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Chirurgia bariatrică 

Chirurgia bariatrică este cel mai eficient tratament al obezităţii morbide. Obezitatea a devenit o problemă serioasă de sănătate publică în majoritatea ţărilor, ea afectând un segment de populaţie în continuă creştere.

Înainte de orice, obezitatea trebuie considerată mai puţin o problemă de estetică şi mai mult o problemă de sănătate, care atrage după sine complicaţii medicale, dizabilităţi temporare sau permanente, scăderea duratei de viaţă şi, nu în ultimul rând, un cost mare pentru întreaga societate.

Ce este obezitatea

Obezitatea este o boală în care se acumulează excesiv grăsime în organism din cauza consumului de alimente mai mare decât nevoile fiziologice ori, mai rar, din cauza unor dereglări metabolice.

Este o boală cronică (de exemplu, un exces de 50 de calorii zilnic poate creşte greutatea cu 25 kg într-o perioadă de 10 ani), condiţionată genetic (normal fiecare persoană are în corp cca. 30-35 miliarde de celule adipoase) şi un factor determinant major pentru o serie de boli asociate (diabet zaharat, hipertensiune arterială etc).

 

Tratamentul chirurgical ‒ cel mai eficient

Chirurgia este considerată astăzi cel mai eficient tratament al obezităţii morbide!

Odată cu scăderea ponderală, toate consecinţele obezităţii (comorbidităţile) enumerate anterior se ameliorează. Este posibilă vindecarea diabetului de tip II şi a hipertensiunii arteriale, dispar problemele respiratorii şi steatoza hepatică, scade riscul de cancer!

 

Ce este chirurgia bariatrică

Tehnicile operatorii care se adresează obezităţii sunt grupate sub denumirea de operaţii bariatrice şi aparţin chirurgiei generale, fiind realizate sub anestezie generală cu intubaţie oro-traheală.

Obiectivele chirurgiei bariatrice urmăresc o scădere ponderală durabilă, cu ameliorarea stării de sănătate, diminuarea sau dispariţia comorbidităţilor, creşterea bunăstării şi a calităţii vieţii pacienţilor.

Tehnicile de chirurgie bariatrică influenţează balanţa echilibrului energetic, diminuând considerabil aportul alimentar şi determinând organismul să consume energie din rezervele acumulate. Reducerea depozitelor de energie înseamnă diminuarea ţesutului adipos, slăbire, recăpătarea aspectului normal, uşurarea semnificativă a funcţiilor vitale, dispariţia sau ameliorarea importantă a maladiilor determinate de obezitate. Pacienţii operaţi slăbesc treptat şi ar trebui să ajungă la o greutate convenabilă în circa 8-12 luni.

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International Details

NOBEZ – The Bariatric Surgery Center provides the most effective treatment for weight loss as well as diseases associated with obesity (type 2 diabetes, hypertension, sleep apnea, dyslipidemia, liver steatosis, etc.). Any patient wishing to undergo surgical treatment of obesity must meet certain criteria. After a series of complex investigations conducted by a dedicated multidisciplinary team, the operation indication can be clearly established. Irrespective of the technique used, hospitalization and recovery are of short duration because interventions are performed laparoscopically. The effects of bariatric surgery are visible from the first month postoperatively, and the associated diseases, improve or even can be completely treated: diabetes disappears, reduces the treatment of high blood pressure and sleep apnea.

For patients meeting the surgical criteria, bariatric surgery has proven to be the most effective method for significantly lowering weight. Like any other surgery, it has risks and requires significant lifestyle changes.

Bariatric surgery results in weight loss either by restricting the amount of food that the stomach can store or by malabsorption of nutrients or a combination of these. These procedures also cause hormonal changes.

 

GASTRIC BALLOON – INSERTED ENDOSCOPICALLY

The purpose of this method is to lose weight between 15-25 kg in six months, after which the procedure can be repeated again depending on the desired results. Intervention has maximum efficacy in patients with BMI between 30-40 or overweight. The intragastric balloon may be recommended even if the person exceeds the ideal weight of only 10 kg.

The method by which the food intake can be greatly reduced is the introduction into the stomach of a silicone balloon. The intervention is non-surgical – it is done endoscopically. The deflated balloon is inserted into the mouth while the patient is under a certain degree of sedation. Arrived in the stomach, the balloon is filled with 400-700 cubic centimeters of physiological saline and methylene blue. The balloon disengages from the feeding tube, closes tightly and stays floating in the stomach, from which it fills a good part, realizing the feeling of satiety when you ingest a small amount of food.

The filled silicone balloon occupies about two-thirds of the normal body’s stomach capacity. After six months, the balloon should be removed because it stays in an acidic environment (gastric juice) and is thinned.

The risks that this treatment involves against weight gain is that the balloon breaks. There is a minimum risk that the serum bag will succumb without any danger.

In the first few days after the balloon implant, nausea, a normal reaction of the body of foreign body rejection, may occur.

Patients stay with the implant in their stomach for up to six months, and after a three to four month break, if they want to lose weight, they can resort to a new intragastric balloon implant.

The balloon is removed from the stomach in the same way it was inserted. First, the serum is aspirated with a needle through the endoscope. The balloon is completely deflated and removed with a special pen through the endoscope.

The duration is 25 minutes for the balloon insertion, 15 minutes for extraction. Externation can be done after a few hours or the next day, depending on the patient’s general condition.

The product is contraindicated for people suffering from the gastric ulcer.

The presence of the balloon should be accompanied by diet and exercise. In these six months, the patient is doing a workout to get used to some diet and physical behavior for the rest of his life. Otherwise, there is a risk that, after balloon extraction, the patient will reach the initial weight.

