THE GASTRIC BYPASS SURGERY

The laparoscopic surgical technique is now the preferred method for removal of the gall bladder. About 90% of all gall bladder operations are performed in this way.

In laparoscopic surgery method is to dispense with a large abdominal incision and instead just cut small holes in the stomach. The operation is performed with the so-called laparoscopes under the perspective of a camera.

The small abdominal incisions to get to such an operation very quickly back on its feet, the recovery is significantly faster than after conventional surgery. Moreover, leaving only tiny scars that stand little later.

Only in difficult and special problems inflammation of the gallbladder is not removed today in a conventional way. When it comes to complications during laparoscopic surgery, is sometimes switched to the open surgery method.

Confusion of terms

For laparoscopic surgery, there are many terms that describe all of the same operation method. By different names but it can come to some uncertainty.
Here are the most common name for the laparoscopic surgical technique.

Laparoscopy: Refers to the laparoscopes, the devices with which you can see inside the abdomen and work.
Minimally invasive: Refers to the smoothness of the operation. The injury to the skin is minimal in this operation method. This term is used for operations outside of the abdomen.
Endoscopic: This term is an umbrella term for medical devices which are inserted through small openings into the body in order to see anything. For a gallbladder removal you need except a rigid endoscope and instruments with which we cut and pack can to operate.
Keyhole surgery: This is a colloquial term that expresses that they are working through a very small hole in the belly, as small as a keyhole.
Laparoscopy: Refers originally ie a laparoscopy for diagnostic purposes, to look into the inside of the abdomen to detect a disease. The term is also used for laparoscopic surgery.
Cholecystectomy: This is the medical term for the removal of the gall bladder. He does not distinguish between the minimally invasive and traditional surgical method.
In all such terms, it is therefore the same surgical procedure.
Will operate

A minimally invasive gall bladder removal is performed in approximately the following manner:
First the patient is anesthetized with general anesthesia. In this anesthesia is the most profound form, in which a ventilation tube is used. The respiration per barrel is needed to counter the pressure in the inflated abdomen a ventilation pressure. The air is then pumped to a certain pressure in the lungs.

Once the patient is anesthetized completely, the entire abdominal disinfected and made a small hole beneath the navel in the abdominal wall. The position under the belly button is used because the abdominal wall is very thin there. In addition, the scar is hardly seen there later.

Through the small hole in the abdominal cavity is inflated with CO2, so the surgical team can better see the inside of the abdomen. The inflated abdomen is medically referred to as pneumoperitoneum. They used mostly carbon dioxide, because after the surgery can be absorbed by the body and broken down.

After the abdomen was inflated, an endoscope through the belly button-hole is introduced in order to look into the belly can.

For the actual surgery for another two or three small holes are cut in the abdomen, are inserted through the laparoscope.

The gallbladder is identified below the liver and at the top and packed folded. Then the connection to the bile duct is disconnected by using clips. The blood vessels of the gall bladder to be disconnected. Then the vessels are separated and disconnected passages.

Since the gall bladder is grown in the liver, it is still separated from the liver. The resulting bleeding is stopped by coagulation.

If the gallbladder is connected by scar adhesions with other parts of the abdomen, these adhesions can be separated.

When the gallbladder was successfully separated from the vessels and the liver, it is pulled through the hole below the belly button outward.

In some cases, the gallbladder is already heavily damaged, so they could get broken if drawn out. In these cases it is still packed in the abdominal cavity in a small mountain bag and then pulled the bag out of the belly.

Even with a porcelain gallbladder, the gallbladder is packed in a bag mountains, as a porcelain gallbladder is no longer stable shell.

If a lot of very large stones or stones in the gall bladder are, they may not fit through the small hole below the navel. Then they will initially only partially pulled out of the belly and the stones are extracted before the gallbladder is removed completely from the stomach.Extremely large stones are crushed prior to suctioning.

Once the gallbladder has been removed from the body, it is examined by members of the surgical team. If you say before the surgery decision, you can often get the gall stones and take them home.

The CO2 is released again from the abdominal cavity. The most successful but not completely, so that gas residues remain in the abdominal cavity. These residual gases are absorbed by the body in the following days.

The holes in the abdominal wall are then sewn together.

In some cases, is routed through one of the holes have a drainage tube, water can flow through the wound. This drainage-tube is then removed after a few hours or days. Mostly, however, are now all equal sewn holes so that the abdomen is closed.

Once the abdomen is closed, the anesthesia is complete.

It is placed in a recovery room, where one gradually comes back to consciousness.

Here you also get first pain medication, to a level at which the pain disappeared or are only very slightly.

If the pain medication delivery was successful and the condition is stable, it is placed in his room at the hospital station. There you can recover from the surgery.

This description is naturally only one of many possible variants of laparoscopic surgery dar. In each hospital operates somewhat differently, and also different degrees of severity of gall bladder disease care for different surgical procedures.

Minimally Invasive Surgery is surgery of the chest and abdomen is performed with the help of a special camera and surgical instruments designed for this purpose. Through this camera and instruments, the surgeon may do major surgery through small holes without making the traditional incision or wound large to achieve the same goal.

