued monitoring of patients over a longer period of time.
A sleeve resection can be suggested to the obese patients, whose body mass index is greater than 40, or patients with the body mass index lesser than 40 and who suffer from the obesity-related diseases (such as hypertension, elevated triglyceride levels, reproductive disorders, etc.). This operation does not create intestinal anastomoses, thus, eliminating the risk of leakage of intestinal contents, stenosis or ulcer in the anastomosis.
The operation is performed through micro incisions, without opening the abdominal wall, which ensures a good cosmetic result, and also reduces the risk of surgical wound infection or of hernial protrusion of the postoperative scar. Furthermore, compared with the open surgery, a sleeve resection is less painful in the postoperative period and has a shorter recovery period. During this operation, the lower sphincter of the stomach is kept intact, which ensures the safety for the normal digestion process. After this surgery, the patient may consume a sufficiently large range of food products. Moreover, the patients demonstrate a significant improvement in quality of life, as well as the healing or significant reduction of symptoms related to other diseases.
Gastric bypass surgery
Gastric bypass surgery combines the restrictive principle by decreasing the stomach volume and the principle of reducing the absorption of nutrients. This microinvasive operation creates a "new small stomach" with the volume of approximately 20 ml, which bypasses the most of the stomach and is directly stitched to the small intestine. Such bypass ensures rapid passage of food into the small intestine. In approximately 10% of patients after gastric bypass surgery, a rapid passage of concentrated, mostly sweet food, from the stomach into the intestines, can cause a so called "dumping syndrome", which manifestes as a spastic abdominal pain, sweating, palpitations and fatigue shortly after the consumption of the food with concentrated carbohydrates.
The advantage of this type of surgery, however, is that it is micro invasive and is performed via 5-6 small incisions, which ensures a good cosmetic effect, pain reduction during the postoperative period and early return to a normal way of life.
Also, micro invasive surgery excludes complications specific to open operations, such as wound infection or the appearance of hernial protrusion of the postoperative scar.
The duration of post-operative stay in hospital after microsurgery is two days. On the first post-operative day, the X-ray is performed, before which the patient drinks a liquid containing a contrast agent to confirm the normal intestinal permeability and to detect any existing leakage of the intestinal contents into the abdominal cavity. After that, patients are allowed to start taking clear liquids in small quantities. During the first eight hours they are allowed of fluid intake to 30 ml every half an hour, and then 60 ml every 30 minutes. On the second day after the surgery, the patient is transferred onto a clear liquid diet and then discharged home. Such eating regimen should continue throughout the first week.A dietitian recommends usually then a way of gradual transition to regular food.