Surgical treatment of obesity, i.e. bariatric surgeries, is a method of treatment for people suffering from the so-called morbid obesity. To undergo such a procedure free of charge, you must be referred to a bariatric surgeon from your GP. Only this specialist can determine if surgery is necessary and determine the type of bariatric surgery - be it a bandage, sleeve gastrectomy, biliary pancreatic exclusion or gastric bypass.
Surgical treatment of obesityenablesto reduce body weight, or lose weightfor those people whose diets do not bring the expected results. The risk in obesity surgery is low and the likelihood of continued weight loss is very high. Modern obesity surgery is primarily gastric surgery, the task of which is:
- reducing the feeling of hunger
- becoming full after eating a small amount of solid food
- reduced food intake
- exclusion of the part of the stomach that produces ghrelin - the hormone responsible for sending a hunger signal to the brain.
Bariatric surgeries: indications and contraindications
Bariatric surgeries are often life-saving procedures. It is performed in people who have a BMI over 35 and have metabolic syndrome: incl. arterial hypertension, diabetes, lipid disorders or joint diseases related to their overload; or when the BMI is 40 and above - even if the patient has not been diagnosed with a disease that is a complication of obesity. Operations are performed on people up to 65 years of age. In Poland, they are also performed in teenagers.
Addictions and mental disorders are contraindications, but people with depression may undergo bariatric surgery. He also does not perform treatments on people who have serious respiratory, circulatory and kidney diseases, disqualifying them for general anesthesia.
It is estimated that in Poland about 700,000 Grade III obesity requires bariatric surgery.
These treatments are included in the so-called major surgery. Therefore, before they are performed, you have to go to the hospital for a few days, where they are performed in the internal medicine warda series of tests that allow you to assess respiratory and cardiovascular fitness. Hormonal tests are also performed to make sure obesity is not caused by a hormonal imbalance, such as hypothyroidism. Before the operation, the patient is under the care of psychologists and nutritionists.
After the operation, the patient should cooperate with a dietitian. He will develop a diet appropriate for him, which will prevent nutritional deficiencies. One year after the operation, the patient is returned to the hospital, where internists assess his general condition. Bariatric surgeries are reimbursed by the National He alth Fund, and it takes about half a year to perform them.
Surgical treatments for obesity can be divided into two categories: reducing the absorption of nutrients in the intestine and reducing the amount of food consumed. Find out what the differenttypes of bariatric surgery work.
Surgical treatment of obesity: gastric balloon
Implantation, i.e. placing a special balloon in the stomach, is an indirect procedure in bariatric surgery. It is performed in those patients whose BMI is more than 60, i.e. patients with obesity, the so-called extremely enormous. The balloon is placed for a specified period of time to reduce the patient's weight to a level that allows for the safe conduct of the main operation. The gastric balloon is placed using a gastroscope under local anesthesia. An empty silicone bag is inserted into the stomach, which is then filled with a saline solution. The balloon compresses the stomach walls, causing a feeling of fullness. So you eat much less, losing up to 20 kg in weight in six months. After the bariatrist has appointed the surgeon, the balloon is removed.
Note: during the entire treatment with a balloon and after its completion, it is necessary to follow a low-calorie diet and exercise under the supervision of a trainer. The cost of the procedure: approx. 8 thousand. PLN.
Surgical treatment of obesity: gastric banding
The operation involves placing a silicone band on the stomach, which divides it into two parts. There is little food in the first "reservoir" of the stomach, so you quickly feel full, even after eating a small meal. With the band you can lose up to 30 kg in a year. While there is a band on the stomach, you must follow a special, semi-fluid diet. The headband can be removed at any time. The operation is reimbursed by the National He alth Fund. It can also be made for a fee. Cost: 15-20 thousand PLN.
Surgical treatment of obesity: gastric bypass
Gastric bypass is a bariatric (usuallyalready performed laparoscopically) consisting in creating a small pouch from the upper part of the stomach, which is directly connected to the further part of the small intestine. Gastric bypass modifies the digestive tract in such a way that a rapidly filling gastric pouch with a capacity of about 30 ml limits the amount of food consumed. Additionally, digestive enzymes from the stomach and duodenum mix with food only in the final section of the small intestine, which results in a significant reduction in the amount of absorbed calories. Weight loss can be 65-85 percent in the first 6-12 months after surgery. The overall risk of perioperative complications ranges from 7 percent for laparoscopic procedures to 14.5 percent for classic operations. The by-pass is a solution mainly for people suffering from obesity, but with a BMI below 50 and with diabetes, who have to take high doses of insulin.
Surgical treatment of obesity: sleeve gastrectomy
This is the method of surgery that is currently the most popular. It consists in removing a fragment of the stomach (about 30% of the volume remains). During surgery using a laparoscope, part of the stomach is removed and the remainder can hold 100-150 ml of food. In addition, it no longer secures the appetite-stimulating hormone ghrelin. After the procedure, patients lose approx. 60 percent within a year. excess body weight. After the operation, the so-called sleeve, it is very important to follow the diet - for the rest of your life you can eat only fragmented and much smaller portions than before the treatment. Sleeve gastrectomy is the first procedure to be performed. If, after many years, the patient develops the so-called recurrence, i.e. due to obesity, he will start to gain weight again (about 20% of the operated patients), then gastric bypass can be performed. The operation is reimbursed by the National He alth Fund. When we do it privately, we have to take into account the costs of 10-15 thousand. PLN.
Surgical treatment of obesity: biliary-pancreatic exclusion
This is a very rare bariatric surgery - it happens that for a year not even one is performed in the country. This type of surgery removes about 2/3 of the stomach and divides the small intestine into 3 parts, two of which connect to form a third (together forming a Y-shape), the first part runs from the reduced stomach and transports food through it, the second part connects to the bile ducts. and the pancreas is the pathway of the digestive juices, they join about 100-150 cm before the exit of the small intestine into the large intestine. Only in this third section of 100-150 cm does the process take placedigestion. Changing the flow of the small intestine causes a decrease in the absorption (absorption) of nutrients, and reducing the stomach causes a decrease in food intake. Together, these two effects make you lose weight. Due to reduced absorption, patients should have blood tests done from time to time, and take extra vitamins throughout their life after surgery. Biliary pancreatic exclusion is sometimes performed as a third operation if sleeve resection and gastric bypass have failed. Unfortunately, this type of operation is fraught with complications.
Bariatric surgery treats diabetes
Bariatric surgery is also used to treat diabetes. Therefore, more and more often bariatric surgery is called metabolic surgery. Two types of surgery are used in the treatment of diabetes - the aforementioned gastric by-pass and the so-called biliopacreatic diversion. These are procedures in which the anatomy of the gastrointestinal tract is changed in such a way that the food content does not pass through the duodenum and a fragment of the jejunum. In addition to reducing the possibility of consuming large amounts of food and reducing the absorption of food portions (both mechanisms reduce the amount of calories consumed), modification of the gastrointestinal anatomy also changes the activity of various gastrointestinal hormones, which have a positive effect on glucose metabolism and lipid metabolism. Thanks to these operations, there is a permanent reduction in the level of glucose and the demand of tissues for insulin. Diabetes progress is therefore stunted.
Cuff gastrectomy
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