The benefits of minimally invasive surgery are many. First, the traditional surgery usually requires a lengthy hospital stay and several weeks to recover. Through minimally invasive surgery, these same procedures require only one or two days or even less time in hospital and recovery time to return to normal activities and return to work is only a few days. That means that you return to work or your regular routine much faster than I would have expected with a traditional or open surgery.

This recovery is possible because only small incisions are required, which are closed with one or two points instead of one large incision that requires cutting through the skin and muscles. Other benefits of minimally invasive surgery include less postoperative pain, less need for post-surgical pain, smaller scars and less likelihood of surgical wound complications such as infection or hernia, as occurs with some frequency in the open surgery.

Description

Conservative treatment methods result in the treatment of morbid obesity is extremely rare for a sufficient long-term weight loss. Can thus morbid obese patients (BMI – 40 kg/m2) will most likely be helped by bariatric surgery only in the long run. Restrictive operations such as gastric band surgery, and malabsorptive procedures such as gastric bypass are now performed in specialized centers with laproskopischer technique with low morbidity and mortality.

Through the gastric band surgery, a long-term reduction is possible by 30-50% of excess weight. In patients with extreme obesity (BMI – 50 kg/m2) was more of a bypass procedure can be chosen that uses a combination of food restriction and malabsorption leads through the elimination of defined sections of small intestine in food intake for weight loss.
Comorbidities such as type II diabetes can be better combined with / restrictive malabsorptive procedures such as Roux-en-Y gastric bypass treatment.
The success of therapy depends on a strict indication by a multidisciplinary team and a lifelong follow-up and monitoring by the surgeon and other specialists. Only way to guarantee that long-term consequences of bariatric surgery are recognized as diverse band complications or deficiencies in suffiency malabsorptive procedures and treated early.

Hospitalization

2 – 4 days

Duration of surgery

1 – 2 hours

Side effect

Sometimes, the adjustable gastric band can be problematic. All the straps are attached below the esophagus from the stomach to the tip. However, in some cases may slip off the tape.
This usually occurs when the patient has tried to eat too much.
If they believe that the gastric band is slipping, it will be necessary to determine by X-ray of his position.
Another, with long-haul flights related problem is, where air bubbles can cause and restrictions.
This can cause they can not keep foods and liquids.

Most surgeons recommend draining the band before and after long-haul flights to fill up again. Under certain circumstances, the leak-adjustable gastric band, usually this occurs in conjunction with the opening.
However, this can be corrected with a tamper minor surgery.

Recovery

The advantages of laparoscopic procedures are primarily rapid recovery, faster healing process, and the reduction of scars.

Risks

Although the gastric band surgery helps you lose weight, but is not without risk. However, applies here: “Who can not lose weight is composed of an even higher risk.”
Thus, the gastric band – while risky – difficult for the obese, which can not be removed by another method, certainly the better option for weight loss.
The following surgical risks are known, however, occur but are rare:

- The slipping of the stomach through the gastric band
- The abdominal distention
- An erosional migration of the gastric band into the stomach

Also, the operative risk of gastric band surgery by the preponderance of any pre-existing conditions and is also increased.

Results

A gastric band forces the obese patient to change his eating habits. He needs to restrict the supply of food, chew longer.
Large food particles could for a long time the narrow channel, called the stoma, between the pouch (stomach bag) and residual stomach move.
It may come to induce vomiting if the patient suddenly takes more food than the pouch (stomach bag) allows.

Patients learn but after two to three months to adjust food intake, so the frequency of vomiting decreases with time continuously.
Two new studies from Europe come to the conclusion that the laparoscopic adjustable gastric banding with a low morbidity and mortality (death) associated.
Patients in both studies have lost about half their initial weight after the surgery within 2 years.

Technology

There are two types of operations:

One is to shorten the digestive tract and on the other hand, you can reduce it. In all operations, the goal is the quantity and the utilization of food is limiting in the body.

1st Gastric bypass surgery to shrink the stomach – a reduction of the digestive tract through a gastric bypass – This operation is performed with keyhole surgery or open surgery performed

2nd Reduction of stomach volume – by stapling (surgery to Mason) – an adjustable gastric band Swedish, which is used by the keyhole technique.

The adjustible gastric band:

This is an adjustable elastic strap, the upper portion of the stomach with a size of about 20 ml separated from the rest of the stomach. Caused by the rapid filling of this new agent in the patient quickly gaining a feeling of fullness, which is another food no longer makes it necessary and possible. In this way, the patient is “educated” to eat slowly and in small quantities. The band is inserted using a minimally invasive technique (laparoscopy and keyhole surgery). A connecting tube to a metal-coated balloon system in the abdominal wall allows the Passenger and further offices in the following therapy.

Conditions (indications) for a gastric band operation:

Body mass index (BMI) – 40 kg / m²

Patients with a BMI of 35.0 – 39.9 kg / m² by the preponderance of which has occurred subsequent illness that can be improved by weight loss (eg diabetes, joint problems, sleep apnea).

Disease duration over 5 years (several phases with lower weight, yo-yo effect ‘are possible)

Therapy will and willingness of patients to regular
Further support from us, driving a diet plan and intensive nutritional counseling and after surgery.