Weight reduction surgery, also called bariatric surgery refers to a series of procedures carried out on overweight people. The size of the stomach is either reduced or a portion of it removed. This is possible either through use of a gastric band or sleeve gastrectomy respectively. Gastric bypass can also be done by resecting and diverting the small intestine to the stomach. Research has shown that this procedure helps in improving the condition of diabetic patients and reducing the risk of cardiovascular risks.
Bariatric surgery is most helpful in persons that have a body mass index, BMI, of more than 40. It is also recommended for those that have medical conditions that are likely to be worsened by obesity. These include among others, glucose intolerance, hyperlipidaemia and diabetes. Surgical options are reserved for cases that are unresponsive to medical therapy.
Pros and cons of such a procedure should be taken into account before the procedure is done. Certain post-operative complications such as gall bladder disease and malabsorption may arise. Psychiatric screening should also be done as there is possibility of patients falling in to depression after the operation.
There are three main categories of surgery to consider. They broadly include the restrictive, malabsorptive and mixed. The malabsorptive technique is one that results in a malabsorption state of the gut. An example here is what is referred to as billiopancreatic diversion with duodenal stitch or BDS/DS. What this means is that a portion of the stomach is cut and removed and the remaining is fashioned into a smaller pouch that is connected to the small intestine bypassing the jejunum and duodenum. Side effects are mainly related to vitamin and mineral deficiency.
Restrictive procedures are done to reduce the amount of food eaten by reducing the size of the stomach. The person that has had this surgery will usually experience earlier satiety than was the case in the previously. A common technique used to achieve this is the vertical banded gastroplasty. In this technique, permanent staples are put on the stomach and this effectively reduces the volume.
Another restrictive technique is known as sleeve gastrectomy. In the hands of a skilled surgeon, up to 15% of the original size of the stomach can be successfully removed. The greatest portion is taken from the greater curvature. The stomach shape is transformed into more of a tube. In advanced centers, laparoscopes are used so as to improve on the accuracy.
There is a need to make dietary changes after operation. The food types that should be taken include liquids such as broth, juices and sugar-free gelatin desserts. These should be maintained until full recovery of the gut takes place. As one recovers, the next foods to be introduced include blended substances that should also be sugar free.
As happens with any surgical operation, there are a number of risks that should be anticipated both in the short term and long term. In these patients calcium absorption is often compromised leading to metabolic bone diseases. Osteopenia and secondary hyperparathyroidism are some clinical features that may be encountered. Rapid loss of weight is a predisposing factor for gall stone formation and one will therefore need to have this at the back of their mind. Other complications of weight reduction surgery include decreased absorption of nutrients such as vitamin B12, thiamine, iron and folate.
Bariatric surgery is most helpful in persons that have a body mass index, BMI, of more than 40. It is also recommended for those that have medical conditions that are likely to be worsened by obesity. These include among others, glucose intolerance, hyperlipidaemia and diabetes. Surgical options are reserved for cases that are unresponsive to medical therapy.
Pros and cons of such a procedure should be taken into account before the procedure is done. Certain post-operative complications such as gall bladder disease and malabsorption may arise. Psychiatric screening should also be done as there is possibility of patients falling in to depression after the operation.
There are three main categories of surgery to consider. They broadly include the restrictive, malabsorptive and mixed. The malabsorptive technique is one that results in a malabsorption state of the gut. An example here is what is referred to as billiopancreatic diversion with duodenal stitch or BDS/DS. What this means is that a portion of the stomach is cut and removed and the remaining is fashioned into a smaller pouch that is connected to the small intestine bypassing the jejunum and duodenum. Side effects are mainly related to vitamin and mineral deficiency.
Restrictive procedures are done to reduce the amount of food eaten by reducing the size of the stomach. The person that has had this surgery will usually experience earlier satiety than was the case in the previously. A common technique used to achieve this is the vertical banded gastroplasty. In this technique, permanent staples are put on the stomach and this effectively reduces the volume.
Another restrictive technique is known as sleeve gastrectomy. In the hands of a skilled surgeon, up to 15% of the original size of the stomach can be successfully removed. The greatest portion is taken from the greater curvature. The stomach shape is transformed into more of a tube. In advanced centers, laparoscopes are used so as to improve on the accuracy.
There is a need to make dietary changes after operation. The food types that should be taken include liquids such as broth, juices and sugar-free gelatin desserts. These should be maintained until full recovery of the gut takes place. As one recovers, the next foods to be introduced include blended substances that should also be sugar free.
As happens with any surgical operation, there are a number of risks that should be anticipated both in the short term and long term. In these patients calcium absorption is often compromised leading to metabolic bone diseases. Osteopenia and secondary hyperparathyroidism are some clinical features that may be encountered. Rapid loss of weight is a predisposing factor for gall stone formation and one will therefore need to have this at the back of their mind. Other complications of weight reduction surgery include decreased absorption of nutrients such as vitamin B12, thiamine, iron and folate.
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