Bariatric surgery is a surgical treatment of obesity. To perform it, the surgeon has to get inside the body. This can be done by a laparotomy or laparoscopy technique. We suggest what laparotomy is and what is laparoscopy.

Bariatric surgeryis a method of treating obesity in people with a body mass index (BMI) of 35+ and complications of obesity, such as type 2 diabetes, osteoarthritis or arterial hypertension and in people with a BMI of 40 and more. Bariatric surgery consists in reducing the capacity of the stomach. Such bariatric surgeries include: sleeve gastrectomy and an adjustable gastric band. The second type of bariatric surgery is the so-called restrictive, i.e. those that interfere with the absorption of nutrients (mainly fats and carbohydrates) in the small intestine. This group of operations includes, among others gastric bypass and mini gastric bypass. Bariatric surgery is a serious, complex surgical procedure. To perform it, the surgeon simply needs to put the patient to sleep and get inside his abdominal cavity. It can do this with two so-calledsurgical technician . The first isLaparotomyand the second isLaparoscopy . We suggest how to perform a laparotomy and how to perform a laparoscopy. What makes a surgeon choose one or the other surgical technique?

Laparotomy - what is it?

Laparotomyis a surgical procedure that opens the patient's abdominal cavity by cutting through the skin, muscles and the peritoneum, or serosa that lines the abdominal and pelvic cavities. The incision is usually made through the center of the abdominal plane, from the sternum to the navel, or at the point closest to the organ that is causing the patient's discomfort. Laparotomy is performed in the following situations:

  • planned - to explain the causes of ailments in the digestive, urinary or reproductive systems, when other diagnostic tests do not provide the answer - this is the so-called exploratory laparotomy,
  • planned - to sleep pathological changes in the abdominal cavity, or to improve the functioning of a specific organ - the so-called laparotomyhealing,
  • scheduled - to take a section of the pathological change and then subject it to further examination,
  • urgent - in patients who are victims of accidents with symptoms of internal hemorrhages and patients with symptoms of acute abdominal conditions and suspected life-threatening conditions.

Laparotomy - how is the procedure performed?

In the case of therapeutic elective laparotomy (e.g. bariatric surgery), the patient arrives at the hospital in advance. How many days earlier it depends on the diagnostic tests that need to be performed on him and the process of preparation for surgery. Before the planned bariatric surgery, if the results of detailed examinations are clear, the patient is admitted to the hospital one day before the surgery. The patient must be on an empty stomach 10 to 12 hours before the procedure. He can only take water during this time. Bariatric surgery is performed on the digestive system, therefore it must be thoroughly cleaned of food debris before the procedure.

Laparotomy is performed under full general anesthesia, so the day before the procedure, the patient is consulted with an anesthesiologist who conducts an interview, including about anesthesia that the patient has had so far, comorbidities (especially those related to the circulatory system) and drugs to which the patient is allergic.Depending on the type of surgery and the type of disease, laparotomy lasts from several dozen minutes to even several hours. The size and place of the incision depend on the patient's complaints. The most common incisions for laparotomy include:

  • from the end of the sternum to the pubic symphysis,
  • from the end of the sternum to the navel,

In bariatric laparotomy, the most common incision is made from the sternum to the navel.

  • from the navel to the pubic symphysis,
  • transverse under the rib arches,
  • above from the pubic symphysis.

After cutting the abdominal wall, the surgeon carefully examines the organs and then proceeds to the main surgery. After the procedure, the patient is sewn up, awakened, transported to the recovery room, where he is constantly monitored, usually for one day after the operation, and then returns to the hospital ward. The patient is usually fully functional about 4 weeks after the procedure.

Laparotomy - complications and contraindications

During or after laparotomy, complications may occur, such as an allergic reaction to drugs administered during anesthesia, breathing difficulties, as well as infections, bleeding, and hernias in the postoperative scar. The latter may appear especially in patients with obesity, as well as diabetes,taking steroids and smoking cigarettes. Laparotomy is not used in patients in advanced age or with cardiopulmonary insufficiency, heart muscle disorders, hemorrhagic diathesis, peritonitis.

Important

Laparotomy is used not only in bariatric surgeries, but also in the diagnosis and treatment of diseases such as cervical cancer, ovarian cancer, pancreatic cancer and intestinal perforation.

