ELROUBY CLINIC         عربيEnFrSpGrSp  Concent
      
























 

Bariatric surgeries (Management of Morbid Obesity) Bariatric

morbid obesity Bariatric surgery, or weight loss surgery, is a type of procedure performed on people who have morbid obesity, for the purpose of losing weight.

This weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).
obesity, obese, bariatric surgery, surgery bariatric, childhood obesity, obesity statistics, child obesity, obesity child, obesity children, obesity surgery, surgery obesity, morbidly obese, obese children, obesity health, morbid obesity, obesity causes, obesity diabetes, obesity facts, obesity treatment, fast food obesity, after bariatric surgery, obesity help, overweight obesity, obesity diet, weight loss obesity, bariatric bypass surgery, bariatric surgery center, bariatric surgery weight, obesity clinic, obesity exercise, obesity problem, teen obesity, treatment of obesity, bariatric surgery cost, bariatric surgery diet, kids obesity, post bariatric surgery, teenage obesity, gastric bariatric surgery, surgery for obesity, bariatric gastric bypass surgery, bariatric laparoscopic surgery, bariatric surgery gastric bypass, bariatric surgery support, bariatric surgery weight loss, bariatric weight loss surgery, laparoscopic bariatric surgery, morbid obesity surgery, obesity solutions, treatment for obesity, youth obesity, obese surgery, obesity information, obesity treatments, bariatric obesity, bariatric obesity surgery, bariatric surgery info, bariatric surgery insurance, bariatric surgery obesity, cost of bariatric surgery, obesity doctors, bariatric surgery before and after, bariatric surgery centers, bariatric surgery complications, bariatric surgery information, obesity and surgery, obesity clinics, obesity dr, obesity surgeon, obesity weight loss surgery, band bariatric surgery, bariatric band surgery, bariatric sleeve surgery, bariatric surgery clinic, bariatric surgery program, center for bariatric surgery, laparoscopic obesity surgery, obesity surgery center, bariatric surgery costs, bariatric surgery doctors, bariatric surgery procedure, bariatric surgery risks, bariatric surgery statistics, bariatric surgery support group, bariatric surgery support groups, diet after bariatric surgery, free bariatric surgery, obesity bypass, post bariatric surgery diet, surgery for morbid obesity, surgical obesity, after obesity, bariatric revision surgery, bariatric surgery stories, information on obesity, laproscopic bariatric surgery, severe obesity, bariatric plastic surgery, bariatric surgery diabetes, obesity gastric bypass, bariatric surgeries, medicare bariatric surgery, bariatric surgery center of excellence, bariatric surgery guidelines, bariatric surgery nutrition, bariatric surgery patients, obesity patients, stomach obesity, american society for bariatric surgery, bariatric surgery pictures, bariatrics surgery, obesity surgeons, obesity surgeries, bariatric surgery canada, bariatric surgery financing, bariatric surgery types, bariatric surgery photos, minimally invasive bariatric surgery, bariatric surgery complication, bariatric surgery programs, bariatric surgery risk, before and after obesity, obesity plastic surgery, obesity weightloss, types of bariatric surgery, american society of bariatric surgery, bariatric surgery for obesity, bariatric surgery clinics, bariatric surgery doctor, bariatric surgery exercise, bariatric surgery options, bariatric surgery price, eating after bariatric surgery, life after bariatric surgery, obesity procedures, roux en y bariatric surgery, bariatric surgery bmi, bariatric surgery procedures, bariatric surgery weight gain, gastric sleeve bariatric surgery, nih bariatric surgery, risks of bariatric surgery, bariatric surgery for weight loss, low cost bariatric surgery, bariatric surgery children, bariatric surgery success stories, asbs bariatric surgery, bariatric surgery seminar, costs of bariatric surgery, cheap bariatric surgery, bariatric, gastric bypass, overweight, bypass surgery, gastric surgery, weight loss surgery, gastric bypass surgery, weight surgery, stomach surgery, roux en y, gastric sleeve, bariatrics, gastric bypass diet, sleeve gastrectomy, bariatric surgeons, rny surgery, bariatric bypass, bariatric diet, bariatric doctors, bariatric surgeon, laparoscopic gastric bypass, bariatric weight loss, gastric by pass, roux en y gastric bypass, stomach stapling, surgical weight loss, gastric banding surgery, gastric bypass surgeons, laparoscopic gastric bypass surgery, stomach bypass, bariatric gastric bypass, gastric sleeve surgery, adjustable gastric band, adjustable gastric banding, bariatric program, weightloss surgery, bariatric eating, stomach banding, stomach bypass surgery, weight loss surgeries, bariatric support group, sleeve gastrectomy surgery, gastro bypass surgery, lap bands, stomach stapling surgery, laparoscopic adjustable gastric banding, bariatric center of excellence, bariatric procedures, bariactric surgery, bariatric surgury, obesity, obese, bariatric surgery, surgery bariatric, childhood obesity, obesity statistics, child obesity, obesity child, obesity children, obesity surgery, surgery obesity, morbidly obese, obese children, obesity health, morbid obesity, obesity causes, obesity diabetes, obesity facts, obesity treatment, fast food obesity, after bariatric