Trocar site placement can aid that other procedures can be
done through the same ports as:
Gall bladder removal, Laparoscopic cholecystectomy can be
done through the same ports, with other bariatric
procedures.
Hiatal hernia, crural repair for gastro-esophageal reflux
disease (GERD) can also be done meanwhile.
Most of the bariatric procedures have direct effect on the
blood glucose level in blood, in a way that it improves the
diabetic state of most patients as in Sleeve gastrectomy,
Roux en-Y gastric bypass & modified gastric plication,
mounting to cure in type II DM.
Modified gastric plication is a combination of well
documented procedures: Laparoscopic gastric plication and
one anastomosis gastric bypass, thus harboring the two
arms of the recent main modalities of bariatric surgery in
general (Restrictive & malabsorptive).
Advantages:
The main advantage is that the whole gastro-intestinal
mucosa is intact with no blind or defunction loops. In this
case the absorption is near normal with no need for
postoperative vitamins or supplements, also no muscle
weakness, wasting or generalized fatigue, as this operation
targets mainly excess fat, sparing proteins (evident in the
post operative in-body), so enhances body contouring with
no need for liposuction or other plastic procedures. One of
the significant advantages is no hair loss as compared to
other bariatric procedures.
Early convalescence (return to work after 4 days).
So, it is cheaper as a procedure also in the postoperative
period as no need for post operative supplements.
As compared to other procedures, it is much safer as there
is no use of laparoscopic staplers to resect mainly the upper
part of the stomach where most leaks after sleeve
gastrectomy occur.
Significant effect on the diabetic state for patients with
diabetes is evident in glycated hemoglobin post operative
repeated assessment. This has a curative effect especially
on type II DM, with return of the glycated hemoglobin to
normal with cessation of all types of medication for DM.
Finally, it is one of the few totally reversible bariatric
procedures (by another operation if needed).
Disadvantages:
In the first 3 days there can be nausea, vomiting, gas bloat
or mild abdominal cramps, these are self limited with no
need to medication.
Choosing a bariatric surgery involves multiple factors that
can influence the decision-making process for both patients
and their healthcare providers. Here are some of the key
factors to consider:
Type of Obesity
BMI: The body mass index (BMI is the product of dividing
weight in kilograms over the height in square meters) is a
critical factor in determining the appropriate surgical option.
Different procedures are recommended based on specific
weight ranges (e.g., gastric sleeve for BMI 30+, gastric
bypass for BMI 35+).
Comorbidities: The presence of obesity-related health
conditions (like diabetes, hypertension, or sleep apnea) can
influence the choice of surgery, as some procedures may
provide better metabolic outcomes
Age:
The patient’s age is a crucial factor in determining the procedure
of choice in a tailored approach. Generally, young adolescents: a
non-resection approach is better. Many of SAPI technique
(Modified gastric plication- Single Anastomosis Plication Ileal
bypass) have much better outcomes than resection approaches in
terms of weight loss and lifestyle (no vitamins or minerals
needed), as the nutrients absorption is full, so no hair loss,
generalized weakness or wasting.
On the other hand, older patients require resection mostly sleeve
gastrectomy to compensate for their low metabolism.
Surgical Risks
Health Status: Overall health, including cardiovascular,
respiratory, and metabolic health, can impact the choice of
surgical options and associated risks.
Surgical Risks: Different procedures come with varying risk
profiles, complications, and recovery times.
Expected Weight Loss
Efficacy: Some surgeries provide more significant weight loss
than others. For example, gastric bypass generally leads to more
substantial weight reduction compared to adjustable gastric
banding. Patients' goals for weight loss can influence their choice.
Lifestyle and Dietary Preferences
Post-Operative Dietary Changes: Some procedures may require
more significant changes in eating habits. For instance, gastric
bypass may necessitate more substantial long-term dietary
adjustments compared to sleeve gastrectomy.
Commitment to Lifestyle Changes: Patients willing to commit to
lifestyle changes post-surgery may prefer restrictive procedures
that promote gradual weight loss, while others may opt for the
more dramatic results of malabsorptive procedures.
Reversibility and Adjustability
Adjustability: Procedures like gastric banding are adjustable and
reversible, which can be appealing to some patients. In contrast,
gastric bypass and sleeve gastrectomy are generally permanent.