Laparoscopy - what is it?

Laparoscopy, or endoscopy, is a procedure in which a few incisions are first made in the abdominal wall. Then special devices are placed in them, the so-called trocars, and a laparoscope and other surgical instruments are inserted through the trocars. The laparoscope is equipped with an optical system and its own light source. Thanks to the camera placed in the laparoscopy, the image of the inside of the abdominal cavity is received on the computer screen.

Currently, almost 100 percent bariatric surgeries are performed laparoscopically.

Laparoscopy is performed for the following purposes:

  • assess the condition and operation of organs located in the peritoneal cavity;
  • medicated - e.g. to perform a bariatric surgery, remove a gallbladder, remove the appendix, inguinal hernia, ovarian cyst or stop bleeding;
  • diagnostic - e.g. to take tumor specimens for histopathological examination, to look for the causes of inflammation, but also to check whether the patient needs a laparotomy. Sometimes the ultrasound head (USG) is connected to the laparoscope to check how deep the lesions in a given organ are.

Laparoscopy - how is the procedure performed?

Laparoscopy is also performed under full general anesthesia, therefore the procedure is preceded by a conversation with the anesthesiologist. Depending on the type of surgery, its complexity and the patient's he alth condition, laparoscopy may last from several minutes to several hours. On the day before the procedure, the patient is served only easily digestible and liquid meals.

As with laparotomy, the patient is placed on the back on the operating table and covered with sterile sheets. The first stage of the procedure is anesthesia. In the second stage, the surgeon operator makes several incisions in the abdominal wall of the patient, introduces trocars and then surgical instruments. Then the peritoneal cavity is filled with carbon dioxide, i.e. it forms the so-called emphysema. The abdomen then resembles an inflated balloon, and in its center the abdominal wall is separated by organs. Thanks to this, the surgeon can observe the so-called operating field and at easeoperate tools. Surgical instruments for laparoscopy are long, 20-30 cm, but their most important part, i.e. the ends, are small. They measure only about 1 cm. So there may be times when the disease lesion is so large that it cannot be removed with small instruments, so the surgeon has to remove the instruments and perform a laparotomy. However, such situations do not occur in laparoscopic bariatric surgeries.

After excision of a specific organ or part of it, e.g. a fragment of the stomach during a sleeve gastrectomy, it is removed from the abdominal cavity through additional incisions in the skin. After the surgery, the pneumothorax is removed, the trocars are removed from the patient's body and the wounds are sewn up and secured with a sterile dressing.

Laparoscopy - complications and contraindications

Laparoscopy is an invasive procedure and examination that affects the skin layers and internal organs, so there is a risk of complications following it. Therefore, pneumothorax, subcutaneous emphysema, mediastinal pneumothorax, gas filling or trocar puncture of the intestines or stomach, damage to the abdominal vessels, local bleeding may occur. Laparoscopic procedures are contraindicated in the elderly, with arterial hypertension, heart diseases (e.g. failure, arrhythmias, after a heart attack), as well as in pregnant women over 12 weeks. Laparoscopy is certainly not performed in people with peritonitis, disturbed homeostasis, i.e. the ability to maintain constant parameters in the body, and severe circulatory and respiratory failure.

Worth knowing

Oral bariatric surgery?

Yes, it's possible now. In Poznań and Wałbrzych, several bariatric surgeries using the endoscopic, or endoluminar, method have already been performed. This technique does not require making any incisions in the abdominal wall. The surgeon enters the patient's abdominal cavity through the esophagus. First, an endoscope with a special head is inserted into it. The endoscopic method can be used in those patients who cannot undergo classical surgery or laparoscopy.

Important

Poradnikzdrowie.pl supports safe treatment and a dignified life of people suffering from obesity. This article does not contain discriminatory and stigmatizing content of people suffering from obesity.

About the authorMagdalena Gajda A specialist in obesity disease and obesity discrimination of people with diseases. President of the OD-WAGA Foundation of People with Obesity, Social Ombudsman for the Rights of People with Obesity in Poland and a representative of Poland in the European Coalition for People Living with Obesity. By profession - a journalist specializing in the subjecthe alth, as well as a PR, social communication, storytelling and CSR specialist. Privately - obesity since childhood, after bariatric surgery in 2010. Starting weight - 136 kg, current weight - 78 kg.

Category:

Obesity