Obesity

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.

This procedure aims to restrict food intake in obese patients by removing approximately 2/3 of the stomach, creating a smaller stomach of around 60-120 cc. By eliminating the appetite hormone ghrelin, this method effectively reduces both appetite and food intake. The surgery is conducted laparoscopically, with minimal incisions, ensuring a swift recovery. On average, the operation takes 45 minutes, with a hospital stay of 3 days. Patients can resume normal activities within 7-10 days, with ongoing nutritional guidance and follow-up provided by our expert nutritionists and staff.

Designed to curb food intake and alter the absorption of ingested foods, this method involves creating a new stomach from the existing one. The new stomach is then connected to a predetermined section of the small intestine, approximately 180-200 cc from its initial part. The goal is to prevent weight gain by reducing food intake and absorption, especially if patients tend to overeat over time. Conducted laparoscopically, the surgery lasts an average of 1 hour and 45 minutes, with a 3- day hospital stay and a return to regular activities within 7-10 days. Our dedicated nutritionists and staff oversee post-operative nutrition and follow-up.

Elevate your approach to combating obesity with our clinic's cutting-edge surgical interventions, ensuring personalized care and optimal recovery.

Roux-En-Y Gastric Bypass is a sophisticated method designed to address both food intake restriction and the reduction of intestinal food absorption in obese patients.

A novel gastric pouch, approximately 25-30 cc in size, is meticulously crafted from the upper part of the stomach. The initial section of the small intestine is separated and anastomosed to the newly created stomach pouch. Another anastomosis is made 100-150 cm from this point to ensure the continuity of the stomach, pancreas, and bile fluid. The reduced size of the stomach pouch induces a sense of saturation with small snacks, leading to decreased calorie intake. Deactivation of certain areas results in reduced food absorption, contributing to the overall effectiveness of the procedure.

Performed laparoscopically through small millimetric holes, the average duration of the operation is 2 hours. Patients typically stay in the hospital for 3 days and can resume their normal lives within 7-10 days. Our team of experienced nutritionists and staff oversees post-operative nutrition and follow-up, ensuring comprehensive care throughout the recovery process. For additional information on these procedures, please do not hesitate to contact us.