Obesity repair surgeries
What is stomach stapling?
Stomach stapling is an operation that is performed through a surgical incision (not through an endoscope) and depends on creating a small pocket of the stomach without cutting it, with placing a mesh or ring around the stomach exit in order to prevent food from leaving the stomach easily.
What is the purpose of stomach stapling?
The aim of stomach stapling is to treat excessive morbid obesity that may affect some people for various reasons.
History of stomach stapling:
The process was invented by DR. EDWARD NASON in 1982 at LOWA University.
Thousands of cases were performed until 1991, when it began to decline until it finally ended in the world in 2005. During this period, this operation was attempted through binoculars and called it the Butterfly or Butterfly operation, to no avail. How to perform the operation:
1- The operation is performed by surgery under the influence of general anesthesia.
2- An incision is made in the upper abdomen, about 10 to 15 cm long.
3- Placing a longitudinal row of pins to create a pocket in the stomach.
4- The size of this pocket is measured accurately, as it does not exceed 10% of the original stomach size, equivalent to 3 or 4 spoons, and a grid of proline material is placed around the new exit of the stomach, as it prevents expansion of the exit of the stomach.
The patient is in the hospital for two or three days without changing the wound, while the patient is discharged in the case of an endoscopic operation on the second day directly. Complications of the operation:
1- The occurrence of a surgical hernia, which is the most common procedure for stapling.
2- The occurrence of latent weakness in the wound that may lead to hardening and re-entering operations to suture the wound.
3- Severe vomiting, as the stomach stapling process depends on severely reducing the stomach and the stomach outlet, which leads to severe vomiting in this type in particular.
4- The occurrence of severe distress in the place of the proline network, and it may reach the occurrence of corrosion in the body of the stomach due to the presence of the proline network.
5- Weight regain, which is the most common in this type of operation, as it was found that only 20% were able to reach and maintain the ideal weight, and more were returned to the previous weight before the operation.
6- Acidity and severe reflux with the possibility of a hiatal hernia. 7- The occurrence of some psychological problems, as the patient is always known for not being able to eat.
1- Rapid weight loss in the first 6 months.
2- The patient needs 18 to 24 months to lose 50% of the excess weight.
3- The percentage of failure to maintain weight reaches more than 50%.
4- Rapid weight loss leads to severe sagging of the skin, which may require a sagging procedure.
gastric sleeve failure
The typical solution is to modify the stapling to the classic conversion How do we judge the failure or success of previous obesity surgeries?
We judge obesity surgeries to fail in some cases, such as:
1- When you fail to lose weight
In the event that the patient was unable to lose 50% of his excess weight within a year of the operation, and this is the main reason for resorting to operations to correct the failed obesity operations.
Some patients cannot reach the appropriate weight after undergoing obesity operations, for example if we consider that a woman weighs 100 kg, and after calculating the ideal weight for her it is found that it is 60 kg, here we notice that there is 40 kg more than the required weight, then, until we reach the minimum For the success of the operation, this woman must lose at least 20 km from her previous weight within one year of her operation.
What is the reason for the failure of obesity surgeries?
There are many factors that contribute to the failure of obesity surgeries, such as:
What is related to the surgeon and his insufficient experience or the use of insufficiently modern tools, including what is related to the patient and his failure to adhere to medical advice after the operation, including what is related to the type of operation and its related complications.
In the following points, we will address the most important reasons for the failure of various obesity surgeries:
The patient’s non-compliance with the medical instructions for the post-operative period:
Where some patients cannot fully adhere to the post-operative plan, not follow a special diet, or not adhere to the exercises specified by the specialist doctor, which contribute to the success of obesity treatment operations and greatly improve their results.
Excessive intake of sugars:
Excessive consumption of sugars is one of the reasons for the failure of bariatric surgeries, as many patients return to consuming sugary substances greedily, especially those rich in calories such as soft drinks, sweets and sugar, and these foods are considered the easiest types of food to digest, especially for those who have undergone certain types of obesity treatment operations, such as the operation Gastric sleeve, but the richness of these foods in calories exposes the person who eats them to a significant increase in weight.
Eating too much, which leads to the expansion of the stomach again:
The patient’s eating large amounts of food after the operation causes an increase in the expansion of the stomach due to pressure on it. The stomach can expand again after obesity treatment operations, which leads to weight gain or the inability to lose it.
Not choosing the appropriate type of operation for the patient:
Each patient has his own medical history that differs from others, and therefore the appropriate procedures differ for each person according to his own health condition, and depending on his ability to perform a certain type of these operations and depending on the development of the health center in which the operation will be performed, and in the event that the appropriate operation is not chosen, there is a possibility of failure Obesity surgeries.
Incompetence of the surgeon who performed the operation:
Lack of sufficient experience in obesity surgeries in general, or the surgeon removing a small part of the stomach that is not enough, leads to an expansion of the pain to its previous size, which in turn leads to weight gain again and the failure of obesity treatment surgeries.