 

GASTRIC SLEEVE (LONGITUDINAL GASTRECTOMY)

Gastric sleeve is a procedure that induces weight loss by reducing the amount of food ingested. In the procedure, the surgeon partially removes the vertical portion of the stomach and thus reduces the stomach volume by about 80-85%, turning it into a gastric tube that continues the esophagus, but also the horizontal part (called the gastric antrum) will have a larger volume reduced. Stomach innervation and pyloric sphincter (which ensures gastric evacuation) are not affected by this procedure. This limits the amount of food consumed and, implicitly, calories, while reducing the hunger. The patient will eat 3 meals a day, reduced in quantity according to the new volume of the stomach, will not suffer from hunger and will have a normal diet.

In some cases, the gastric sleeve is performed as a definitive treatment for obesity. For some patients, especially those with a body mass index greater than 60, the gastric sleeve may be the first part of a 2-stage operation.

Gastric sleeve works by two mechanisms:

The volume of the stomach is low so that the patient will feel feeble after a smaller meal.

The bottom of the stomach is removed. This is the area that secretes Ghrelin, a hormone that makes it feel hungry. So the gastric sleeve can also help reduce hunger.

Benefits

  • From 30 to 60% weight loss during the first 12 months of the procedure
  • Less invasive than gastric bypass
  • No cutting or disconnection or alteration of the intestines
  • No risk of “dumping syndrome”, usually associated with gastric bypass
  • Post-intervention less restrictive regime
  • The procedure may be followed by gastric bypass or duodenal switch for even better results for patients with a BMI> 70
  • It can be performed laparoscopically in extremely obese patients

Disadvantages

As with any medical procedure of this nature, there may be adverse effects. The biggest drawback is that the procedure is irreversible and patients need to really understand all the implications before starting a gastric sleeve surgery.

 

GASTRIC PLICATION

Gastric plication surgery is a restrictive procedure for bariatric surgery involving the invasion of the large stomach curvature into the lumen of the stomach. This operation involves the realization of five or six small incisions in the abdomen to perform the procedure using a video camera (laparoscope) and long instruments that are placed through these small incisions. Gastric enveloping involves sewing one or more large folds (strands) into the stomach with continuous sutures with non-resorbable thread. So the stomach volume is reduced by about 70%, which makes the stomach less and can help you eat less. There is no cutting, stapling, or removal from the stomach or intestines during the intervention. Gastric plication may be reversed or converted to another procedure if necessary.

Gastric plication is a minimally invasive procedure and lasts approximately one to two hours. Most patients stay in the hospital for 1-2 days after the procedure.

Gastric plication is a restrictive process. It greatly reduces the size of the stomach and limits the amount of food that can be consumed at a time. This does not cause a decrease in nutrient absorption. After eating a small amount of food, you will feel very fast and you will continue to feel full for several hours. Gastric glands can also cause a decrease in appetite.

Advantages of the method:

  • Does not involve the resection of the stomach or the implantation of foreign bodies
  • Is potentially reversible
  • Can be converted into, or combined with, other types of bariatric surgery.
  • The complication rate is low (about 1%)
  • Is financially accessible – it does not involve the purchase of a special kit, but only of certain handpieces (Ligasure, trocar).

Risks or complications

Gastric plication (PGL) is a low-risk, lower-risk method, inferior to other types of bariatric surgery (gastric ring, gastric sleeve, gastric bypass). However, suture gastric fistulas, peritoneal abscesses, and even a low mortality rate are described. Other complications (hemorrhage, infections, organ damage) are common to all surgical procedures.

 

GASTRIC BYPASS

Gastric bypass is one of the most effective and often used types of surgery against obesity and the disease caused by it. The process involves the complete isolation of a small portion of your stomach from the rest of your stomach. Thus, food will only reach the upper part of the stomach and never the lower one. This newly formed stomach will connect a part of the intestine, which will take the swallowed food, thus ensuring the digestive transit.

After this intervention, patients will eat less, but non-selective, because sugars and fats do not pass through the surface of the intestine that makes it possible to absorb them. When the food comes into contact with the intestinal mucosa, a series of signals go to the brain, causing the feeling of saturation to appear very quickly.

This surgical method helps alleviate metabolic disorders associated with obesity: diabetes mellitus, hypertension, liver steatosis, etc.

Benefits

You will lose up to 80% of the excess weight.

You will only be satisfied with a few sips, this being enough to fill your stomach. Foods will get much faster in the gut, quickly generating satiety.

You will recover quickly, without scars, with limited postoperative pain, 48-hour hospitalization.

 

RISKS

The greatest risk, which often occurs in surgical interventions, is the infection of the incision. It then causes stomach leakage that passes into the abdominal cavity or instead of the intestinal connection, which can result in triggering peritonitis and accumulation of blood in the lungs.

The conclusion is that up to one-third of people with gastric bypass develop at some point anemia, osteoporosis or various gastric disorders. Approximately 3 out of 200 people lose their lives. After surgery:

– Deficiency of iron and vitamin B12 occurs

– The connection between the stomach and the intestine narrows, causing nausea and vomiting immediately after eating

– About 105 of the patients develop ulcers

– Special patches that fix the fold inside the stomach can weaken over time

– A hernia may occur

– Bypass-adjusted stomach can increase, causing bloating and cramping

Each process has its advantages and disadvantages.

Bariatric surgery may be a solution if you feel ready

  • Follow a physical activity program
  • Make a long-term diet change that includes vitamin and mineral supplements,
  • Counseling and follow-up.
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