surgery, obesity help, overweight obesity, obesity diet, weight loss obesity, bariatric bypass surgery, bariatric surgery center, bariatric surgery weight, obesity clinic, obesity exercise, obesity problem, teen obesity, treatment of obesity, bariatric surgery cost, bariatric surgery diet, kids obesity, post bariatric surgery, teenage obesity, gastric bariatric surgery, surgery for obesity, bariatric gastric bypass surgery, bariatric laparoscopic surgery, bariatric surgery gastric bypass, bariatric surgery support, bariatric surgery weight loss, bariatric weight loss surgery, laparoscopic bariatric surgery, morbid obesity surgery, obesity solutions, treatment for obesity, youth obesity, obese surgery, obesity information, obesity treatments, bariatric obesity, bariatric obesity surgery, bariatric surgery info, bariatric surgery insurance, bariatric surgery obesity, cost of bariatric surgery, obesity doctors, bariatric surgery before and after, bariatric surgery centers, bariatric surgery complications, bariatric surgery information, obesity and surgery, obesity clinics, obesity dr, obesity surgeon, obesity weight loss surgery, band bariatric surgery, bariatric band surgery, bariatric sleeve surgery, bariatric surgery clinic, bariatric surgery program, center for bariatric surgery, laparoscopic obesity surgery, obesity surgery center, bariatric surgery costs, bariatric surgery doctors, bariatric surgery procedure, bariatric surgery risks, bariatric surgery statistics, bariatric surgery support group, bariatric surgery support groups, diet after bariatric surgery, free bariatric surgery, obesity bypass, post bariatric surgery diet, surgery for morbid obesity, surgical obesity, after obesity, bariatric revision surgery, bariatric surgery stories, information on obesity, laproscopic bariatric surgery, severe obesity, bariatric plastic surgery, bariatric surgery diabetes, obesity gastric bypass, bariatric surgeries, medicare bariatric surgery, bariatric surgery center of excellence, bariatric surgery guidelines, bariatric surgery nutrition, bariatric surgery patients, obesity patients, stomach obesity, american society for bariatric surgery, bariatric surgery pictures, bariatrics surgery, obesity surgeons, obesity surgeries, bariatric surgery canada, bariatric surgery financing, bariatric surgery types, bariatric surgery photos, minimally invasive bariatric surgery, bariatric surgery complication, bariatric surgery programs, bariatric surgery risk, before and after obesity, obesity plastic surgery, obesity weightloss, types of bariatric surgery, american society of bariatric surgery, bariatric surgery for obesity, bariatric surgery clinics, bariatric surgery doctor, bariatric surgery exercise, bariatric surgery options, bariatric surgery price, eating after bariatric surgery, life after bariatric surgery, obesity procedures, roux en y bariatric surgery, bariatric surgery bmi, bariatric surgery procedures, bariatric surgery weight gain, gastric sleeve bariatric surgery, nih bariatric surgery, risks of bariatric surgery, bariatric surgery for weight loss, low cost bariatric surgery, bariatric surgery children, bariatric surgery success stories, asbs bariatric surgery, bariatric surgery seminar, costs of bariatric surgery, cheap bariatric surgery, bariatric, gastric bypass, overweight, bypass surgery, gastric surgery, weight loss surgery, gastric bypass surgery, weight surgery, stomach surgery, roux en y, gastric sleeve, bariatrics, gastric bypass diet, sleeve gastrectomy, bariatric surgeons, rny surgery, bariatric bypass, bariatric diet, bariatric doctors, bariatric surgeon, laparoscopic gastric bypass, bariatric weight loss, gastric by pass, roux en y gastric bypass, stomach stapling, surgical weight loss, gastric banding surgery, gastric bypass surgeons, laparoscopic gastric bypass surgery, stomach bypass, bariatric gastric bypass, gastric sleeve surgery, adjustable gastric band, adjustable gastric banding, bariatric program, weightloss surgery, bariatric eating, stomach banding, stomach bypass surgery, weight loss surgeries, bariatric support group, sleeve gastrectomy surgery, gastro bypass surgery, lap bands, stomach stapling surgery, laparoscopic adjustable gastric banding, bariatric center of excellence, bariatric procedures, bariactric surgery, bariatric surgury, obesity, obese, bariatric surgery, surgery bariatric, childhood obesity, obesity statistics, child obesity, obesity child, obesity children, obesity surgery, surgery obesity, morbidly obese, obese children, obesity health, morbid obesity, obesity causes, obesity diabetes, obesity facts, obesity treatment, fast food obesity, after bariatric surgery, obesity help, overweight obesity, obesity diet, weight loss obesity, bariatric bypass surgery, bariatric surgery center, bariatric surgery weight, obesity clinic, obesity exercise, obesity problem, teen obesity, treatment of obesity, bariatric surgery cost, bariatric surgery diet, kids obesity, post bariatric surgery, teenage obesity, gastric bariatric surgery, surgery for obesity, bariatric gastric bypass surgery, bariatric laparoscopic surgery, bariatric surgery gastric bypass, bariatric surgery support, bariatric surgery weight loss, bariatric weight loss surgery, laparoscopic bariatric surgery, morbid obesity surgery, obesity solutions
What are the Benefits of Bariatric Surgeries?

Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 40% to 23%.

The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes. However, research is emerging that suggests bariatric surgery could be appropriate for those with a BMI of 35 to 40 with no co-morbidities or a BMI of 30 to 35 with significant co-morbidities.


Who is the Best Candidate for Bariatric surgeries?Bariatric

A medical guideline by the American College of Physicians concluded:
"Surgery should be considered as a treatment option for patients with a BMI of 40 kg/m² or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. A doctor–patient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gallbladder disease, and malabsorption." "Patients should be referred to high-volume centers with surgeons experienced in bariatric surgery."

When determining eligibility for bariatric surgery for extremely obese patients, psychiatric screening is critical; it is also critical for determining postoperative success. In patients with a body mass index of 40 kg/m² or greater, there is a 5-fold risk of depression, and half of bariatric surgery candidates are depressed.


Classification of surgical procedures:

Procedures can be grouped in three main categories: Standard of care is for laparoscopic as opposed to open procedures. Future trends are attempting to achieve similar or better results via endoscopic procedures.

A- Predominantly Malabsorptive procedures:

Predominantly malabsorptive procedures, although they also reduce stomach size, these operations are based mainly on creating malabsorption.

- Biliopancreatic diversion
This complex operation is also known as biliopancreatic diversion (BPD), or Scopinaro procedure. This surgery is rare now because of problems with malnourishment. It has been replaced with the Duodenal switch, also known as the BPD/DS. Part of the stomach is resected, creating a smaller stomach (however the patient can eat a free diet as there is no restrictive component). The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum.

In around 2% of patients there is severe malabsorption and nutritional deficiency that requires restoration of the normal absorption. The malabsorptive effect of BPD is so potent that those who undergo the procedure must take vitamin and dietary minerals above and beyond that of the normal population. Without these supplements, there is risk of serious deficiency diseases such as anemia and osteoporosis.

