Introduction

" Laparoscopic techniques are now used in the treatment of severe obesity. Whether it be a gastric band, gastric bypass, or vertical gastrectomy (gastric sleeve), postoperative recovery is considerable different to the open procedures that we used to perform".

BELOW PLEASE FIND MORBID OBESITY SURGERY AND INFORMATION THAT YOU MAY FIND USEFUL.

Morbid Obesity is a disease and should be treated as seriously as any other medical problem. For each person the Body Mass Index (BMI) is calculated by dividing the body weight in kilograms between the height in square centimeters. For example, a person that weighs 75 kilograms with a height of 1.70 mts: 75 Kg ÷ (1.70 x 1.70) mts = 25 of BMI. Any score over 35 is considered morbid obesity. Those with BMI of 40 or with BMI ranging between 35 to 40 and suffering from a medical complication related to their overweight (hypertension, sleep apnea, arthritis, etc.) are candidates for surgery. It is estimated that one of every 5 people in Latin America is overweight. In the United States, 5% of the men (2.9 millions) and 7.2% of the women (4.5 millions) present morbid obesity. The exact cause is unknown but genetic, metabolic and psychological factors play an important role in the development of the disease. Obese patients have increased risk of having:

- depression
- coronary disease
- several joint arthritis
- sleep apnea
- hypertension
- diabetes mellitus
- premature death

Even though there are a certain number of patients that may loose weight in a transient manner with a combination of dietetic measures, medication and exercise, the incidence of gaining back lost weight is 95%.

While surgery is the last resort for those that have not been able to lose weight through diets and exercise, many clinical trials have demonstrated that when performed by good hands, it is a safe and effective method to loose weight.

Weight loss is achieved by reducing the functional size of the stomach and limiting its voiding. When this happens, it is simply impossible for the patient ingest sufficient calories to maintain its previous weight. This concept is valid for the Gastric Banding or the Vertical Gastrectomy, Sleeve type, as both of these are restrictive procedures. In other words, the amount of food entering the body is restricted. Gastric bypass combines the restrictive effect and malabsorptions since the amount of food entering the stomach is restricted and at the same time absorption is prevented. Results may vary from patient to patient but many reach close to 20% of their ideal weight, meaning they loose 80% of the body excess weight.

Gastric Plication Technique

This is a procedure that has been in the medical literature for about 10 years but it is not commonly used due to other techniques that have gained more attention. Lately, more people have been gaining interest in this procedure and its demand is constantly increasing. It consists of a restrictive surgery like the gastric band but without strange devices that may cause a reaction to the patient nor the risks of other surgeries may imply such as bleeding or peritonitis.

The surgery is made in laparoscopic form and with the help of small tubes known as trocars that helps us to inflate the abdomen with CO2. A camera is introduced into the abdomen and it is connected to a High-Definition TV. The stomach is located and all adherents are removed to initiate the plication.

The Plication Technique consists in making a series of stitches in the wall of the stomach in order to reduce the capacity of the organ to ingest food. It is being said that the ingestion is reduced in a 66%. Recent studies are promising and interesting facts about this procedure are that staples are not being used, the stomach is not cut, there’s no risk of peritonitis due to staples ruptures, the risk of bleeding is minimum and the patient stays in the hospital just one night. For those patients who have to lose a lot of weight, maybe this is not the best option. This is rather for cases in which the patient has an overweight or obesity of Type 1.

Patients that suffer from obesity and can’t afford the total cost of a surgery find this procedure as an option to solve their overweight problems because this is the less expensive procedure that exists.

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Gastric Bypass

Gastric Banding consists of a procedure that removes the upper portion of the stomach leaving a small reservoir with a 25 ml capacity and at the same time, the reservoir is connected to a segment of the small intestine that has a length of approximately 1.5 meters. This intestine will only serve to transport the food to a place where digestion will initiate when food is combined with pancreatic juices (See figure). The gastric bypass combines the restrictive effects with the malabsorption producing a large weight loss in a short period of time. This is the ideal procedure for patients with severe obesity and that have to loose a great amount of weight to attain their ideal weight. The rate of weight loss has been reported to be greater in patients that have undergone gastric bypass than those with gastric banding or vertical gastrectomy but all the procedures have demonstrated good results. The majority of the researches show a reduction of 40-50% of the excess weight in patients with gastric banding versus a 66-70% of weight loss with the gastric bypass after a year. Weight loss continues in all the procedures for 18 to 24 months after the surgery is performed.

Alter the bypass surgery, there may be nutritional deficiencies of Vitamin B-12, folic acid and iron. If you take the necessary vitamins and supplements, these may be prevented. Another potential effect of the gastric bypass is the Dumping Syndrome which consists of abdominal pain, colic, sweating, and diarrhea that typically happen after the patient ingests foods that are rich in sugars. Dumping Syndrome can be prevented by avoiding sugar ingestion.

See the following animations:

• Gastric Bypass (watch animation)

Watch the following videos of the surgery:

• Gastric Bypass - Dr Moises Chitrit

Vertical Gastrectomy Sleeve Type or Gastric Sleeve

Vertical gastrectomy Sleeve type is a relatively new procedure that consists of removing 66% of the stomach decreasing considerably its capacity. Obese patients need to fill their stomach in order to create a stimulus or message indicating that enough food had been ingested. When two thirds of the stomach are cut out, the patient will have the same feeling of satiety with a small amount of food. This procedure is being recommended to patients that are extremely obese (BMI greater than 50 kg/mt²) and that perhaps might not resist a prolonged surgery. Weight reduction is seen during 12 to 18 months. If after this time, the patient has lost weight notably but not sufficiently, the patient may be taken back to the operation room and complete a gastric banding procedure with an improved health condition and with the capacity to resist a longer surgical procedure. On the other hand, if the patient has lost enough weight and is close to the ideal weight, no other procedures are added and in these cases this procedure would compete with gastric banding in the sense that it is a pure restrictive procedure but without foreign bodies, without calibrations and without the control and follow-up by the physician that is required for other surgeries. It is usually performed using instruments with linear cutters that shoot three lines of staples on each side to guarantee an impermeable seal. In 2005, Dr. Chitrit performed the first gastric sleeve in the Republic of Panama. Since then, he has realized this procedure succesfully in more than 180 patients with a weight loss of more than 70% of the excess weight, with minimum complications and no mortality at all. Without a doubt, he is the best panamanian surgeon with more experience in this field in Panama. In the year 2006 he realized a course of Gastric Sleeve Surgery in New York, along with Dr. Michel Gagner, considered the world pioneer in the gastric sleeve developtment and surgery. Usually patientes have to say at the hospital for 2 nights. Then they are sent home with oral analgesics and liquid diet for 2 weeks. The weight loss during the first month is between 15 and 25 pounds (7 to 11.5 Kg.) and usually after 6 months, the patients have loss more than half the excess weight they had. At the end of the first year, you will be in your ideal weight and enjoying the benefits of a new and healty life.

The Gastric sleeve can also be achieve by using a new procedure called SILS (Single Incision Laparoscopic Surgery). If you want more information, just click here

Watch the following animation:

• Gastric Sleeve (watch animation)

Watch the following video of the surgery:

• Laparoscopic Gastric Sleeve - Dr. Moises Chitrit