如何进行腹腔镜胃切除？

Frequently asked questions about Sleeve Gastrectomy

What is Sleeve Gastrectomy?

Sleeve gastrectomy is a surgical weight-loss procedure generally done by laparoscopy where the stomach is reduced to about 25% of their original size. By laparoscopic surgery removal of a large area of the stomach is done , following a major curve. Outer edges stomach are then attached together often with surgical staples to create a sleeve or tube having a banana shape. The process permanently reduces the size the stomach. The procedure is performed laparoscopically and isn't reversible.

Sleeve gastrectomy is also called gastric sleeve is usually performed on extremely obese patients with BMI more than 35 - 40. This procedure is more popular nowadays because the chance of performing a gastric bypass or duodenal switch procedure might be too large. Patients usually lose a large volume of their excess fat after the sleeve gastrectomy procedure alone, but if weight loss ceases the second step of bypass is conducted in some patients.

For patients which are obese but not extremely obese, sleeve gastrectomy alone is a suitable operation with minimum risks. The sleeve gastrectomy currently is acceptable weight loss surgery option for obese patients as a single procedure. Most surgeons prefer to make use of a bougie between 32 - 60 Fr using the procedure and also the ideal approximate remaining size of the stomach after the procedure is about 15 mL.

How the sleeve gastrectomy procedure is done?

The majority of weight loss sleeve gastrectomies performed today use a laparoscopic technique, which is considered minimally invasive. Laparoscopic surgery usually produces a shorter stay in hospital, faster recovery, smaller scars, and fewer pain than open surgical treatments.

The amount of time from the surgery varies. One study found that the average operative time was 1.5 to three hours and also the average hospital stay was 2 to 5 days. Patients usually go back to normal activities in 2 weeks and are fully recovered in 30 days.

Laparoscopic sleeve gastrectomy could possibly be the initial step before gastric bypass or it's really a single process of weight loss. If a sleeve gastrectomy can be used included in a two-step procedure, the initial step is for the surgeon to produce the small stomach "sleeve." Over time of time based on choices, another procedure would be completed in which the surgeon attaches a piece of the small intestine directly to the stomach pouch. This enables food to bypass some of the small intestine. Doing so enables your body to soak up fewer calories, in addition to consuming less food. This two-step procedure may be done because patients may not be able to tolerate both procedures throughout a single operation. Studies show that the two-step procedure has been utilized successfully in patients having a bmi greater than 50 or perhaps in high-risk patients.

What is the main benefit of the sleeve gastrectomy over gastric bypass?

There is two benefits of the sleeve over a gastric bypass:

(1) There is no malabsorption of nutrients or vitamins, unlike with gastric bypass. The risk of developing malnutrition or a vitamin deficiency thus remains really low.

( 2) The chance of a sleeve gastrectomy is slightly lower than a gastric bypass in most studies, the rate of weight reduction is about the same.

What is the main advantage of the sleeve gastrectomy over gastric banding?

There is two advantages to the sleeve over gastric banding:

(1) The rate of weight reduction is all about 2-3x faster with a sleeve than a band.
(2) There isn't any implantable device, so slips and erosions are not an issue.

Sleeve gastrectomy patients have been shown to experience significant weight loss and improvements in their health. Patients have been shown to lose an average of 55% of their excess weight.

Decrease in comorbidity after Sleeve Gastrectomy.Comorbidity after Sleeve Gastrectomy
ResolvedImproved

Type 2 Diabetes

56%3637%36

High Blood Pressure

49%3629%36

High Cholesterol

43%3638%36

Sleep Apnea

60%3633%36

What is the main drawback to the sleeve gastrectomy when compared with gastric banding?

The short-term risk of a sleeve gastrectomy is greater than that of gastric banding. Risk of surgery is slightly high in sleeve gastrectomy but lower than gastric bypass

How quickly to patients slim down having a sleeve?

Our average excess fat loss at six months using the sleeve is 60%.

How long may be the stay in hospital?

It is typically an overnight stay.

How large will my stomach be after surgery?

How big your stomach will be different with respect to the surgeon. All surgeons make use of a tube to guide them when stapling the stomach. This tube size can differ from as small as 32 French Bougie to as large as 64 French Bougie. This is a very important question to inquire about when it comes to this surgery, since those patients with larger pouches might have less weight loss.

