Obesity Surgical Treatment
Today, there are more than 50 types of surgical procedures used to treat the obesity. Every time the modern methods are introduced, they have the purpose to provide permanent weight loss with minimal risk for the patient. According to the American and European standards, we offer the most effective methods of surgical treatment of obesity.
Adjustable Gastric Band (AGB)
Adjustable Gastric Band (AGB), can be also called a stomach bandage, is an inflatable band that is placed on the top part of the stomach. It’s created a limited-sized food bag above the band (stomach pouch).
The core principle of the procedure is the following: eating even a small amount of food satisfies hunger and promotes a feeling of satiety. The feeling of satiety depends on the size of the strait between the stomach pouch and the rest of the stomach created by the bandage. With the help pf the port device, located directly below the skin, controls the tightness of the band. Bandage volume can be regulated with a sterile solution.
The reduction of the strait is carried out gradually, over time, with re-adjustment of the filler.
For the moment AGB is not the first line of the surgical therapy. The feeling of hunger and satiety doesn't depend on the food amount that stayed in the stomach pouch. Also, no other mechanisms, such as hormonal changes or malabsorption is added to the restriction factor of the AGB.
Most patients cannot lose at least 50% of their excess weight compared to other procedures that are usually performed. Also, there is a possibility of possible "slippage" of the band or its erosion into the stomach. Some mechanical problems with a ring are possible, tube or port are not excluded.
Gastric Balloon (GB)
Some patients don't want to have any bariatric procedure, despite the comorbidities associated with the obesity, or has medical contraindications for the procedure. An option for these patients is a gastric balloon. It provides a temporary, reversible and potentially recurrent alternative treatment. The balloon is placed endoscopically, and is usually filled with 500 ml of saline, and after about 6 months it will be removed endoscopically throught the mouth.
This technique has a temporary effect for up to 3 years, despite the possibility of re-manipulation. Gastric balloon does not solve the problem of an obesity because it cannot provide a long-term effect and do not affect pathogenetic aspects of the disease.
Interesting fact, that up to 32% of patients who choose this technique, eventually undergo bariatric surgery.
Laparoscopic Sleeve Gastrectomy (LSG)
Firstly described as the first stage of biliopancreatic diversion (BPD), laparoscopic sleeve gastrectomy (LSG) has gained popularity in recent years and is now the most common bariatric surgery performed in the United States. Improving the performance of LSG as the main weight loss procedure is partly explained by its technical superiority comparing to the biliopancreatic diversion and promising results.
Studies have shown metabolic and weight loss results that significantly exceed AGB and comparable to the RYGB.
During Laparoscopic sleeve gastrectomy surgeon removing approximately 80% of the stomach, involves resection of the greater curvature from the antrum to the esophago-gastric junction, leaving a tubular sleeve, which resembling a banana. Most patients who underwent LSG as a preparatory stage for BPS lost enough weight and resolve their comorbidities, so secondary surgery was unnecessary.
The first laparoscopic sleeve gastrectomy was registered in 1999, and the first report of LSG as a stand-alone procedure was in 2003. Later Gagner published a comparison of LSG and gastric banding procedures and showed that short-term weight loss in 1 year was almost the same, but LSG had less need for re-intervention and has a much better effect on reducing ghrelin production.
During LSG procedure the hormone-producing zone of the stomach is removed. During bandaging, and other similar procedures, the stomach is reduced but not removed, which does not affect its hormone secretion site, and therefore does not so much deprive the patient of appetite after surgery, but simply mechanically prevents him from saturating the stomach with the same volume. Such patients feel the need for high-calorie treats, which doctors kindly call a "symptom of sweets." In fact, such a patient can be compared to an addict who experiences a "break" in the absence of "pleasure". Patient is again and again offered to maintain a diet, denying the pleasure of eating what he or she wants. Patients who have undergone LSG are change their eating behavior. Patients become independent of food and can, like the average person, control their desires.
LSG has many advantages over other surgical options.
It is technically less demanding than gastric bypass surgery or BPD-DS, has minimal morbidity and has no marginal ulcers, dumping syndrome, internal hernias or nutritional deficiencies.
Complications found in LSG include leaks and strictures of the staple lines. Over time, the rate of leakage has decreased due to improvements in technology and steps of the procedure.
Positive LSG results in weight loss, significant remission of comorbidities, and very low postoperative mortality and morbidity rates have contributed to the rise in its popularity. There is also evidence that LSG is just as effective in treating type 2 diabetes as primary metabolic procedures, regardless of weight loss.
The advantages are that LSG does not require foreign objects, does not bypass gastrointestinal tract and does not reconfigure the flow of food. Provides a short stay in the hospital - about 2-3 days.
This technique is relatively new, but already has enough long-term data, so LSG is our team's advantage in the fight against metabolic syndrome, but it is always decided individually.
Single-incision Laparoscopic Sleeve Gastrectomy (SILS)
Minimally invasive approach to treatment is the main direction of modern surgery. The doctors of our center have the necessary skills and equipment to offer you the most modern methods of laparoscopic surgery, such as - sleeve resection of the stomach with single-port access. This technique has many advantages over others, such as:
- Less trauma (which is the main advantage)
- Less time in the hospital and rapid recovery (2-3 days after surgery, patients can go home)
- Less complication rate
- Cosmetic effect (especially relevant for young girls)
This technique requires serious theoretical and practical training, as well as the use of special equipment.