Because gallstones are a common complication of the rapid weight loss following any type of bariatric surgery, some surgeons remove the gallbladder as a preventative measure during BPD. Others prefer to prescribe medications to reduce the risk of post-operative gallstones.

Far fewer surgeons perform BPD compared to other weight loss surgeries, in part because of the need for long-term nutritional follow-up and monitoring of BPD patients.

- Jejunoileal bypass
This procedure is no longer performed.

- Endoluminal sleeve
This procedure is no longer performed.


B- Predominantly restrictive procedures

Predominantly restrictive procedures primarily reduce stomach size.

- Vertical Banded Gastroplasty
In the vertical banded gastroplasty, also called the Mason procedure or stomach stapling, a part of the stomach is permanently stapled to create a smaller pre-stomach pouch, which serves as the new stomach.

- Adjustable gastric bandgastric lap band
The restriction of the stomach also can be created using a silicone band, which can be adjusted by addition or removal of saline through a port placed just under the skin. This operation can be performed laparoscopically, and is commonly referred to as a "lap band." The first non-adjustable gastric band was patented in 1979 and successfully applied in animal experiments. An American company, INAMED Health, later designed the BioEnterics LAP-BAND Adjustable Gastric Banding System (based on the design by Kuzmak in 1986), which was introduced in Europe in 1993. Neither of these bands was initially designed for use with laparoscopic surgery.

The LAP-BAND System received U.S. Food and Drug Administration (FDA) approval in June 2001. In 2000, a lower pressure, wider, one-piece adjustable gastric band called the MIDband was introduced by Medical Innovation Development of Lyon FranceIn 2002, a lower pressure, wider, one-piece adjustable gastric band called the Bioring designed specifically for laparoscopic insertion was introduced in France by Cousin-Biotech, and swiftly become one of the leading bands in that country. There are now a number of band manufacturers including Ethicon (Realize Band), A.M.I. (Soft Band) and Bariatric Solutions (Mini Mizer Extra).

- Sleeve gastrectomy
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.

This combined approach has tremendously decreased the risk of weight loss surgery for specific groups of patients, even when the risk of the two surgeries is added. Most patients can expect to lose 30 to 50% of their excess body weight over a 6 - 12 month period with the sleeve gastrectomy alone. The timing of the second procedure will vary according to the degree of weight loss, typically 6 - 18 months.

- Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts.
- Removes the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin), although the durability of this removal has yet to be confirmed.
- No dumping syndrome because the pylorus is preserved.
- Minimizes the chance of an ulcer occurring.
- By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are significantly reduced.
- Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m²).
- Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m²).
- Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.

- Intragastric balloon
This surgery involves endoscopic placing a deflated balloon into the stomach, and then filling it to decrease the amount of gastric space.
The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5-9 BMI over half a year.
While not yet approved by the FDA the Intragastric balloon is approved in Australia, Canada, Mexico, India and several European and South American countries.

C- Mixed procedures
Mixed procedures apply both techniques simultaneously.

- Roux-en-Y gastric bypass - Gastric Bypass Surgery roux en Y
A common form of gastric bypass surgery is the Roux-en-Y gastric bypass. Here, a small stomach pouch is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration.
The gastric bypass had been the most commonly performed operation for weight loss allover the world.
The gastric bypass operation is considered the "gold standard" in the U.S. A factor in the success of any bariatric surgery is strict post-surgical adherence to a gastric bypass diet.

- Sleeve gastrectomy with duodenal switch
A variation of the biliopancreatic diversion includes a Duodenal switch.
The part of the stomach along its greater curve is resected. The stomach is "tubulized" with a residual volume of about 150 ml.
This volume reduction provides the food intake restriction component of this operation.
This type of gastric resection is anatomically and functionally irreversible. The stomach is then disconnected from the duodenum and connected to the distal part of the small intestine.
The duodenum and the upper part of the small intestine are reattached to the rest at about 75-100 cm from the colon.

- Implantable Gastric Stimulation
This procedure where a device similar to a heart pacemaker is implanted, with the electrical leads stimulating the external surface of the stomach.
Electrical stimulation is thought to modify the activity of the enteric nervous system of the stomach, which is interpreted by the brain to give a sense of satiety, or fullness.
Early evidence suggests that it is less effective than other forms of Bariatric Surgery.

