LAPAROSCOPIC SLEEVE GASTRECTOMY AND TRANSIT BIPARTITION

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LAPAROSCOPIC SLEEVE GASTRECTOMY AND TRANSIT BIPARTITION

1. Preoperative Evaluation: This includes routine blood tests, ultrasonography, endoscopic examination, chest disease evaluation, and cardiology evaluation. The patient should not be operated on unless the deficiencies (diabetes control, iron deficiency, vitamin B12 deficiency, vitamin D deficiency) that affect the wound healing are eliminated. Smoking should be discontinued. Preoperative d

Transit Bipartition Surgery

 

What is Transit Bipartition Surgery?

 

Standart sleeve gastrectomy is made. Calibration of the stomach is provided with a 50F tube. Anastomosis is formed betweeen the last 200 cm of the small intestine and the stomach. Anastomosis is made 5-6 cm proximal the pyloris. Anastomosis is made about 3 cm in diameter.  Two-third of food is not digested in two-thirds of the small intestine. One-third of foods are involved in normal digestion. It stimulates hormone secretion more effectively than other surgeries. In addition, the digestion of food in the last part of the small intestine with a large amount of obesity that leads to break the vicious cycle of hormones begin to secrete.

 

 

How to Lose Weight?

Most of the stomach is removed so that a tube-shaped stomach remains. A 150-200 cc volume of stomach remains.Patients eat less amount of food they can consume at a meal, they get less calories. The appetite is reduced by removing the part of the ghrelin hormon secreted part of the stomach that causes the starvation signal in the brain.

Two Third of the foods consumed due to the bypassed small bowel segment cannot be fully digested. One third of the foods use normal GIS pathway. Ghrelin secretion is reduced in the disabled stomach

Hormonal activation begins again as undigested foods come to the last part of the intestines more.

Re-secreted hormones include GLP-1, PYY, TGR5, PTP1B, FXR, FGFR4.

In addition, a number of hormones from the liver and pancreas begin to re-secrete.

 

What are the Health Benefits of Transit Bipartition Surgery?

 

Clinically, patients have been shown to provide a great number of postoperative benefits.

  • 85-90% of the excess weight is lost.
  • Significant improvement in type 2 diabetes (85%), hypertension (90%), sleep apnea (75%) and hyperlipidemia (95%).
  • Increase in physical activity, productivity, well-being, economic opportunities and self-confidence.
  • > 10 years permanent weight loss
  • Short hospital stay due to closed method
  • Vitamin deficiency is less common

 

After transit bipartition surgery, many diseases may improve or heal completely.

  • Type 2 Diabetes (%85-90)
  • Hypertension (>%90)
  • Hyperlipidemia (%95)
  • Sleep apnea (>%75)

 

 Advantages and Disadvantages of Gastric Bypass Surgery

 

Advantages:

 

  • Causes long-term apparent weight loss (EWL 80-90%)
  • Improvement in obesity-related comorbidities (85 to 90% of comorbidities depending on the type, duration, and damage to the organ in which it occurs)
  • Diabetes resolving ratio is better than gastric bypass and sleeve gastrectomy.
  • Macro and micro-nutritional deficiency complications are seen less than gastric bypass and no need for life-long vitamine supplement.
  • As in the stomach band, a foreign object is not used.
  • The amount of food consumed in a meal is reduced.
  • There is a decrease in hunger sensation due to hormonal changes and the increase in metabolism is higher than sleeve gastrectomy surgery.
  • Revision surgery in case of weight gain again is a easier than gastric bypass surgery.
  • There is no remaining stomach tissue that can not reached by endoscopy.
  • There is a endoscopic access to duodenum and biliary system.

 

Disadvantages: 

 

  • A proper nutrition program and routine exercise program should be continued throughout life.
  • Transit bipartition is more complex surgery than sleeve gastrectomy.
  • Vitamins and mineral deficiencies are seen but lifelong vitamin, mineral and protein support is not required.
  • Due to Dumping syndrome complications, some foods are not allowed to be consumed.

 

Possible Complications

  • Associated with obesity (possible complications when performing any surgery in each obese patient regardless of the operation)
  • Deep vein thrombosis (thrombosis of leg veins)
  • Pulmonary embolism (thrombosis of the lungs)
  • Wound site infection
  • Lung infection
  • Anesthesia complications
  • İncisional hernias
  • Surgery related (complications specific to this surgery)
  • Bleeding (3-5%). Blood thinners may be caused by cuts of the stomach or other organs in the abdomen.
  • Leakage (3-5% in old technology stapler group, 0.1% in new technology stapler group. More than 90% of patients can be treated with endoscopic stent implantation and feeding tube insertion)
  • Vitamins, protein and mineral deficiencies (Patients begin life-long protein, vitamin supplementation)
  • Dumping Syndrome (rich in carbohydrates and nausea, vomiting and discomfort if ingested)
  • Ulcer

 

Risks

 

Obesity and metabolic surgery is a safe surgery. It is as safe as other surgical procedures, such as gall bladder surgery. In experienced obesity and metabolic surgery specialists, the life-risk associated with obesity surgery is about 0.13%, while the life-risk of gall bladder surgery in an obese individual is 0.4%.

All surgical methods include risks. These risks vary according to weight, age and comorbidities. Each patient should have a specific risk assessment. A clearer interpretation cannot be made until the patient and the physician come together and make a preliminary assessment interview and conduct an examination evaluation.

But safe surgey is based on three main points.

1. Preoperative Evaluation: This includes routine blood tests, ultrasonography, endoscopic examination, chest disease evaluation, and cardiology evaluation. The patient should not be operated on unless the deficiencies (diabetes control, iron deficiency, vitamin B12 deficiency, vitamin D deficiency) that affect the wound healing are eliminated. Smoking should be discontinued. Preoperative diet should be applied.


2. Surgery: The appropriate surgical procedure should be selected for the patient. Surgical experience is required. The most current stapler technology should be used during surgery. Preventing clotting in the operating room measures should be taken.


3. Postoperative: A good follow-up after surgery is very important for complication management.

2. Ameliyat: Hastaya uygun cerrahi prosedür seçilmelidir. Ameliyat sırasında en güncel stapler teknolojisi kullanılmalıdır. Bacaklarda pıhtılaşmayı önleyici ameliyathane tedbirleri alınmalıdır.

 

3. Ameliyat Sonrası: Ameliyattan sonra iyi bir takip komplikasyon yönetimi açısından çok önemlidir.