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Sleeve Gastrectomy
This procedure involves converting the stomach into
a long thin tube by stapling it along its length and
removing the excess stomach. Unlike the gastric bypass,
in which food enters the small gastric pouch and then
passes straight into the small bowel, the route that
food takes following a sleeve gastrectomy is the same
it took before surgery. Because the stomach is smaller,
able to hold less and stretches more quickly to give
a feeling of fullness and satiety, patients want to
eat less and therefore loose weight. This operation
can be completed laparoscopically.
For very large patients where the risks of a long surgical
procedure are considered too high, a sleeve gastrectomy
may be utilised as the first part of a two stage operation:
the second stage being undertaken a number of months
later when the patient has lost a significant amount
of weight and the risks of further surgical procedures
is much less. The second operation may be either a pancreatico-biliary
diversion or a roux-en-y gastric bypass.
About 50% of patients who have a sleeve gastrectomy
may get such a good weigh loss with it that they do
not need to undergo further surgery. Patients can loose
up to 70% of their excess weight with a sleeve gastrectomy
alone. The general complications of a sleeve gastrectomy
are the same as the other weight reduction operations.
The commonest specific complication is leakage from
the staple line.
Pancreatico-bilary
bypass
This operation involves a sleeve gastrectomy and bypass
of most of the small bowel. Whilst the sleeve gastrectomy
acts to restrict the amount of food eaten, much of the
effect of this procedure comes from malabsorbtion produced
by bypassing most of the small bowel. Unlike the gastric
bypass operation where the small bowel is divided 80
cm from its upper end the small bowel is divided 300
cm from where it joins the large bowel (close to its
far end). Once divided the far piece of small bowel
is called the intestinal limb and the near end of the
small bowel the pancreatico-biliary limb. The bowel
is divided again at the point where the stomach becomes
the duodenum (the duodenum is the very first part of
the small bowel). The far end of the small bowel (intestinal
limb) is then brought up and joined to the duodenum.
Food will now pass through the refashioned stomach and
straight into the very last part of the small bowel.
It is then necessary to join the near end of the small
bowel (pancreatico-biliary limb) to the intestinal limb
100cm from the point where it joins the large bowel.
This ensures that all the digestive juices that come
from the gallbladder, pancreas and small bowel are mixed
in with the food and digest it.
Intra-gastric
balloon
The intra-gastric balloon is a plastic balloon placed
in the stomach to help you to feel full and therefore
eat less. Weight loss tends to be modest and because
it can only remain in place for 6 months it represents
a short term rather than permanent solution to weight
problems. It is not free of complications and can lead
to intestinal obstruction.
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