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Bariatric surgery
Obesity surgery through laparoscopy : the principles |
Obesity surgery through laparoscopy : the operations |
Principle 1 : surgery through laparoscopy :
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Renewed interest for surgery to treat obesity is not only the result of a continuing growing demand by patients but also the recent development of laparoscopic surgery. This surgery enables efficient operations to be achieved counteracting obesity without opening the abdomen. This represents considerable progress, as the healing of abdominal wounds in obese people forms a serious difficulty after an operation.
With laparoscopic surgery, the abdomen is not opened. The instruments are inserted into the abdominal cavity through tubes of 5 to 12 mm in diameter. Vision is assured by a camera that transmits the images to a video screen.
The precision is remarkable.
Because there are no scars, the recovery after the operation is simple, fast and practically painless.
The stay in the hospital is shorter than with « traditional » surgery.
Laparoscopic surgery needs general anaesthetic.
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Laparoscopic surgery: Operating the digestive canal without opening the belly, how does it work? | 
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The laparoscope
The lightguide
The trocars | 
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The laparoscope is an optical instrument with a diameter of 10 mm connected to a high-resolution camera. The image of the operation is shown on a video monitor. CO2 is pumped into the abdomen with an electronic pump. A Xenon light source supplies the necessary light via a lightguide connected to the laparoscope. The instruments enter the abdomen through tubes fitted with valves, the trocars. | The video monitor
The insufflation pump
The light source |  |
Principle 2 : bariatric surgery
| Bariatric surgery : How does it make you lose weight ?
| | In order to lose weight, a surgical intervention is used to either reduce the possibility of food in-take, or to prevent its assimilation:
- capacity reduction of the digestive canal in such a way that the patient is physically incapable of eating the same quantities he/she is used to:
THESE ARE RESTRICTIVE OPERATIONS,
- modification of the digestive canal in such a way that the food taken in will be only partially absorbed:
THESE ARE MALABSORPTIVE OPERATIONS,
For some operations the two principles are combined to achieve a better result.
RESTRICTIVE AND MALABSORPTIVE OPERATIONS
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Principle 3 : the right operation for the right person |
A complete physical and psychological evaluation of the obese person must be carried out thoroughly in order to select the type of operation to be proposed. This is done on the one hand in function of his/her mechanism of obesity, and on the other, his/her capability to adapt to a new digestive physiology.
The conclusive algorithm that our team has decided to follow when selecting the type of operation is presented here.
It is based on :
| 1. the BMI value | | 2. the presence of Gastroesophageal Reflux Disease (GERD) / hiatal hernia / diabetes | 3. the type of eating disorder : sweet eater -->
volume eater -->
addicted --> | gastric bypass RYGB
sleeve gastrectomy
duodenal switch DS |
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Some other factors of the personal medical history may modify the choice of operation. They are always discussed individually.
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Decisive algorithm
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