Is removing the stomach safe?

This kind of stomach removal has been performed with the Duodenal Switch procedure since the mid 1980’s. It does involve stapling, just like within the gastric bypass and it has similar risks. Interestingly, patients do not ever return requesting their stomach back however, many do wonder if it is easy to reduce the size it again.

Will I need to take vitamins and minerals like calcium?

Vitamin and mineral deficiencies are rare with this procedure since there is no intestinal bypass. However, the procedure is very restrictive so most surgeons recommend that patients have a multivitamin, calcium and possibly a B12 vitamin after surgery.

Will I regain weight?

All patients undergoing bariatric surgery are in risk for weight regain. None of the operations can prevent this. Those patients who maintain good dietary habits and use patterns of exercise may keep your weight off than those who don't exercise and who snack frequently.

What's going to my diet end up like after surgery?

The diet will progress over the first year. It usually begins with 2-4 weeks of liquid protein drinks and water. Patients gradually progress to thicker food items and by 8 weeks are able to eat seafood, eggs, cheese along with other regular foods. The diet generally recommended is low-calorie roughly 500 Kcal per day, high protein 70gm daily, low fat 30 gm daily and low carbohydrates as 40 gm daily. The calorie consumption increases over the newbie by twelve months many patients have achieved their goal weight reduction and consume between 900 and 1500 calories daily. This final calorie consumption depends upon level of activity, age and gender men usually can consume more calories and keep their weight normal.

Who is the right candidate for the Bariatric Surgery?

Bariatric surgery is not just a fashion. It's a serious, life changing procedure that is helping thousands of obese patients loses the weight necessary to improve health and lengthen their lives.

Why someone would choose that particular therapy which has many complications?

This kind of weight loss is for people who have severe obesity. It’s all a matter of risk-benefits. The mal-absorption operations are much cruel. They are even more effective than gastric bypass and lap band in terms of weight loss. In fact, these patients tend to lose 80% of their excess weight or more. So in some very, very large patients, perhaps in the four- or five-hundred-pound category, these operations will enable them to get closer to their ideal body weight. But there's a price to pay for that. So there may be a role for these operations for some patients, but probably for the majority who are seeking bariatric surgery the gastric bypass or lap band would be the best options.

Who is a good candidate for weight loss surgery?

First and foremost this kind of weight loss is for people who have severe obesity, which is usually defined as more than 100 pounds of excess body weight. Usually that amount of weight is almost always associated with many other medical conditions, such as diabetes, high blood pressure, sleep apnea, elevated cholesterol, and joint problems with knees, hips, and back. So these operations are for people who have 100 pounds or more of excess weight and medical conditions related to that heavy weight; they're not for patients who want to lose 30 pounds, or people who want to get into a bikini for their vacation.

How much hospital stays, how much time it take in recovery?

The majority of sleeve gastrectomy procedures are carried out utilizing a laparoscopic technique. Laparoscopic surgery results in a shorter hospital stay, faster recovery, smaller scars, and fewer pain than open surgical treatments.

Is there any fFinancial savings with time?

Research conducted recently showed that expenses associated with bariatric surgery were recouped in about 24 months. One important reason is that bariatric surgery might help to improve or resolve conditions associated with obesity, such as diabetes type 2 and cholesterol, so patients save money on related prescription drugs, doctor visits, and hospital visits. In addition, monthly savings related to laparoscopic bariatric surgery reach a lot more than $900 as soon as 13 months following surgery.

Is there any reduction in cravings for sweets?

A clinical study showed that 50% of patients who had a sleeve gastrectomy procedure lost their craving for sweets after 12 months, and after Three years 23% still experienced a loss of revenue of cravings for sweets. Additionally, the amount of a hormone called ghrelin, which has been referred to as a hunger-regulating hormone, was found to become significantly reduced after sleeve gastrectomy surgery.

Is there any quality-of-life improvements?

Clinical studies of laparoscopic weight loss surgery patients discovered that they believed better, spent more time doing recreational and activities, taken advantage of enhanced productivity and economic opportunities, and had more self-confidence compared to what they did prior to surgery.