-Obesity can have an important negative effect on the general status health of the patient.
-The most common consequences of obesity are: type 2 diabetes, cardiovascular diseases, sleep apnoea syndrome, high blood pressure, dyslipemia, arthritis or venous insufficiency.
In Belgium, the surgical treatment is accepted in the following cases:
– the BMI must be = or> 40kg/m2
– the BMI must be> 35kg/m2 in combination with at least one of the following criteria:
You can check the aspects of the bariatric surgeries in this section.
-Gastric bypass is a bariatric surgery design to produce a weight loss will all the associate benefits. This surgery consist in creation of a small gastric pouch and a bypass of one part of the bowel for the food absorption.
-The food pass directly from the stomach to the intestine (alimentary loop) and are only absorbed more distally, when they are mixed with biliopancreatic secretions at the level of the common loop.
-The gastric pouch, constituting the “restrictive” part of the operation is small (volume of 15-20 ml) to induce early satiety and reduce the risk of anastomotic ulcers.
-The remaining stomach even if food no longer passes through its lumen, but will preserve the physiological function.
-This intervention is reversible.
-The modes of weight loss are complex and multiple:
1 / Restrictive effect: the small volume of the gastric pouch (15-20 cc) is accompanied by early satiety.
2 / Malabsorptive effect: This assembly leads to malabsorption which mainly concerns fats because they can only be absorbed in the presence of bile salts. Protein malabsorption is less because proteins are still partially absorbed by saliva and intestinal juices all along the digestive loop. Carbohydrates can be absorbed through the food loop and their intake in large quantities is one of the causes of failure during a gastric bypass.
Postoperative attitude:
• Day0 – The patient will be fasting.
• Day1- The patient is allowed to drink water (small amounts, spaced out during the day). The patient is also advised to mobilize, the first mobilization will be carried out with an accompanying person (nurse or physiotherapist) to avoid vagal mechanisms (eventually a temporary loss of consciousness with a subsequent fall).
• Day2- A control blood test is carried out and if the result is within the physiological limits and the patient is in a good general status, the discharge is authorized.
– The dietetician will see the patient before leaving hospital to explain the regime
Complications:
– Anastomotic leak- related to problems of healing on the anastomosis with a peritoneal spillage of the digestive content
– Hemorrhages- related to vascular injuries
– Internal hernia- related to the passage of the small bowel through the mesenteric or Petersen space (this are spaces between the digestive structures created by the surgical configuration of the loops)
The “sleeve gastrectomy” consists in resecting most of the stomach by a stapling technique to keep only one tube connecting the esophagus to the duodenum, with a volume equivalent to 100-150 cc with preservation of the gastric antrum.
It was initially developed as the first stage of a two-stage surgery (bypass or duodenal diversion) for super-obese patients (BMI> 50 kg / m2) due to its greater technical ease.
Inconvenients:
• Dilation of the gastric tube with decreased satiety. This may require a new intervention such as re-stapling to reduce the volume of the tube associated or not with a bypass conversion.
• A risk of reflux in the esophagus (20% at 1 year)
• The irreversibility of the technique.
Postoperative attitude:
• D0- the pral alimentation of the patient is not allowed
• D1- An eso-gastro-duodenal transit scheduled to assess the remaining stomach and check for the presence of a complication. The patient will be fasting until the examination. If the exam is normal, then the patient is allowed to drink water (small amounts and spaced throughout the day). The patient is also advised to mobilize, the first mobilization will be carried out with an accompanying person (nurse or physiotherapist) to avoid vagal mechanisms and a temporary loss of consciousness with a subsequent fall.
– An oeso-gastroduodenal transit is performed to check the correct sealing of the stapling line
• D2- The patient is authorized to return home if the control biology is within physiological parameters. The authorised diet is liquid.
– The dietetician will see the patient before leaving hospital to explain the regime.
In the postoperative period, PPIs are also administered and continued for 3 months in order to reduce nausea and risk of anastomotic ulcers. Semi-liquid diet for 10 days, followed by a specific diet for 3-4 weeks.
Complications:
– Anastomotic leak
– Hemorrhages
– Intestinal obstruction
– Internal hernia
I am an Digestive Surgeon specialized in advanced laparoscopic and robotic surgery with activity in the field of parietal, bariatric, colorectal and hepatobiliary surgery with an active interest for the academic aspect and for the research in the field of digestive surgery.
Val des Seigneurs 53, 1150 Woluwe-Saint-Pierre