Reversibility: The permanence of certain procedures may be a
concern for patients who are apprehensive about making a
lifelong commitment.
Personal Goals and Motivation
Weight Loss Goals: Individual goals around weight loss and body
image can significantly impact the choice of surgery.
Motivation Level: A patient’s readiness and motivation to follow
dietary and lifestyle changes post-surgery can influence their
decision.
Surgeon's Expertise and Recommendations
Surgeon Experience: The surgeon's experience with specific
procedures can affect recommendations, as some surgeons may
have better outcomes with certain techniques.
Comprehensive Evaluation: A thorough evaluation by a
multidisciplinary team can provide insights into the most
appropriate procedure for the individual patient.
Cost and Insurance Coverage
Financial Considerations: The cost of different procedures and
what is covered by insurance can be a significant factor for many
patients.
Access to Care: Availability of certain procedures and the
expertise of local surgeons could also impact the decision.
Conclusion:
Selecting the best bariatric surgery is a personalized process that
takes multiple factors into account, including health status,
surgical risks, expected outcomes, dietary needs, and individual
goals. A thorough discussion with a healthcare provider
specializing in bariatric surgery is essential for making an
informed decision.
If you want to delve deeper into any of these factors or have
specific questions, feel free to ask!
The timing for cosmetic surgery after bariatric surgery can
vary based on several factors, including individual recovery,
weight stabilization, and the specific procedures being
considered. Here are some general guidelines:
Recommended Timing:
Weight Stabilization:
It is typically advised to wait until you have reached and
maintained your goal weight for at least 6 to 12 months after
bariatric surgery. This allows for any additional weight loss
and helps ensure that your weight is stable before
undergoing cosmetic procedures.
Overall Recovery:
After bariatric surgery, your body goes through significant
changes, and it may take time to fully recover. Most
surgeons recommend waiting at least 12 to 18 months post-
bariatric surgery before considering cosmetic procedures.
This period allows your body to adjust and for any swelling
or changes to settle.
Consultation with Healthcare Providers:
It's essential to have a thorough discussion with your
bariatric surgeon and a qualified plastic surgeon. They can
evaluate your individual situation, including your health
status, weight loss progress, and any specific concerns you
may have.
Factors to Consider:
Health Status: Ensure that you are in good health and have
no complications from your bariatric surgery.
Type of Cosmetic Surgery: The type of procedure (e.g.,
tummy tuck, breast lift, body contouring) may influence the
timing. Some surgeries may require a longer wait than
others.
Psychological Readiness: Consider your emotional and
psychological readiness for cosmetic surgery, as this can
impact recovery and satisfaction with the results.
Conclusion:
In summary, waiting at least 6 to 18 months after bariatric
surgery is generally recommended before pursuing cosmetic
surgery, with a focus on weight stabilization and overall
recovery. Always consult with your healthcare providers for
personalized advice tailored to your specific situation.
If you have more questions or need further details about
specific procedures, feel free to ask!
The gastric balloon is a non-surgical weight loss procedure
designed to help individuals achieve significant weight loss.
Here’s an overview of its efficacy, including benefits,
considerations, and what you can expect:
Weight Loss Results:
Studies show that patients can lose an average of 10-15% of
their body weight over a six-month period with the gastric
balloon, wish is the usual duration of the intragastric balloon.
Extended use of a balloon (usually up to 12 months) can
lead to even more weight loss, but results can vary based on
individual lifestyle and adherence to recommendations.
Mechanism of Action:
The balloon occupies space in the stomach, which helps to
reduce the amount of food intake.
It also creates a sensation of fullness or satiety, which may
aid in reducing hunger.
Duration:
The balloon is typically placed in the stomach for 6 months
to a year.
After this period, the balloon is removed by the gastroscope
which is an added intervention, long-term weight
maintenance strategies are emphasized.
Benefits
Non-Surgical: The gastric balloon is a less invasive option
compared to surgical bariatric procedures.
Temporary: It provides a short-term solution, allowing
individuals to start their weight loss journey.
Minimal Recovery Time: Most patients can resume normal
activities shortly after the procedure, often the same day.
Behavioral Change: The use of the balloon can encourage
better eating habits and lifestyle changes, as patients
typically undergo counseling during the treatment.
Considerations
Not Suitable for Everyone: Candidates for the gastric balloon
should have a BMI of 30 or higher and must commit to
dietary and lifestyle changes.
