Metabolic and Bariatric Surgery
Intragastric balloon
Placing of intragastric balloon for weight loss


What does the procedure is?

An intragastric balloon is a newer kind of weight-loss procedure. A saline-filled silicone balloon is placed in your stomach. Balloon limits food consumption, makes you feel fuller faster and causes weight loss.
This procedure is an option if you're overweight or obese, and diet and exercise haven't worked for you.
Like other weight-loss procedures, an intragastric balloon requires commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success.

What it’s done?

Insertion of intragastric balloon assists the quicker and successful weight loss. Weight loss can lower your risk of potentially serious weight-related health problems, such as
•    Heart disease and stroke
•    High blood pressure
•    Sleep apnea
•    Type 2 diabetes
•    Others

An intragastric balloon and other weight-loss procedures are typically done only after you've tried to lose weight by improving your diet and exercise habits..

Who it's for:

An intragastric balloon may be an option for patients:
•    With body mass index (BMI) between 30 and 40.
•    If you are willing to commit to healthy lifestyle changes and regular medical follow-up.
•    You have not had any previous stomach or esophageal surgery.
Intragastric balloons aren't the right choice for everyone who is overweight. A screening process will help your doctor see if the procedure might be beneficial for you.

Procedure risks:

Pain and nausea affect about one-third of people soon after insertion of an intragastric balloon. However, these symptoms usually only last for a few days after balloon placement and they can be treated with oral medication
Serious risks after procedure are rare. It's possible that the balloon could deflate, there's also a risk that it could move through your digestive system. This can cause a blockage that may require a further procedure.
Other possible risks include ulcers or a hole (perforation) in the stomach, which might require surgery to eliminate the defect.

How you prepare?

Your health care team will give you specific instructions on how to prepare for your procedure. You may need to have various lab tests and exams before your procedure.

How does the procedure pass?
Insertion of intragastric balloon is non-surgical endoscopic  procedure. Total anesthesia is used. Balloon is inserted into the stomach via the throat by a thin tube. Thereafter in the same way the doctor advances a flexible tube with a camera  attached (endoscope) which  allows your doctor to see the balloon while it is filled  with saline. The procedure takes about a half-hour. You can normally go home several hours after the procedure.

What happens after procedure?

You can have small amounts of liquid starting about six hours after the procedure. The liquid diet generally continues until the start of the second week, when you can start eating soft foods. You'll probably be able to start eating regular food around three weeks later.
Intragastric balloons are left in place for up to 6 months, and are then removed using an endoscope. In this period as well as later you should have regular consultations with nutritionist and psychologist.

What results could be expected?

An intragastric balloon can make you feel fuller faster than you normally would, which often means you'll eat less. The intragastric balloon slows down the time it takes to empty the stomach and changes the  levels of hormones that control appetite. The amount of weight you lose also depends on how much you can change your lifestyle habits.
Loss of about 10 to 15 percent of body weight is typical during the six months following intragastric balloon placement. In a combination with the total therapy, including diet and physical exercises, this percentage is increased.
As with other procedures and surgeries that lead to significant weight loss, the intragastric balloon may help improve or resolve conditions often related to being overweight, including:

•    Heart disease or stroke
•    High blood pressure
•    Severe sleep apnea
•    Type 2 diabetes
•    Others

When weight loss procedures don't work?

It's possible to not lose significant weight or to regain weight, if you do not follow strictly the definite diet and if you do not move sufficiently.
The procedure itself could be very effective but not sufficient to maintain long-term weight loss. Permanent efforts and engagement on behalf of the patients are necessary for more healthy lifestyle.
Sleeve gastrectomy
Laparoscopic sleeve gastrectomy
 



Laparoscopic sleeve gastrectomy or the so called “Sleeve” is carried out by removal of about 80 per cents of the stomach. The remaining part of the stomach is a tube-shaped stomach about the size and shape of a banana.

About procedure:

This procedure works by several mechanisms. On the first place, the new stomach case is significantly less in volume than the normal stomach, assists reduction of food quantity and thus the calories to be consumed become less. More significant, however, is the effect from the procedure on intestinal hormones, which exert effect on many factors, inclusive hunger, repletion and control of blood sugar. The short-term studies show that the sleeve is quite effective from the point of view of weight loss and improvement or remission of diabetes. There are evidences also which suggest that the sleeve, similar to the gastric bypass, is effective in improvement of the status of people with diabetes type 2, independently of the quantity of weight loss.

Advantages:

1. Restricts the food quantity which could go into the stomach;
2. Causes quick and significant weight loss – about 50 % within 3 to 5 years and weight loss comparable with the one in bypass;
3. Does not need placing of foreign bodies, bypass or redirection of food flow;
4. Comparatively short hospitalization -2 days;
5. Causes favourable changes in intestinal hormones which inhibit hunger, reduce appetite and improve the sense of repletion.

Disadvantages:

1. Procedure is irreversible;
2. Probability of long-term vitamins deficiency.

 
Gastric bypass
Roux-en-Y gastric bypass



Roux-en-Y gastric bypass or the so called “gastric bypass” is considered to be the “golden standard” in bariatric surgery and it  is the most often applied procedure of that type all over the world.

About procedure:

The procedure consists of two components. Small pouch is formed (30 ml volume approximately) by dividing the upper part of stomach from the remaining part. Then the first part of small intestines is separated and their lower end is lifted and connected to the newly formed pouch. Procedure is completed by stapling the upper part of small intestines to the lower small intestines so that the gastric acids and digestive enzymes from the gastric bypass and the first part of small intestines finally mix with the food.
Gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly formed pouch is significantly less and significantly facilitates swallowing of less food, which is expressed in consumption of less calories. Most important is that the food flow is redirected, there are changes in intestinal hormones which inhibit hunger, and it prevents the main mechanisms via which obesity causes diabetes type 2.

Advantages:

1. Provokes significant and long-term weight loss (about 60-80 % of the overweight);
2. Restricts the food quantity which the stomach contains;
3. May lead to conditions which increase energy consumption;
4. Provokes favourable changes in intestinal hormones which inhibit hunger and improve the sense of repletion;
5. Usually loss of over 50 % of overweight is maintained.

Disadvantages:

1. Technically this type of operation is more complex than the other, which increases the complications risk;
2. There is probability of long-term vitamins/minerals deficiency i.e.: vitamin B12, iron, calcium and folic acid;
3. Longer hospitalization period as compared with banding;
4. Requires observation of the recommendations for dietary regimen and administration of vitamins/mineral supplements for lifetime.
 

 

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