The need for another operation complementary to the first operation:
In cases of severe obesity and overweight, the patient may need to perform the operation in two stages, the first is basic and the second is complementary to obtain the best adequate weight.
Failed to change body composition:
In order for the patient to obtain satisfactory results after bariatric surgeries, the body itself makes some changes to reduce the rate of weight loss, which leads to a complete fat loss. Examples of these changes are:
– Expansion of the stomach pocket.
– An infectious fistula between the pocket and the stomach causes complications.
Increased intestinal absorption capacity more than expected. – Sliding stomach ring, increasing the ability to eat.
In these cases, a correction process must be performed for the previous process, and then return to weight loss.
Failed in metabolic and digestive surgeries:
In order for the patient to obtain an ideal weight after the surgery, this process requires more than just following a special diet, as correct metabolism and metabolic processes are an important factor in obtaining less weight, but some people may fail their bodies to achieve this system. .
In these cases, fixing this problem may require converting the primary operation to another type of these surgeries, for example: conversion. From surgeries based on volume determination (such as sleeve gastrectomy) to those based on reducing intestinal absorption (such as traditional and mini gastric bypass), and thus we can obtain
We point out here that the main and fundamental reason in most cases of failure of obesity operations is due to patients not following a healthy diet, developed by specialized doctors and experts in this field that takes into account individual differences between people and depends on their medical history and health condition.
What are the complications of bariatric surgery that lead to resorting to repairing the failure of bariatric surgery?
Despite some side effects, some of the most common obesity surgeries are among the relatively safe operations, but there are many complications and side effects that may occur, which lead to resorting to repairing the failure of obesity surgeries, which amounts to only 15% of cases. It should be noted here that these complications are relatively few compared to the minor complications that are treated medically without resorting to the surgical path.
Examples of these complications that require surgical intervention include:
Persistent nausea and vomiting. be gallstones.
Malnutrition occurs due to the fact that patients took vitamins after the operation.
However, these complications may be remedied and treated by continuous follow-up of the patient with the attending physician.
The solution to the failure of the sleeve gastrectomy:
The failure rate of the laparoscopic sleeve gastrectomy is small, but it is likely to fail due to some factors, such as the patient’s non-compliance with the nutritional instructions after the surgery.
In the event of failure, the patient has two options, to undergo the laparoscopic sleeve gastrectomy procedure again, or to perform the laparoscopic mini-gastric bypass or the classic diversion. Diversion operations are the most appropriate option for such cases, but as we mentioned previously, each disease case differs from the other. Therefore, the appropriate option varies for each.
Gastric bypass repair
Gastric bypass operations may fail after a period of time
Gastric bypass surgery can fail?
Yes, if the patient insists on eating sugars, sweets, or starches and putting pressure on the stomach, then the operation was performed incorrectly in the first place, or the operation was performed well, but the patient cannot maintain it and did not adhere to the doctor’s instructions, or that there is a medical impediment to Losing weight, for example, the patient may be unable to move, so at first he will lose weight after the operation, and then he will suffer from weight stability.
Can gastric bypass failure be repaired?
Recently, methods have emerged to repair the classic gastric bypass, as during the repair we discover that the stomach was originally large in size and was not cut well, and it can be repaired by installing a band or a ring around the stomach in the classic gastric bypass, which is considered one of the most powerful types of operations.
How to avoid failure of bypass surgery?
You must choose the best place to perform the operation, and after the operation, you must perform a 3D x-ray in order to know the shape of the stomach after the operation and its dimensions, and to confirm whether it is correct or not.
Is it necessary to do a diet or diet after obesity surgery?
Yes, you are making a change to the health system, eating food that is commensurate with the size of the new stomach, and we are replacing heavy and fat-laden foods with light foods that suit your new stomach.
Classic gastric bypass
Laparoscopic R-Y Gastric Bypass (gastric bypass) is the first surgery in the world to treat severe obesity, and more than 600,000 operations have been successfully performed.
It is called the gold standard for bariatric surgeries, as it is very effective in losing weight with a comfortable way to eat without suffering from regurgitation, with a constant sense of satiety. It has a very high effectiveness in obese patients who love sweets.
Steps of the classic gastric bypass operation?
In this process, the stomach is reduced by making an upper pocket at the top of the stomach, about the size of a thumb finger. It makes the stomach and separates it from the rest of the stomach using very modern staplers (these are the same staplers used in the United States of America and Europe, with connecting the small intestine to the pocket and connecting the intestine with the intestine, so you feel full after Eating a small amount of food, in addition to that, the speed of food reaching the intestine leads to a decrease in the absorption of some calories with an increase in the secretion of some hormones that help lose weight.
The amount of food decreases significantly after the operation without suffering from hunger completely, as bypassing a part of the intestine in the bypass operation leads to the body absorbing a smaller number. of calories, which doubles the effectiveness of the process in reducing weight.
The operation is performed laparoscopically (we use the latest high-resolution telescope in Egypt) and it can also be performed in the traditional way (laparotomy), but it is not recommended to perform the operation in the traditional ways.