Nowadays, our team has the most experience in this area, modern equipment, and the best results with the lowest percentage of complications, the largest number of operations in this area.
We also providing conferences and workshops, both in Ukraine and abroad!
Contact us to improve the quality of your life!
Roux-en-Y Gastric Bypass (RYGB)
RYGB gastric bypass surgery reduces the volume of the stomach to the 15-30 ml gastric sac by separating the upper part from the rest of the stomach and redirecting the flow of nutrients from the stomach to the proximal colon through the gastrojejunal anastomosis. Next, the first part of the small intestine divides.The lower end of the divided small intestine connects with the newly formed small gastric sac. The procedure ends by connecting the upper part of the divided small intestine to the small intestine, so that stomach acids and digestive enzymes from the lower part of the stomach and the first part of the small intestine are eventually mixed with the food. As a result, the procedure creates three different intestinal limbs: the biliopancreatic limb (from the Treitz ligament to the jejunojenostomy), which carries bile and pancreatic enzymes to the jejunojejunostomy, and the alimentary limb 100–150 cm (Ru-en-Y small intestine, anastomosed to the stomach sac), as well as the general canal (enteroenterostomy to the ileocecal valve).
Gastric bypass works by several mechanisms. First, like most bariatric procedures, the newly formed stomach pouch is much smaller and causes taking much smaller portions of food, which results in less calories consumed. In addition, because of the less food digestion by the smaller stomach sac there is a segment of the small intestine that normally absorbs calories, as well as nutrients that is no longer have food passing through it, there is probably some less absorption of calories and nutrients. Most important, that changing the passage of food flows contributes to the change of intestinal hormones that suppress hunger and give a feeling of satiety, as well as corrects one of the main mechanisms by which obesity causes type 2 diabetes.
The main aim of this additional surgical experiments and modifications are to improve work. This operation has good results due to similar operation. However, gastric bypass has its own set of complications. F.e., patients may suffer from dumping syndrome if they eat too many carbohydrates. But, some have argued that it is because of excessive weight loss.The potential serious complication can be the marginal ulcers. Technically, this is a more complicated operation than LSG and can potentially lead to higher risks complications. May lead to long-term vitamin / mineral deficiencies, especially vitamin B12, iron, calcium and folate deficiencies. Usually patients longer stays in the hospital. Also this treatment requires adherence to dietary recommendations, lifelong vitamin / mineral supplement.
Biliopancreatic diversion with duodenal switch (BPD/DS)
Biliopancreatic diversion with duodenal switch, abbreviated as BPD/DS, is a procedure with two components. First, a smaller, tubular pouch for the stomach is created by removing part of the stomach (LSG, described above). Next, most of the small intestine is circled.
The duodenum, or the first part of the small intestine, is cut off just behind the gate of the stomach. The segment of the distal (last part) of the small intestine connects with the end of the newly formed stomach, so that when the patient eats, food passes through the newly formed tubular sac of the stomach and enters directly into the last part of the small intestine. About three-quarters of the small intestine is excluded from the passage.
This leads to a significant reduction in the absorption of calories and nutrients (especially protein and fat), as well as nutrients and vitamins that depend on fat for absorption (fat-soluble vitamins and nutrients). Finally, BPD/DS acts on intestinal hormones in a way that affects hunger and satiety, as well as blood sugar control. BPD/DS is considered the most effective operation for the treatment of diabetes among those described here. Leads to more weight loss than RYGB, LSG, ie 70% of excess weight loss or more in 5 years.
The detached small intestine, which carries the enzymes of bile and pancreas needed to digest and absorb protein and fat, reconnects with the last part of the small intestine so that they can mix with the food stream. Like the other operations described above, BPD/DS initially helps reduce the amount of food consumed. However, over time, this effect decreases and patients may end up consuming about "normal" amounts of food.
Because it is the most technically difficult operation, it has a higher complication rate and risk of death than AGB, LSG and RYGB. Requires a longer hospital stay than AGB or LSG. Has a higher risk of protein deficiency and long-term deficiency of some vitamins and minerals, such as iron, calcium, zinc, fat-soluble vitamins, vitamin D.
Bariatric surgery of children
Over the past three decades, in many countries the proportion of adolescent obesity has increased. Adolescent obesity can lead to serious consequences not only for adolescents but also for society. Those who have obesity in adolescence usually have it in adulthood.
First of all, obesity in adolescents is not only an aesthetic problem, but contains a set of socio-medical problems. This disease causes many medical and psychological problems that can lead to premature death.
This patients, according to the tests from a meta-analysis proved that this patients type of health problems, is much more likely to suffer from depression and depressive symptoms. This can lead to social problems, also to the development of alcohol addiction, drug addiction and others, and even suicidal behavior.
Bariatric surgery in adolescents is safe and effective, and most importantly - significantly improves the quality of life.