Frequently Asked Questions

Sleeve gastrectomy, popularly referred to as stomach reduction surgery or sleeve gastrectomy, is the most common weight loss surgery performed worldwide.

As with all morbid obesity surgeries, standard rules apply:
* Body mass index (BMI) >40;
* BMI>35 and comorbid diseases such as type 2 diabetes, high cholesterol, sleep apnea, degenerative joint disease, high blood pressure
* The patient has been unable to lose weight despite diet and regular physical activity for at least 6 months or has gained back more than the weight lost.
Gastric sleeve gastrectomy (SG) causes weight loss by 2 mechanisms:

1) Mechanical restriction by reducing gastric volume and impairing gastric motility;
2) Hormonal modification of ghrelin production by removing a large portion of tissue. Ghrelin is a 28 amino acid peptide secreted by the occintic glands of the gastric fundus. It is a potent orexigenic (appetite-stimulating) peptide mediated by activation of its receptors in the hypothalamus or pituitary region. The gastric fundus contains 10 to 20 times more ghrelin per 1 gram of tissue than the duodenum. In sleeve gastrectomy surgery, resection of the fundus is also performed, eliminating the main site of ghrelin release, thus reducing appetite.
Morbid obesity is a major health problem in many countries. It is associated with serious life-threatening comorbidities. Unfortunately, many studies have proven that non-surgical approaches to weight loss are doomed to fail. There is good evidence that bariatric surgery is the most durable and effective way to combat morbid obesity in terms of long-term weight loss. Gastric bypass is one of the gold standard surgeries today. It relies on several mechanisms: restriction, malabsorption and changes in gut hormone secretions. It both restricts food intake and reduces the absorption of the food eaten. Like all obesity surgeries, Gastric Bypass surgery is applied to obese patients who cannot lose weight with diet and exercise. It is applied with two different methods. RNY AND MINI-GASTRIC BYPASS
Laparoscopic or robotic surgery is performed through millimetric incisions. The main surgical steps to perform gastric bypass are as follows:

1) Creation of an isolated 25 mL gastric pouch,

2) Creation of a Roux-en-Y gastroenterostomy into the gastric pouch. The length of the duodenojejunal limb is usually 30 to 50 cm (up to 75 cm if BMI >50). The length of the gastrojejunal limb (or Roux limb) ranges from 100 cm for Body Mass Index (BMI = weight in kg/square of height in meters) <50 to 150 cm for BMI >50.

This method involves a combination of two weight loss mechanisms.
– The primary mechanism is mechanical restriction through the creation of a 25 mL upper gastric pouch; – The secondary mechanism is malabsorption: The Roux limb delays the mixing of nutrients with bile and pancreatic fluids while preserving the entero-hepatic cycle of bile salts. This second mechanism improves insulin sensitivity in obese type 2 diabetic patients by stimulating gut-derived hormones.
In recent years, a surgical technique known as single anastomotic gastric bypass or mini gastric bypass has been developed. This procedure, originally described by Rutledge in 1997, is a simplified form of Roux-en-Y bypass by performing a single anastomosis with a significant reduction in technical complexity, shorter operative time and a potential reduction in morbidity and mortality.

Several studies have demonstrated the benefits conferred by this procedure, including excess weight loss and treatment of comorbidities (type 2 diabetes, high cholesterol, sleep agne syndrome, high blood pressure, etc.) equivalent to those observed after Roux-en-Y gastric bypass. Weight loss, both by reducing food intake and by reducing the absorption of the food eaten. Improves insulin sensitivity by early stimulation of intestinal hormones by food
It is performed laparoscopically and/or robotic. It consists of a long duct that runs from the bottom of the goose foot to the left of the His angle. The tube is similar to, but more importantly not identical to, the stomach pouch. The MGB contains a large gastro-jejunal anastomosis to the anti-colic ring of the jejunum 150-200 cm distal to the Trietz ligament. The strength of the MGB lies in the fact that it is both a “non-blocking” restrictive procedure and has a significant fatty food intolerance component with minimal malabsorption.

A gastric pouch of approximately 15-18 cm (50-150 ml) and a gastroenteric anastomosis (biliopancreatic loop) in a pre-colic isoperistaltic loop of 200 cm in duodenojejunal aspect.

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