2023 Author: Philip Bishop | [email protected]. Last modified: 2023-08-25 07:54
Stomach reduction surgery
To reduce excess weight, there are many methods: therapeutic diet, drugs for the treatment of obesity, the use of massage and specially designed exercise complexes, fasting. These methods are indicated for those who have gained excess weight as a result of improperly composed diet, neglect of physical activity, hormonal jump as a result of pregnancy and childbirth. In such people, the body mass index (BMI) usually does not exceed 30-35 kg / m 2.
BMI is calculated using a very simple formula: a person's weight (in kg) must be divided by the height (in meters) squared. For example, with a height of 1.7 m and a weight of 80 kg, the body mass index will be 80: 1.7 2 = 27.6. The upper limit of the norm is 25 kg / m 2, the further from this figure the BMI value, the higher the degree of obesity.
Surgery to reduce the stomach is required for those who have a BMI of 40 kg / m 2 and above ("marbid obesity"). In addition, people with health problems will not be able to lose weight on their own:
- Endocrine system pathologies;
- Disorders of metabolic processes in the body.
Further preservation of excess weight is fraught for such patients with an increased risk of hypertension, ischemia, stroke and joint diseases. With such indications, surgical methods are used to reduce the size of the stomach.
- Stomach ballooning
- Stomach banding
- Gastric bypass
The predicted effectiveness of this manipulation is a loss of 40% of the initial body weight. The operation consists in placing a balloon inside the stomach to temporarily reduce its volume. Indications for intervention - BMI more than 30-35 units. This manipulation is performed under general anesthesia by analogy with gastroscopy. An elastic container made of thin silicone is introduced into the stomach through the mouth. It is filled with blue tinted water. Such a precaution is necessary so that when the integrity of the bladder is violated, the patient can determine this annoying circumstance by the color of his urine.
However, patients almost never have to contact a doctor with such complaints, since the likelihood of such incidents is too low. To prevent the destruction of the walls of the silicone container by the aggressive environment of gastric juice, patients take drugs that reduce the acidity of the stomach.
After getting out of medication sleep, the patient can leave the hospital.
Likely symptoms in the first few days after ballooning:
- Taste of rubber in the mouth.
After 5-7 days, adaptation to a foreign body in the stomach ends and discomfort is no longer felt. The balloon is in the stomach for six months. During this time, the patient gets used to getting by with small portions of food, body weight is reduced by 40%. The next and final stage is the removal of the balloon from the stomach. The manipulation is carried out under anesthesia, under the control of a gastroscope. The container is pierced, the liquid is pumped out of it and the balloon is taken out of the stomach. The main task of the patient after ballooning is not to return to the old eating habits, to maintain the achieved results.
The effectiveness of this surgical manipulation is the ability to lose 50% of the original weight. Indications for the imposition of a bandage on the stomach - BMI above 30 units. The patient must be over 18 years old.
Contraindications to manipulation:
- Children and adolescents;
- Heightened hell;
- Alcohol addiction;
- The use of hormonal drugs;
- History of autoimmune pathologies.
The sequence of laparoscopic banding operation:
- The patient is given general anesthesia, 5 punctures are made in the abdominal wall.
- Under the control of special equipment (a miniature camera and a special monitor), a band-ring is mounted around the stomach and fastened.
- A tube is passed from the bandage with an outlet to the adjustment port on the front wall of the chest under the ribs.
- After 2 months, saline is introduced into the bandage through the port and thereby the size of the stomach is reduced. After surgery to reduce the stomach, you need to eat mainly soft food, in small portions, do not drink water.
- After 6 months, the band is deflated, removing the fluid through the port to the outside.
- If excess weight is returned, the procedure is repeated.
The ring must be removed to alleviate the psychological state of the patient who is forced to live with a miniature stomach. Not everyone can eat scanty portions of food, not feel hungry and maintain the same self-awareness. Even the preliminary work with a specialist psychologist does not always help to overcome such a test.
Unfortunately, not all patients are able to keep the obtained results. After returning to the previous size of the stomach, some of the operated add the volume of their portions and gain weight again.
This volumetric surgery is performed with a BMI over 40 kg / m 2. It is performed as a result of laparoscopic surgery under general anesthesia and radically changes the anatomy of the stomach. In short, this operation can be described as complete removal of the stomach. From it remains a small tube no more than one and a half centimeters in diameter. After 5-6 days, the patient can return home.
Nutrition rules in the postoperative period:
- For 2 weeks, you should eat liquid food: broths, juices;
After this time, the patient switches to yoghurts and mashed vegetable purees;
- After 5 weeks, they switch to their usual diet;
- All food should be chewed thoroughly;
- To replenish useful minerals and vitamins, complex preparations should be taken;
- You may need to take a means to help digest food.
This intervention drastically changes not only food habits, but also the entire lifestyle of a person. The previous weight is reduced by half, but it will no longer be possible to return the usual volume of the stomach. This psychological discomfort cannot be overcome immediately; the help of a specialist will be required.
The indications for bypass surgery are the same as for gastrectomy. Bypass surgery is the creation of a new additional pathway bypassing the stomach using a bypass system. During this operation, the digestive organ cavity is divided into 2 parts, one of which is connected to the small intestine, where most of the nutrients are absorbed.
Thanks to this tactic, most of the stomach is not involved in the digestion process, and satiety occurs much faster than before.
The operation takes place in 2 stages:
- After performing 8 punctures in the abdominal wall, the surgeon performs a resection of the stomach and cutting out a new digestive organ with a volume of up to 30 ml.
- The part of the small intestine that intensively absorbs nutrients is shortened, and the remaining segment of the intestine is sutured to the truncated new stomach.
Thus, 2 goals are achieved at once - the volume of food consumed is reduced and fewer calories are absorbed.
Possible complications of gastric bypass surgery:
- Inflammation of the peritoneum due to poorly executed seam and leakage of the liquid fraction of food. Peritonitis threatens the patient with death.
- The appearance of scar tissue in the intestinal lumen, reduced patency. To treat this complication, a special balloon is inserted into the intestinal lumen.
- Violation of the blood supply to the sutured part of the stomach and the formation of ulcers on it, arises from smoking, stress, high acidity.
- The emergence of dumping syndrome due to exceeding the permissible amount of carbohydrates in the diet. Symptoms: epigastric pain, cold sweat, tachycardia.
Such complications are extremely rare, since such operations are performed by highly qualified specialists. After bypass surgery, as well as after gastrectomy, the volume of minerals and vitamins should be replenished with additional intake of special agents. The peculiarity of this type of surgical intervention is a long postoperative period.
Surgery to reduce the stomach by surgery is performed after a thorough examination of the patient and in the absence of contraindications. They are used only in cases where other means are found to be ineffective. To maintain the achieved results, to avoid the appearance of sagging skin and muscles, you need to use physical activity, take vitamin and mineral complexes.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
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