Bariatric surgery is a branch of general surgery that deals with the treatment of obesity of the 2nd and 3rd degree. Bariatric surgery consists in introducing such changes in the gastrointestinal tract in order to improve the disturbed mechanisms of neurohormonal regulation of food intake and, as a result, lead to the reduction of excessive body weight.

Basicsbariatric surgerywere created in the 1950s. However, the development of obesity to a global pandemic made bariatric surgery one of the most dynamically developing domains of surgery in Poland and around the world. How was bariatric surgery born and what bariatric surgeries are currently performed, i.e. what does a bariatric surgeon do?

Let's start with the definition. Bariatry is a branch of medicine that deals with the diagnosis, determination of causes, prevention and treatment of overweight and obesity, including surgical methods. This term was created in 1965 and comes from the Greek language (βάρος-ἰατρός,weight-medicine) . Interestingly, in recent years, the name that arose from Greek has been abandoned in favor of a new one, derived from the English language. The field of medicine dealing with obesity treatment is more and more often called obesitology ( obesity - obesity) , but surgeons treating obesity with a scalpel still say:bariatric surgeons.

Contents:

  1. Bariatric surgery - shutdown operations?
  2. Bariatric surgery - restrictive operations
  3. Bariatric surgery - other methods
  4. Bariatric surgery - for 50 years in Poland

Bariatric surgery - shutdown operations

The pioneer of bariatric surgery is Dr. Linnear, who in the 1950s observed that patients who have part of their stomach or intestines removed also lose significant weight after such surgery. It was then that Linnear performed the first anastomosis of the jejunum and ileum. In this way, he obtained a shorter so-called passage, that is, the path of passage of food. In the following years, more surgeons modified the Linnear method to create agroup of bariatric procedures , which are still called:disabling . The most famous, named after the surgeons who developed and implemented them, are: the Payne - de Winda procedure and theScott.

Although these methods resulted in significant weight loss, they had many side effects. In patients who were subjected to the then exclusionary treatments, the absorption of fats and vitamins was disturbed, and consequently the so-called avitaminosis as well as gallbladder stones. Patients also complained of severe diarrhea which led them to severe dehydration. And because the clinical results and patient satisfaction were not satisfactory, disabling operations were abandoned (for some time).

Bariatric surgery - restrictive operations

At the beginning of the 1960s, the basics ofof the second group of bariatric procedures- the so-called operationsrestrictive . Their idea was to reduce the volume of the stomach involved in the digestive process. The first such treatment was the so-called horizontal gastroplasty acc. Pacey and Carreya. With the help of the so-called staplers, or special staples, this organ was sutured in 1/3 of the upper part of the stomach, but without cutting it and leaving a small hole for food to pass to the distal part of the stomach. In this way, a small, only 30 ml "container" was created, which was the first to fill up while eating. Unfortunately, the movements of the stomach caused the staples to separate. After the initial weight loss, the patient returned to the starting weight again after some time.

The surgeons decided, however, that it is worth continuing work on restrictive treatments, because they do not cause such large side effects as exclusionary ones. At that time, attempts were also made to combine both types of treatments. Among other things, the Rouxen Y gastric by-pass (RYGB) procedure was developed, which is now one of the most frequently used bariatric surgeries.

Dr. Mason returned to the idea of ​​gastroplasty in the early 1980s. In his version, he changed the position of the staples to vertical ones, placed the "passage" between parts of the stomach in a different place and additionally secured them against widening with Teflon tape. This operation, although no longer used today, is called vertical banded gastroplasty (VGB) and, together with RYGB, forms the basis of classic bariatric surgery.

Bariatric surgery - other methods

Also in the early 1980s, Dr. Scopinaro introduced a procedure called: biliary-pancreatic bypass. This complicated operation, consisting in excision of a significant part of the stomach and combining its remains with the cut into sections of the small intestine, has gone through many modifications. It is performed to this day, but rarely. Although after such a procedure the weight loss is very high, it also has many side effects. Becausealso, if it is already used in patients who need fast and significant weight loss.

It should also be mentioned here that as a result of the modification of the bile-pancreatic exclusion, one of the most common procedures was created - sleeve gastrectomy.

A variety of gastroplasty operations are the so-called gastric banding. They consist of putting bands around the entire organ. Thus it takes the shape of an hourglass. These treatments were introduced by surgeons Wilkinson, Kolle and Molina, and another - Kuzman - modified the band to the shape of a fluid-filled inner tube. In this way, it can be tightened and released from the outside through the port located just under the skin. The idea is similar to gastroplasty. The stomach is divided into two parts, including the upper, smaller one that is filled first when eating.

The laparoscopic technique was introduced to bariatric surgery in the early 1990s. With this method, the operations of putting on an adjustable band were the first to be performed. Today it is also used in RYGB and sleeve gastrectomy. And recently, the so-called endoluminar, i.e. endoscopic surgical technique.

Do you know that…

The goal of modern bariatric surgery is not to "shrink the stomach" or to reduce digestion or absorption of ingested food substances. Bariatric surgeries repair the disturbed mechanisms of the neurohormonal regulation of food intake: they lower the concentration of ghrelin (the hunger hormone) and restore the postprandial secretion of GLP-1 (satiety hormone).

Bariatric surgery - for 50 years in Poland

In our country, the first surgical treatment of obesity, and these were intestinal exclusions, began in the mid-1970s. the first vertical band gastrectomy was performed by prof. Marian Pardela from Zabrze - (since 1977), one of the pioneers of Polish bariatric surgery. Also in the early 1990s, the team of prof. Edward Stanowski, apart from disabling procedures, he also began to perform gastric wrapping with a silicone band. Back then, with the use of a classic surgical technique, but five years later the band was put on with the use of a laparoscope. When it comes to gastric exclusion, it was classically performed in 1999. and a year later laparoscopically. The biliary-pancreatic exclusion technique was first used in Poland as a method of obesity treatment in 2001. and in 2003. the first sleeve gastrectomy was performed.

Currently in Poland, between 2,000 and 3,000 are performed in approx. 30 hospitalsbariatric surgery annually. All operations are reimbursed by the National He alth Fund. The number of bariatric surgeons is also increasing. Currently, bariatric surgeries are needed by approximately 700,000 Poles suffering from grade III obesity (the so-called enormous).

Bariatric surgeries are also performed in patients suffering from 2nd degree obesity with diseases that are complications of obesity, e.g. type 2 diabetes, hypertension and sleep apnea. They are also performed in patients without obesity, but only with type 2 diabetes. Therefore, bariatric surgery is also called metabolic surgery.

Bibliography:1. Edward Stanowski, Mariusz Wyleżoł; " Development of the surgical treatment of obesity in the world and in Poland ", Postępy Nauk Medycznych, vol. XXII, No. 7, 20092. Mariusz Wyleżoł, " What every doctor should know about surgery bariatric " , journal" PULS ", No. 12/2018

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 he alth issues, 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