Obesity surgery is increasingly employed. This technique is however not trivial and before opting for the knife, discover the essence of these methods.
Very common in the United States, obesity surgery has known for ten years a boom in France. The appearance of adjustable rings allows today to realize gastroplasty with a minimally invasive surgical methods.
The principle of obesity surgery is simple: with the ring placed around the stomach, the patient is satisfied with small amounts of food. But if this solution seems ideal, its long-term success is subject to many constraints.
1 – Who are these patients?
It is mainly the adults 18 to 65 years suffering from obesity for at least 3 years.
It is the same for obese with a body mass index greater than 40 or greater than 35 but with medical complications (hypertension, diabetes, lipid metabolism disorders, osteoarthritis, sleep apnea syndrome ….). Please note that this surgery is to consider that when all medically supervised diets have not resulted in a sustainable weight loss. Of course, do no cons-indication to general anesthesia or severe medical conditions (severe respiratory failure, cirrhosis, cancer …).
2 – What are the terms of the intervention?
This operation is considered only after a full assessment: consultation with a nutritionist endocrinologist, a psychiatrist, a cardiologist and pulmonologist; a gastroscopy checks the condition of the stomach. It takes about 1 hour and requires hospitalization of 3 or 4 days. The resumption of professional activities is done within 2 weeks after the operation.
3 – What is monitoring?
After the next radio control, the patient begins to recharge; first with liquid foods, paste and mixed. Then, as quickly as possible, it should make small regular meals. It is only when all the solid foods pass and the patient loses more weight than we consider the clamping ring. This tightening will be under control in radiology room without any anesthesia. Monitoring by the nutritionist, the surgeon and, if necessary, by the psychiatrist is imperative and indispensable. Physical activity is highly recommended. Finally it is possible to be pregnant: the ring is simply released for the duration of pregnancy.
4 – What are the advantages of stomach stapling?
This is a totally reversible art. It is now almost always laparoscopically, which allows faster recovery. Finally, the ring placed around the stomach to an adjustable diameter, thereby, in theory, the physician to control the weight loss.
5 – What are the constraints?
It is imperative to make only 3 meals a day; snacking should be avoided to the maximum. The patient’s eating behavior must radically and permanently change: he who had the habit of eating too fast, swallowing the food must force yourself to swallow very slowly, chewing each bite, and sat in the quiet.
This ring must be kept to a priori life; its removal almost always resulting in weight gain. Therefore, it requires close and careful monitoring that too many patients are struggling to resolve. This monitoring is provided by the nutritionist and surgeon. From a loss of more than 20 kilos, deficiencies in vitamins and trace elements are almost constant and must be treated.
6 – What are the main complications?
During the intervention, the perforations of the stomach or esophagus are rare if the operation is performed in specialized centers in obesity surgery.
Acute dilatation of the upper stomach pouch rare; their occurring could be promoted by the absorption of soft drinks, which are therefore prohibited. Vomiting are very common, or they must be avoided at all costs because they cause esophageal burns and sometimes especially a movement of the ring with chronic dilation of the upstream pocket. This type of complication may require the removal of the ring.
Note the dilation of the esophagus can occur in a few years. The patient gained weight, the concept of satiety disappears … The food is stored in the esophagus as if a second stomach had formed above the first! The final withdrawal of the ring then usually requires. It is to avoid this complication even the liquid to be absorbed slowly, in small sips between meals and never to the bottle.
The ring can move, that’s why an endoscopic control is required every 3 years. Finally, minor incidents can occur on the housing that serves to tighten the ring: turning, breaking the connection to the ring, leak … These problems are simply treated with minor surgery.
7 – What are the results of obesity surgery?
They depend mainly on the strict monitoring of food requirements by the patient. If he understands that the ring should be taken as an aid scheme, it can expect to lose more than 80% of its weight in less than 2 years surplus. In the long term, the effects of the ring seems to weaken, especially if a dilation of the esophagus appears. Again, it is the patient’s will that allows him to maintain his weight. It should not rely on the ring, and especially not “cheat”: snacks, sweets, too much liquid food, alcohol …
8 – What to do in case of failure of obesity surgery?
In the absence of weight loss or complication, it is better to permanently remove the ring. The procedure is done laparoscopically. There are other types of operations, heavier, irreversible, whose complications can be more serious, but their effectiveness is certainly more important and the best comfort food. These short circuits – (bypass) gastrojéjunaux: the principle is to avoid a part of digestion. This procedure works even in nibblers and seems to give better results in super obese (patients with a BMI greater than 50).
Thus, the result of obesity surgery can be spectacular but for this it is necessary that the patient agrees to consider his ring as an aid to the regime, certainly not great but miraculous. It is therefore imperative to change their eating behavior. And monitoring is essential to detect possible complications and ensure long-term outcome.