Potential Side Effects: Common side effects might include
nausea, vomiting, and abdominal discomfort, especially in
the initial days after placement.
Weight Maintenance: While the gastric balloon can kickstart
weight loss, long-term success relies heavily on the
commitment to a healthy lifestyle post-removal.
Temporary Solution: Once the balloon is removed,
individuals may regain weight if they do not continue
managing their diet and activity levels, which usually
happens as the candidate after balloon removal will continue
eating in a meal till the previously occupied space by the
balloon is now replaced by food to reach satiety. This
mechanism helps weight regain!
Conclusion
The gastric balloon can be an effective tool for those looking
to lose weight, especially as part of a broader weight
management plan. However, it’s important to have realistic
expectations about weight loss and to be prepared for
lifestyle changes that support long-term success.
If you have more specific questions about the procedure or
its effectiveness for certain situations, feel free to ask!
When discussing obsolete procedures in bariatric surgery,
it's important to understand that the field has evolved
significantly over the years. Some procedures that were
once common are now considered less effective, more risky,
or outdated due to advancements in surgical techniques and
better understanding of weight loss physiology. Here are a
few examples:
Vertical Banded Gastroplasty (VBG)
Description: This procedure involved creating a vertical
stomach pouch using staples and placing a band at the
outlet to restrict food passage.
Obsolescence: It has been largely replaced by more
effective procedures like gastric bypass and sleeve
gastrectomy, primarily due to lower long-term weight loss
and higher rates of complications.
Adjustable Gastric Banding (Lap Band)
Description: This procedure involves placing an inflatable
band around the upper part of the stomach to create a small
pouch that limits food intake.
Obsolescence: While it was popular in the 2000s, it has
fallen out of favor due to issues with band slippage, erosion,
and insufficient weight loss compared to other methods.
Bariatric Surgery for Purely Cosmetic Reasons
Description: Early bariatric procedures were sometimes
performed for cosmetic weight loss without considering
health benefits.
Obsolescence: Current guidelines emphasize the need for a
body mass index (BMI) threshold and associated health
conditions to justify such surgeries.
Restrictive Procedures without Malabsorption
Description: Past techniques relied purely on restricting food
intake without addressing nutrient absorption. Surprisingly as
in sleeve gastrectomy!
Obsolescence: Procedures like gastric bypass not only
restrict intake but also alter gut hormones that aid in weight
loss and improve metabolic health.
Open Surgery Techniques
Description: Earlier bariatric procedures were performed via
open surgery, involving larger incisions.
Obsolescence: Most current bariatric surgeries are now
performed laparoscopically, allowing for smaller incisions,
reduced recovery time, and fewer complications.
While some older techniques may still be performed
occasionally, they are generally not recommended due to
their lower effectiveness and increased risks compared to
modern approaches. If you're considering bariatric surgery,
it's crucial to discuss the latest options with a qualified
healthcare provider.
If you would like to know about current best practices or
specific surgical options, feel free to ask!
Various ways of obesity medications are present as:
Appetite Suppressants
Phentermine: A stimulant that suppresses appetite and is
often prescribed for short-term use.
Diethylpropion: Similar to phentermine, it helps reduce
hunger
Fat Absorption Inhibitors
Orlistat (Alli, Xenical): This medication works by inhibiting the
enzyme that breaks down fats in the intestine, causing some
of the fat to be excreted undigested.
GLP-1 Receptor Agonists
Liraglutide (Saxenda): Originally developed for diabetes, it
also assists with weight loss by increasing feelings of
fullness.
Semaglutide (Wegovy): Another diabetes medication that
has been shown to significantly aid weight loss.
Combination Medications
Phentermine-topiramate (Qsymia): This combines an
appetite suppressant with a medication used to treat
epilepsy and migraines
Considerations
Eligibility: These medications are typically recommended for
individuals with a BMI of 30 or higher, or 27 or higher with
obesity-related health conditions.
Side Effects: Each medication can have various side
effects, so it's important to discuss these with a healthcare
provider.
Lifestyle Changes: Medications are most effective when
combined with diet changes, physical activity, and behavioral
therapy.
Always consult with a healthcare professional for
personalized advice and to discuss the potential benefits and
risks of obesity medications based on your individual health
profile.