Morbid obesity surgeries

 

What is after? Eating after Bariatric surgeries:

Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free gelatin desserts.
- This diet is continued until the gastrointenstinal tract has recovered somewhat from the surgery.
- The next stage provides a blended or pureed sugar-free diet for at least two weeks.
- This may consist of skimmed milk, cream of wheat, a small pat of margarine, protein drinks, cream soup, pureed fruit and mashed potatoes with gravy.
- Post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting.
- Diet restrictions after recovery from surgery depend in part on the type of surgery.
- Many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients. Because patients cannot eat a large quantity of food, physicians typically recommend a diet that is relatively high in protein and low in fats and alcohol.


Effectiveness of surgery:

a- Weight loss
In general, the malabsorptive procedures lead to more weight loss than the restrictive procedures however, have a higher risk profile.
before-and-after-obesity
- Biliopancreatic diversion - 53 kg
- Roux-en-Y gastric bypass (RYGB) - 41 kg
- Open - 42 kg
- Laparoscopic - 38 kg
- Adjustable gastric banding - 35 kg
- Vertical banded gastroplasty - 32 kg

In terms of percentage of successful excess weight lost:
- Biliopancreatic diversion with duodenal switch – 65% to 75%
- Roux-en-Y gastric bypass (RYGB) – 50% to 70%
- Adjustable gastric banding – 25% to 80%
- Vertical banded gastroplasty – 50% to 60%
- Sleeve gastrectomy – short-term results – 65% to 75%


More recent studies have demonstrated that the medium (3-8 years) and long term (>10 years) weight loss results for RYGB and LAGB become very similar. However, the range of excess weight loss for LAGB patients (25% to 80%) is much broader than that of RYGB patients (50% to 70%).

b- Reduced mortality and morbidity
Several recent studies report decrease in mortality and severity of medical conditions after bariatric surgery. But long term effects are not clear.

Death rates were lower in the gastric bypass patients for all diseases combined, as well as for diabetes, heart disease and cancer. Deaths from accident and suicide were 58% higher after the surgery.

Bariatric surgery in older patients has also been a topic of debate, centered on concerns for safety in this population.

Laparoscopic bariatric surgery requires a hospital stay of only one or two days. Short-term complications from laparoscopic adjustable gastric banding are reported to be lower than laparoscopic Roux-en-Y surgery, and complications from laparoscopic Roux-en-Y surgery are lower than conventional (open) Roux-en-Y surgery.


What are the Complications and adverse effects of Bariatric Surgeries?

Complications from weight loss surgery are frequent.
- 21.9% complications during the initial hospital stay and a total of 40% risk of complications in the subsequent six months. This was more common in those over 40 and led to increased health care expenditure.

- Common problems were:

1- gastric dumping syndrome in about 20% (bloatedness and diarrhea after eating, necessitating small meals or medication),
2- leaks at the surgical site (12%),
3- incisional hernia (7%),
4- infections (6%).
5- pneumonia (4%).
6- Mortality is 0.2%.

As the rate of complications appears to be reduced when the procedure is performed by an experienced surgeon.


How Much Do Bariatric Surgeries Typically Cost?

Although price is a factor when deciding on surgery, the most important factor is that you feel you are getting a good quality, natural-looking result from the procedure.

Bariatric Surgeries costs are variable according to the BMI, the used technique. Usually the cost is ranging from 6000 to 11,500 U.S. dollars. When dealing with costs, you also need to take into consideration the fact that the procedure may need to be repeated. Most medical insurance providers do not cover the procedure.


Summary of Bariatric Surgery Procedures:

The time of the procedure: from 3 to 6 hours.
Type of anesthesia:
local anesthesia +/- sedation or General.
Location:
hospital with 3 days postoperative hospital stay.
Expected Side effects:
frequent.
Recovery time:
return to work after 2 weeks and the final outcome within 6 months up to years.
Cost:
according to procedure ranging from 6000 to 11,500 U.S. dollars.
Results: according to procedure ranging from years and sometimes permanent results.