Today there are more than 50 types of surgical procedures which are used to treat obesity. New techniques are being offered each year which aim to create maximum conditions for an excessive resistant weight loss with a minimal risk to the patient. We offer the most effective methods of surgical treatment of obesity.
Gastric bandingThe main reason of weight gain (in 90% of cases) is overeating. The volume of the stomach is increased and as a result in order to obtain a saturation feeling more and more food is required. Furthermore, ghrelin hormones that control the degree of saturation of the organism (which are synthesized in the widest part of the bottom of the stomach) enhance its activity and thereby make the patient dependent on the food consumption. In medicine this condition is called bulimia or "food addiction". It is almost impossible to handle this on your own. And if you cannot lose weight, surgery is there for you. "Sleeve" or longitudinal gastrostomy is one of the most successful operations which is recognized worldwide today as the most productive.
"Sleeve" Gastrectomy reduces the volume of the stomach and eliminates hormonally active zone while maintaining the integrity of the physiological body. Herewith all the physiological transition from the esophagus to the stomach and from the stomach into the duodenum is being saved which has practically no effect on the future state of the patient and leaves open the possibility for further interventions when the weight is very big and requires further surgical correction. In this case it is considered to be an intermediate step and allows to reduce the weight for 40-50 kg in the short term and to safely prepare the patient for a more complex stage of surgical correction.
What is the difference between this operation and the proposed bypass gastric operations when also a "mini-stomach" is created?
Sleeve gastrectomyDuring the longitudinal resection the part of the stomach is resected in the vertical direction with a decrease of its volume and hormone-removal zone. In case of gastric bypass or banding or other similar surgeries, the stomach is decreased in a horizontal way which does not affect its "bottom" and, therefore, does not make the patient lose appetite after operation, but only makes it impossible to get enough of food with same volumes. Such patients are in need of high-calorized, often sugary food that doctors affectionately call "a symptom of a sweet tooth." In fact such a patient can be compared with a drug addict experiencing "break" during the absence of a "pleasure". The patient again and again is offered to keep a diet, refusing to eat what you want and to get pleasure. Patients who have undergone a longitudinal resection of the stomach do not have this painful feeling. Saturation with small portions brings pleasure. Patients become independent of food and can control their desires as any other person. This surgery is performed in an open and laparoscopic version. In those cases when the patient’s weight is significantly higher than normal one (body mass index is greater than 40) and also in the case of diabetes type II, the surgery which reduces gastric volume may be ineffective. In this case we use a technique of Biliopancreatic bypass in modification of Hess-Marceau.
This methodology was developed by American and Canadian Professor Hess and Professor Marceau more than 30 years ago. Based on their own experience and the experience of their predecessors they studied the physiological aspects of obesity and offered a new, more sophisticated in terms of technical execution, technique for this kind of operation. It turned out that overweight people have a genetic predisposition, inherited one, due to which the length of a small intestine which absorbs all the nutrients - fats, proteins and carbohydrates is much longer than other people’s, and in contrast, is not just 4.0-4.5 m long but sometimes even 7.5 m. The food motion through the digestive tract is significantly slower for people with overweight, which allows the small intestine to absorb the maximum amount of the proteins, fats and carbohydrates. At the first stage of the surgery "hose" Gastrectomy (Sleeve gastrectomy) is performed which reduces volume of the stomach and eliminates hormonally active zone, while maintaining the integrity of the physiological body. Then the length of the small intestine is measured throughout in order to determine whether there is an inherent elongation.
Biliopancreatic bypass ScopinaroThe next phase is determining the required length which will participate in the digestion of food and absorption of nutrients in order to provide the body with normal weight. Usually it is 40% of the total length of the small intestine. Thereafter, the duodenum is excluded from the passage while its intersection does not affect gastric sphincter (valve device which regulates the transition from the stomach to the duodenum). Then part of the small intestine which will participate in the food digestion process is connected with the stomach lower to its sphincter allowing to create anastomosis which would work identically to the way a normal stomach does. Exactly this technical feature which preserves the physiology of the body and its functional operation makes it possible to avoid in future many long-term complications united in a surgical name "operated stomach disease." The distal part of a small intestine that drains the bile and pancreatic juice is starting to work at a distance of 80-100 cm from the finely-colonic transition which completely restores the conditions for the digestion of food.
Surgical treatments of diabetes type II
Biliopancreatic bypass ScopinaroObese patients eventually have diabetes type II. What does it mean? The pancreas secretes so much insulin which is enough for the breakdown of carbohydrates consumed by a person with a normal weight. The amount of insulin produced is limited by B cells of the pancreas which are present in it from the birth. If a person consumes a lot of carbohydrate foods your own insulin is not enough for its cleavage and an excess amount of glucose enters the blood in an undigested state, causing diabetes. It is known that carbohydrates which come with food are digested and degraded mainly in the initial part of the small intestine.
There are two possible ways of suction reduction:
- to speed up the movement of food in those divisions of the small intestine;
- to completely avoid food contact with this site.
- It is known that the longitudinal gastrectomy practice among the obese patients accelerates the motion of food through the gastric tube (?) and the initial section of the small intestine by 2-2.5 times. Therefore, after the operation the patients suffering from not only obesity but also diabetes, in most cases got rid not only of excess weight, but also of diabetes. After the Biliopancreatic bypass surgery initial parts of the small intestine are not involved in the passage of food, so the carbohydrates excess cannot be split and absorbed, body gets only the required part for the sustenance.
- Almost all patients who underwent Biliopancreatic bypass surgery noticed that glucose tolerance returned to the normal level, and most of them completely got rid of diabetes. Today, the principles of surgical treatment of diabetes type II are based on the experience of the appliance of such bariatric surgery as "sleeve" gastrectomy and Biliopancreatic bypass. These types are considered as an opportunity for patients without obesity to treat diabetes type II.
- However, the experience of such treatment in some clinics around the world does not exceed more than 50-60 patients. We have successfully treated 12 not obese patients with diabetes type II which gives us the right to promote, with the support of endocrinologists this surgical technique as an alternative treatment.