Weight Loss Surgery Tips For Everyone
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1. Body mass index over 40.
2. To be serious attempts have undergone medical treatment, without results.
3. In patients with body mass index of 35, provided that they have added pathology resulting from their obesity. Gastroesophageal reflux, sleep apnea, hypertension, dyslipidemia, fatty liver, hyperinsulinemia, diabetes, osteo problems.
4. It is recommended between 15 and operate up to 65 years old.
To determine the degree of overweight, using the Body Mass Index (BMI), which is calculated easily (Calculate your BMI)
If this is more than 40 (Kg/cms2), we are talking about morbid obesity, but also in cases where there is aggregate pathology , such as hypertension, diabetes, sleep apnea, joint problems, or other, it is considered morbid obesity from 35 BMI.
The importance of morbid obesity is a serious disease which is a life-threatening, people who have a morbid obesity has twelve times more likely to die than a normal person.
It is said that a morbid obesity complicated aggregated with any disease, diagnosed at age 20, has little chance to reach fifty years.
Many of them may show symptoms such as gastroesophageal reflux roncadores large, sometimes arouse drowned, is what is called sleep apnea, severe respiratory distress that means having virtually collapsed lung. In some cases suffer what is called Pickwick syndrome, and that is that the low ventilation can be seated asleep, sometimes at risk as driving while awaiting the green light at the traffic lights.
Even the morbid obese have a lower fertility, women suffer from menstrual disorders and a higher incidence of some cancers like breast and uterine cancer. It is also the most common heart attack and brain attacks, this must be added to the psychological problems that usually drag, especially if they have been since obese children.
Many morbid obese have a hard time establishing a relationship of partner satisfaction at the high level of insecurity they generated their illness, as well as some degree of social sanction that experience, because in general are not well accepted by any means, even by his family. Usually the obese are relegated socially.
Feeding
The Operation is one thing, then it is also how to eat. To ensure proper healing internally, we must adhere to a strict diet for two months. It is not very clear is what I told myself, but you have to say that only small for two months. I have been followed by an excellent dietician , in fact I’ve never been so happy to see one.
The first month
The food must be liquid only, because of 100ml maximum every hour taken very slowly to the teaspoon tea, tea, coffee, fruit juices, vegetable juices, skim milk, yogurt, soup.
The nutritional compliments must be taken to avoid loss of energy:
1 FORTIMEL or 1 NUTRIDORAL, 2 CLUNITREN soup
and a complex vitamin and mineral: 1 PLENYL or VIVAMYNE (chew or suck)
The second month
The first fortnight
The power should be pasty (texture puree) or jars of baby (100 to 150ml maximum), at regular intervals (7am - 9.30 - 12 - 14:30 - 17h - 19:30 - 22h), well chewed. Do not drink during meals. The consumption of liquid should be 1.5 litres per day, taken regular 100ml swallowed up very slowly without food.
The last fortnight
The food must be chopped, always well chewed and taken in small quantities (200ml maximum) six times (7am - 10.00 - 13 - 16 - 19h - 22h). Do not drink during meals. The consumption of liquid should be 1.5 litres per day, taken regularly from 100 to 200ml swallowed up very slowly without food.
The third month
The menu from the beginning of the third month
The food can be varied but always well chewed and divided into several small meals. The sauces and fried foods should be avoided, and that sugary foods.
Some foods are banned:
— Hard Fibres: celery, fennel, leeks, asparagus, salsify, artichokes fund, a symbol of white beans, pineapple.
— Thick skins and seeds: grapes, tomatoes, kiwi fruit, peppers.
And after …
Well now I eat normally, my bypass regulates quantities, but I can go perfectly in a restaurant. In any case I can eat any red meat, white meat, ham, fish, pasta, rice, potatoes. It rediscovers food, food has become a real pleasure. I enjoyed my delights new flavors, he said doing experiments. Do not hesitate to repeat if a food wrong, another day, another time of the day before the outlawing of its food. A little secret: chewing, it begins in the mouth with saliva.
Before I was greedy, now I became gourmet.
The Gastroplasty is not a magic wand that will make us lose our kilos too effortlessly, it should be seen as a tool which we are obese are the masters of works on a daily basis.
Air access via laparoscopy.
1 - Gastroplasty horizontal isolating a small pocket by an adjustable silicone ring connected to a reservoir of sizing.
2 - Gastroplasty vertical insulation stapling a small pocket calibrated by a ring.
In these 2 techniques stomach is changed to “hourglass” and food is divided and limited.
3 - “Gastric Bypass-or short-circuit gastric adding the reduction in the volume gastric malabsorption.
In this technique (the most used in USA) food is both less and less assimilated.
4 - “Switch” or gastrectomy gutter with a duodenal switch and biliary-pancreatic diversion.
A. The gastric bypass (Diagram No. 8):
This is the standard intervention in the USA. It includes:
– Preparation of a small gastric pouch by stapling
– Section jéjunale
– Anastomosis gastrointestinal jéjunale
– Anastomosis “at the foot of the loop”
B. The gastric bypass with cross-section gastric (Figure No. 9):
The cross-section avoids désagrafage by technical failure, but it remains possible and then leads a gastric fistula. This modality bypass is currently the most common, and in particular the only possible if this intervention is performed under coelioscopie.
