Chirurgie-Digestive.com Docteur Paul Lachowsky
 
Surgery of the Digestif Tract
Surgery of Obesity
Laparoscopy

Locations of activity in the heart of the CHIREC
Centre Hospitalier Inter-régional Edith Cavell

New Hospital of the Basilique
Pangaertstreet 37
1083 Brussels
Tel.(0032).2.434.21.11.

Medical Institute Edith Cavell
Edith Cavell street
32 1180-Brussels
Tel.(0032).2.434.42.40.

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Obesity Surgery > Choice of procedure

  TABLE

Technique
Gastroplasty: Laparoscopic gastric band
Gastroplasty: Laparoscopic vertical stapling
Laparoscopic sleeve gastrectomy
Laparoscopic (mini-)gastric bypass
Laparoscopic
Duodenal switch
Mode of action
Reduces ingested volume
Reduces ingested volume
Reduces ingested volume
Reduces ingested volume+ reduces absorbed nutrients
Reduces ingested volume+ reduces strongly absorbed nutrients
Surgical risk
Very Low
Very Low
low
Low (in experienced hands)
Moderate (in experienced hands)
Reversibility
Totally and easy
Totally and easy
Non reversible
Totally - easy for mini gbp
            - difficult for gbp
Non reversible
Average excess weight loss over 5 years
50 - 60%
50 - 60%
To be evaluate
60 - 75%
65 - 80%
Late complications
Seldom
-benign and rare nutritional deficiencies
-late pouch dilatation (17%): surgical correction by laparoscopy
-erosion of the band through the gastric wall (2%): easy removal by laparoscopy
Seldom
benign and rare nutritional deficiencies (iron, Vit B12, folic acid)

distension of the staple line (35%): surgical correction by new staple line
technique is less popular due to the high failures
Seldom
benign and rare nutritional deficiencies
in case of insufficient weight loss combine with duodenal switch
Frequent
benign and rare nutritional deficiencies iron, calcium, Zinc  and Vit B12

possiblet dumping syndrome dietary management is needed
Frequent
Deficiencies in Vitamins A, D, E, B12
Deficiencies in iron, calcium and proteins

Voluminous and smelling faeces (malabsorption syndrome)
Galbladderstones
 
The complcation rate for these procedures is low: 4% or less.
It increases if these proceedures are perfomed on patients already operated for morbid obesity: between 10 and 15%
  
CONCLUSION

The  laparoscopîc gastric bypass is actually the "gold standard" procedure.
The mini gastric bypass performed by laparoscopy approach  is promising and can be seen as an alterantive to the gastric by pass procedure

- The adjustable gastric banding  remains a good procedure  and is indicated  for "volume eaters " patients with a BMI<45

- The Sleeve gastrectomy is also an efficient restricitve procedure (for "volume eaters") but some more experience is needed to evaluate the long-term efficiency. It is also the first surgical step for hyper-obese patients who undergo a duodenal switch procedure. 

- The duodenal switch (and the Scopinaro procedure) is indicated for the hyper-obese patients.

 

avant et deux ans après chirurgie
before and two years after the procedure




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