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Practiced procedures

Gastric Bypass

This is done dividing the small intestine just after passing the duodenum, in order to raise and to form union with the gastric bag recently formed. The side joins to the lateral part of Roux's ramification of the intestine, which form a "Y" that gives his name to the technic.

Any GBP drives to a notable reduction in the functional volume of the stomach, accompanied by a physiological and psychological response altered to the nourishment. The loss of weight resultant reduces dramatic the obesity notably as consequence of a mechanism or metabolic effects. The rate of long-term mortality of the patients of bypass gastric has demonstrated that to diminish up to 40 %.

About operation

The gastric derivation, in its diverse forms, represents a great majority of surgical procedures realized bariátrica. It is estimated that 140.000 of these operations were realized in the United States during 2005. An increasing number of these operations fulfill now by means of technic of limited access, called "laparoscopic".

The gastric derivation reduces the size of the stomach in more than 90 %. A normal stomach can stretch, sometimes to more than 1000 ml, whereas the gastric derivation can be 15 ml in size. The bag of bypass gastric generally is formed on the part of the stomach that is less capable to stretching. And its small original size, it prevents any long-term significant change in volume of the bag. This changes with time the size of the connection between the stomach and of the intestine and the capacity of the small intestine to contain a major volume of the food. With the time it is increases the functional capacity of the bag then the loss of weight has taken place and increase the aptitude to allow the maintenance of a minor corporal weight.

When the patient consumes only a small quantity of food, the first response is a stretching of the bag wall of stomach to stimulate the nerves that the brain will indicate that the stomach is full. The patient feels a fullness sensation, as if only he had eaten a big food. The majority of the persons do not stop eating simply in response to a fullness sensation but the patient learns rapidly that the stings food must be eaten very slowly and carefully, to avoid the increasing discomfort or vomits.

The food is spoilt first in the stomach before passing to the small intestine. When the lumen of the small intestine enters in touch with nutrients a number of the hormones is liberated including cholecystikin (CCK) in the duodenum and PYY and the GLP-1 from the ileon. These hormones disable moreover the ingestion food, therefore, factors of satiety have been nicknamed. Changes in hormonal levels after gastric derivation have been hypothesis to produce the reductions in food body and the ingestion of weight in the obese patients

To obtain the maximum benefit of this physiology, it is important that the patient eats only 2 to 3 small portion of food daily and to avoid refreshments and snacks between meals that can reduce the efficiency of the "bypass". The reason of the recovery of the weight is to eat between meals, usually high - caloric with scrap food. There is no known operation that completely can offset the adverse food destructive effects of the behavior.

Postoperative follow-up

Assist to your programmed doctor visits, after going out of the hospital, it is another important part of your managing.

Such as any surgical procedure, the obesity surgery has complications, some of them serious.

The visits to the doctor will be; once a month during the first semester. Once every three months during the second semester and, when the weight has become stable, it(he,she) will come as minimum once a year.

The change of food habits is one of the most important factors to maintain the weight that got lost.

It is necessary to remember that the nutritional support and the multidisciplinary group of managing is relevant to achieve the major success of the obesity surgery.

Operation Recovery

Habitually the patient gives himself(herself) of discharge of the hospital in the third day of the postoperatory.

The drainage pipe that was placed in the surgery can be removed from this day or on the 7 º day after when stiches points are removed.

The diet will be only water or tea after the first day of the operation followed by liquid diet for one more week and semiliquid another week, ending with a mashes diet for 2 or 3 weeks. It is very important to eat in small quantities and in balanced form. It is necessary to chew slow and very well. To avoid the profit of calories, there must be restricted the sugar liquids ingestion (sweets, chocolates, malted etc.), alcohol and carbonated drinks.

The physical exercise can be done from the second week of the surgery.


Preparations for the operation

The surgeon will explain you how to be prepared for the operation. For example, if you smoke he will ask you to avoid it, because to smoke can increase the risk of an infection in and delay the recovery.

You should be visit the nutriologist to take a previous liquid diet before the surgery due to the fact that the liver of the obese person has a bigger size therefore having a liquid diet lower it size and facilitates the surgery.

The operation generally it is under an anesthesia, this means that it will be slept during the operation and requires a night stance in the hospital.

You must be willing to ask to follow the fasting diet instructions. Normally you must not eat or drink for approximately six hours before the general anesthesia. However, some anesthetists allow taking occasional water sips two hours before.

In the hospital your nurse can verify your cardiac rhythm, arterial pressure and take a urine test.

Your surgeon will ask you to sign a assent form. This confirms that you understand the risks, the benefits and the possible alternatives for the procedure and has given you permission to continue.

Your surgeon will ask you to sign a consent form. This confirms that you understand the risks, benefits, alternatives to the procedure and have given your permission for it to go ahead.


What are the risks?

An anastomosis is a surgical connection between the stomach and the intestine or between two parts of the intestines. The surgeon tries to create a connection of waterproof connecting both organs with clamps or with sutures, any of that really does a hole in the intestinal wall. The surgeon will base on the curative power of the body and his aptitude to create a stamp as a pneumatic autosell, to be successful with the surgery. If this stamp fails for any motive, the liquid from inside of the alimentary canal can filter towards the abdominal sterile cavity and give place to formation an infection and abscess. Filtration of an anastomosis can happen in about 2 % of the procedures of bypass gastric, generally in the connection of intestinal stomach. Sometimes escapes can treat with antibiotics, and sometimes it needs a new immediate operation. It is generally safer for re-operate if an infection cannot be definitively controlled immediately.

When anastomosis is healthy, it forms a cicatricle tissue, that, naturally, tends to reduce the size with time, doing a smaller opening. This is named "estrechez". In general, the food across the anastomosis will keep the stuck opened, but if the process of inflammation and cicatrization surpasses the process of stretching, cicatrization of the opening can do so small that liquid even already they cannot pass across it. The solution is a procedure called gastro endoscopy and the stretching of the connection for inflating a globe in his interior. Sometimes this manipulation can they have to be realized more of once to achieve lasting alteration.

Normally, the pilórica valve in the low end of the stomach regulates the liberation of the food in the intestines. When the patient of bypass gastric eats a sugar food, the sugar passes rapidly in the intestines, where it gives place to a physiological reaction called syndrome of dumping. An affected person feels his heart rapidly and strongly, divides in a cold sweat, obtains a butterfly feeling in the stomach and has a type "sky is diminishing " of the anxiety. In general it has to go to bed and is very inconvenient about 30 to 45 minutes. It can follow by diarrhea.

After the surgery, the patients feel fullness after consuming only a small volume of food, followed soon after a sensation of satiety and loss of appetite. Food ingestion diminishes notably. Due to the small size of the stomach newly created a suitable nutrition and consumption of small food quantity, it is required that the patient follows instructions of the surgeon for food consumption, including the number of the eaten take every day, It is assume consume of proteins adapted and the use of vitamins and mineral supplements.

de Cirugía
Colegio Mexicano de Cirugía de la Obesidad y Enfermedades Metabólicas Colegio Mexicano
de Cirugía de la Obesidad
y Enfermedades Metabólicas
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