C. The gastric bypass with additional restriction (Diagram No. 10):
This is the principle of the Fobi pouch, where a ring stricture is included on the proximal pocket, reinforcing the coercive effect on dietary intake. Fobi adds a probe, in order to keep permanent access to the stomach “défonctionnalisé.”
D. The gastric bypass Cove on Long (long limb gastric bypass) (diagram No. 11):
Here, the effect is clearly malabsorption, and the technique is similar to that described by Scopinaro in principle. Several American surgeons defend this principle in super-obese (body mass index greater than 50).
4. The gastric stimulation transparietal (Figure No. 12):
Last born bariatric interventions, this procedure is neither restrictive nor malabsorbtif, but in fact plays on satiety. The probe stimulation is connected to a pacemaker subcutaneous delivering pulses continues
Figure 12
A. The bypass biliary-pancreatic or operation Scopinaro (Diagram No. 6):
Described by an Italian surgeon, Nicola Scopinaro in 1979, is the intervention malabsorbtive type. The fact that the vast majority of the small intestine is deprived of bile and pancreatic secretions (rich in digestive enzymes) creates a poor absorption of certain foods, especially fats, resulting in an apparent weight loss without restriction in food.
In return, a serious medical surveillance is needed, and side effects or reactions are common (diarrhea). In technical terms, it includes the following times:
– Removal of half of the stomach (hemi-gastrectomy)
– Removal of the gallbladder (cholecystectomy)
– Preparation of a portion of small intestine (severed) measuring 250 cm
– Anastomosis gastrointestinal jéjunale = suture between the stomach and small intestine
– Other intestinal anastomosis, called “at the foot of the cove, about 100 cm before the cecum
(ie the junction between large and small intestine)
– The small intestine and is divided into three portions: a portion of “food”, a portion “biliary-pancreatic”
(which collects secretions liver and pancreas), and a portion.
B. The bypass biliary-digestive altered or “duodenal switch” (Diagram No. 7):
Described by Hesse and Marceau in 1995, it aims to add to bypass biliary-pancreatic conservation of the pylorus (the “sphincter” lower stomach), and a “useful” for the stomach. His times are as follows:
– Release of the stomach
– Section duodenum
– Gastrectomy
– Anse jéjunale severed climb to 250 cm of cecum
– Anastomosis duodéno-jéjunale
– Anastomosis “at the foot of the loop”
This change is very fashionable now, and is the subject of numerous descriptions by the method coelioscopique.
Figure 6 Figure 7
There are many techniques of surgery, and so many variations. The most common are described in the chapter “surgery” on this site. At a recent congress (American Society of Surgery Bariatrique ASBS, 5-9 June 2001, Washington), surgeons and specialists in nutrition have been able to review the various possibilities in this field continuous expansion. The main finding - it is hardly surprising - is the persistence of a large variety of techniques. Despite the emergence of new, habits peculiar to certain countries remain in effect or almost intangible. However, this is an area rapidly changing, and who has not finished evolving!
We can classify these different technical operations restrictive malabsorbtives and mixed according to their mechanism of action. Here is a summary of the main of them in 2001. It is noteworthy that all these interventions can be performed by coelioscopie, with varying degrees of technical difficulties depending on their complexity.
The restrictive operations :
They are based on the principle of a severe limitation on the ability to ingest solid foods, through a gastric pouch the smallest possible (a few ml, 15 to 20 most often). You can to some extent to assimilate technology poses an intra-gastric balloon (see chapter), which is not strictly speaking an operation, but also aims to create a satiety (however temporarily).
A. The gastroplasties with adjustable rings:
They are detailed in the chapter on the surgical technique. Whatever the model ring, the procedures are very similar (only two models, marketed by companies Bioenterics and Obtech (diagrams No. 1 and 2), have been studied and publications since 1994, d ‘ Other models are being evaluated).
Their very popular today (especially in Europe) is mainly due to their feasibility almost constant coelioscopie.
We only mention the rings or non-adjustable gastric bands, operations and highly criticized only practised in some centres (USA, Czech Republic, Israel).
B. The gastroplasties Mason and relatives:
From the name of the surgeon promoter (Edward Mason) they are based on the principle of stapling the stomach, which creates a “gastric compartment” close s’évacuant by a small channel of about 9 mm in diameter. Past the adjustable rings, such gastroplasty remains a reference to “historic” and is still widely practised despite the rise of short-circuits gastric the USA and the flexible ring in Europe. Many alternatives have been described, which we will mention just three:
– Mason “standard” (Diagram No. 3): it involves the creation of a “window” into the stomach through an automatic clip, then the partition gastric staples (several rows) to create a 15 cc pocket, then the calibration of channel evacuation by a strip of cloth prosthetic.
– Mason “simplified” (Diagram No. 4), or silastic ring vertical gastroplasty (technical Eckout): by using a special stapling tongs, fitted with a notch, the initial gastric perforation is unnecessary. The grading is performed by a plastic ring from 4.5 cm to 5 cm in diameter.
– Mason with cross-section, or technical Mac Lean (Diagram No. 5): it avoids the very frequent failure by désagrafage of gastroplasties because the stomach is sectioned frankly here.
Figure 3 Figure 4 Figure 5
- Weight loss surgery, resulting in a loss of substantial weight, improves significantly over the long term blood pressure patients with fatal obesity (exposing them to danger of death) say researchers who recommend this type of interventions for a target population.
