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Old 02-12-2006, 01:37 PM   #4
AmazonKelli
 
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In order to understand how bariatric surgery results in weight loss, it is necessary to understand how food is digested
After swallowing, food enters the stomach, which acts to hold the food and then allow small amounts of the food to pass further into the digestive tract. The volume of the stomach is usually between 600 - 1000 cc (20 - 30 oz.)

In the first part of the small bowel (duodenum), food comes into contact with bile, secreted by the liver as well as enzymes from the pancreas. These secretions help in the digestion and absorption of food. The small bowel is where most of the absorption of food occurs and may reach a length of 6 - 7 meters (over 20 feet). The proximal (closest to the mouth) two-fifths of the small bowel is called the jejunum and the distal (farthest from the mouth) three-fifths is called the ileum

Most bariatric procedures work by two methods - a restrictive component and a malabsorptive component

Restrictive component - a portion of the stomach may be removed or bypassed so as to reduce the volume of the stomach. Thus, only a limited amount of food can be eaten prior to getting full
Malabsorptive component - Bile and pancreatic secretions, which are necessary for digestion of food, are directed away from the food. These secretions reach the food several yards down the length of the small bowel, thus delaying and causing incomplete digestion and absorption of the food

Bariatric surgery is indicated for patients who are morbidly obese, BMI greater than 40, or for patients with a BMI greater than 35 if they have associated medical problems.
Patients with a BMI of less than 35 are usually treated with a weight reduction diet, a program of increased physical activity, approved weight loss medication and counseling to modify behaviour.
Remember that this is major surgery and great thought and care should be given before deciding this is your best option.

Vertical Banded Gastroplasy - this is a restrictive type of procedure. Food intake is reduced becasue the stomach is smaller. A vertical (up and down) pouch is constructed using the upper part of the stomach usually by using a surgical stapler. The pouch usually allows only 1-2 ounces of food to enter the stomach. This pouch may be surrounded by cloth mesh to prevent the stomach from distending.

Roux-en-Y Gastric Bypass - this is a combination of a restrictive and malabsorptive procedure.

the upper portion of the stomach is freed and a row of staples is placed horizontally a few centimeters below the esophagus - stomach junction. The gastric pouch measures about 1-2 ounces and is totally separated from the stomach.

the small bowel is divided approximately 24 inches beyond the stomach. The distal loop is brought up and attached to the stomach pouch. This forms the food channel.
the proximal loop contains secretions of bile and pancreas and is called the biliopancreatic channel. This channel is attached to the side of the food channel approximately 24 inches distal to the attachment of the stomach and small bowel forming a Y-shaped arrangement of the bowel
In this procedure food intake is restricted because of the small stomach pouch and there is poor absorption of food because the bile and pancreatic secretions do not come in contact with food until about 48 inches beyond the stomach.

Adjustable Gastric Band (Lap Band) - restrictive gastic operations, such as an adjustable gastric banding procedure,serve only to restrict and decrease food intake and do not interfere with the normal digestive process.

In this procedure, a hollow band made of special material is placed around the stomach near its upper end, creatingthe small pouch and a narrow passage into the larger remaining portionof the stomach. This small passage delays the


emptying of food from the pouch and causes a feeling of fullness. The band can be tightened or loosened over time to change the size of the passage. Initially, the pouch holds about 1 ounce of food and later expands to 2-3 ounces

The MIDBAND is an adjustable peri gastric belt, implantable by coelioscopie. It is indicated for surgical treatment of morbid obesity defined by an index of mass in excess of 40 kg/m2.

The MIDBAND provides a very attractive alternative to conventional surgical methods which are intense and irreversible, requiring extended hospitalization.

The MIDBAND is extremely flexible making it easy to fit. It’s inextensible and original fit double clodure system insures a fastening capacity far in excess of the physiological conditions recured.


The MIDBAND has no sharp edges or irregularities preserving the gastric wall intact, even in event of rubbing. It is opaque to X rays, making it easy to locate and adjust.



Complications
Several complications, although possible with any surgery, are more prevalent in obese patients due frequently to poor heart and lung function. These are:

myocardial infarction (heart attack) or heart failure
pulmonary complications such as respiratory failure requiring ventilator support, pulmonary embolus (blood clot from legs or pelvis going to the lungs), lung collapse (atelectasis) or pneumonia
Complications specific to bariatric surgery include:

bowel leaks that may give rise to abcesses that may need reoperation to repair
wound dehiscence (separation of the wound exposing the bowel)
injury to the spleen
ulcers forming at the attachment of the small bowel to the stomach. If antacids are not effective, the surgery may have to be redone
obstruction of the stomach at the point it joins the small bowel may require dilation
poor absorption of iron, folate, vitamins B12, A, D, E and calcium may be seen if these are not given after surgery
gallstones and decreased liver function may be seen due to poor absorption of bile salts
loose skin from loss of fat under the skin may require plastic surgery to excise the loose skin
excessive weight loss despite vitamin and mineral supplements may require a reversal of the bypass


Just thought I'd cover all bases LOL

Post-Operative Care
Immediate post-operative care:

Patients stay in the hospital for 1-3 days for recovery of bowel function
One or more drains may be placed in the abdomen. These are removed as the drainage decreases and the bowel regains function
The incision is closed by absorbable sutures
Some surgeons obtain an x-ray dye swallowing study to see if there is adequate emptying of the stomach pouch prior to starting a diet. Diet is usually started with liquids and slowly advanced to solid food. A dietician may be consulted to advise a patient of the proper diet. It is important to remember that the amount of food that a patient can eat is much more limited.
Long-term care

Patients may experience diarrhea with flatulence due to partially digested food for a few months
Patients may need to increase the number of meals a day due to the small size of each meal. Patients notice a quick loss of weight over the first six months, followed by a slower loss of weight over the next 12 to 18 months. By about two years the weight stabilizes
Many patients notice that associated illnesses improve after a few months with the weight loss.
It is important to check for anemia (low blood iron) and deficiency of vitamins and minerals, which can occur from the surgery. Multivitamins and iron supplements are needed to make up for their poor absorption.
Follow-up visits may include blood tests for sugar and cholesterol, which usually fall after surgery.
There may be excessive loose skin hanging from the abdomen due to loss of fat under the skin. This may require plastic surgery (tummy tuck) to trim away the excess skin.
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