The
surgery is a sure and very effective solution on the long term
to fight against obesity and the morbid hunger. Several types
of interventions are possible, more or less important, reversible
or not, according to the gravity of the obesity of the patients,
their food mode and their motivations.
The installation of a simple adjustable gastric ring is the simplest
operation. It does not modify of anything the digestive system
patient, while eliminating his irrational desires, source of its
discomfort. The great effectiveness of this technique involves
important and fast behavioral modifications, from where utility
of a personalized psychological framing.
Installation of a gastric ring
The gastric ring acts like a sand glass. It obliges to change
its practices, with good mastiquer for example. The volume of
the food catches largely will be decreased because the pocket
located at the top of the ring which accomodates introduced food
fills quickly, but lets pass its contents only gradually. The
caloric intakes thus strongly will drop, obliging the organization
to draw from its reserves of greases to transform them into calories.
If the dietetic recommendations are respected, there will be however
no protidic deficiency, nor in vitamins.
The
installation of a gastric ring constitutes an adjustable intervention
because this one will be inflated in several times by the surgeon
one month after his installation. The gastric ring is of nothing
mutilating, it acts just of an element “posed” which
has a restrictive mechanical role. It is thus a reversible method,
one can deflate it in the event of pregnancy for example.
The social security deals with this operation for the indices
of body mass (IMC) higher than 40 kg/m ².
The
decision of the installation of a ring should however never be
made with light but to be maturely considered. It is necessary
to be aware of the consequences, such as the abandonment of the
immediate oral satisfaction gotten by the abuse food. In addition
to the paramount importance of the opinion of the psychologist,
the dietetician and the family practitioner which know the patient,
we recommend also the exchanges with associations concerned and
the discussions with already operated patients. We are obviously
available to bring all the councils necessary to you, to explain
you in details the operation and to accompany you throughout your
step.
This
step starts with the confirmation of the founded good of this
operation by the surgeon, the dietician and the psychotherapist.
A draft-agreement is then subjected to the signature of the patient.
It informs it incurred risks, describes the induced intervention
and processes with its continuation. It follows from there a consultation
with the anaesthetist as well as a blood assessment whom can be
supplemented by a cardiologic or pneumologic assessment. The ultimate
checking with the feasibility of the operation will be made by
gastric fibroscopy.
The
operation of installation of a gastric ring is done under coelioscopy.
This one in general lasts a little less than one hour. It is a
question of inflating the abdomen under general anaesthesia to
introduce an optics connected to a camera by an opening d'1 cm.
The wire are withdrawn at the end of one week, period during which
the not very important post-operative pains will grow blurred.
During the first two weeks, the patient must privilege a soft
food. It is a question of not moving the ring not fixed by the
cicatrization. One month after the operation, the surgeon will
carry out the first inflation by simple puncture far from painful
through the skin, in the membrane of the case of injection of
the ring.
The
patient will have then to be followed during several months by
the surgeon (for a progressive adaptation of inflation - one should
not especially want to go too quickly!) and by the dietician who
will frame the mode induced by the ring. An additional psychotherapeutic
help with is not neglected. This follow-up is essential! The loss
of weight is spread out during 18 to 24 months, at a rate of 0,5
to 1 kg every 30 days. At the end of two years, when the weight
is stabilized, it is advisable to found an annual consultation
by radiography of the stomach. It is also at this time that the
patient can consider an intervention of plastic surgery, according
to its desires.
By-pass technique
The by-pass or jejunal short-circuit gastro is now regarded as
the intervention of reference or the “standard gold”
of the surgery of obesity.
Held
little time ago still to very large obesities, this technique
takes rise more and more.
It consists in shorting-circuit the way of the food (cf diagrams).
The intervention is heavier than a gastroplastie by ring, because
more technical. It is an intervention which lasts two A four hours,
and is also practised under coelioscopy.
The results are much better than the ring bus with the gastric
restriction brought by the small fastened gastric tube is added
with dimensions malabsorptif intervention (short-circuit of the
reabsorption of greases and sugars).
It is about a final and exceptionally reversible intervention.
The results on the loss of weight are spectacular : up to 80%
of loss of excess of weight over one year.
This intervention is proposed from the start in first intention
with the obese grignoteurs, obese of which the IMC are raised,
and with the failures of the gastroplasties by ring.
Technique of parietal gastrectomy in gutter or sleeve
gastrectomy
This technique consists with tubuliser the stomach over all its
length. It obtains very good results. It is about an intervention
purely restrictive and suggested in certain indications.
Other techniques exist. We obviously invite you to consult
a specialist who will advise you and will direct you in function
from diagnostic suitable.
