Bariatric Surgery In Bangalore | Gastric Bypass Surgery In Jayanagar | Healios

SURGERIES

Sleeve Gastrectomy

In this procedure, the fat stomach is converted into a long,thin tube ( like small intestine) by using staplers which simultaneously cut and staple the stomach on either side. The redundant portion of the cut stomach (which accounts to about 75% of its volume) is removed through the small key hole. The continuity between the esophagus (food pipe), stomach and small intestine is maintained. This is a restrictive type of operation.  Malabsorption rarely occurs.

Laparoscopic Sleeve Gastrectomy helps to reduce weight and resolution of obesity associated co-morbid conditions in the following ways

  • Decreases calorie intake as the stomach size and capacity is decreased.
  • Decrease circulating levels of ghrelin resulting in decreased appetite: Ghrelin is an hormone which is secreted in majority from the upper part of the stomach (fundus).This hormone increases appetite.Since the fundus of the stomach is removed in sleeve gastrectomy, the levels of this hormone decreases resulting in decreased appetite.
  • Accelerate gastric emptying: As the majority of stomach is removed, nutrients pass rapidly to proximal gastro intestinal tract stimulating the secretion of an hormone called GLP-1 which helps in stimulating pancreas to produce more insulin. This in turn helps in achieving glycemic control and resolution of diabetes.

Gastric Bypass

Laparoscopic Roux- en – y Gastric Bypass:

This procedure works by changing the anatomy of your digestive system. Staplers are used to divide the stomach into two halves, a smaller upper pouch and a larger remnant stomach. The small intestine is then joined to nt of food to be consumed. A larger remnant portion of stomach and portion of small intestine is bypassed thus delaying food from mixing with digestive juices to avoid complete calorie absorption. Thus this is both a restrictive and malabsorptive procedure.

Laparoscopic Roux- en – y Gastric Bypass helps to reduce weight and resolution of obesity associated co-morbid conditions in the following ways

  • Decreases calorie intake
  • Majority of stomach and proximal small intestine bypassed with enhanced delivery of nutrients into the distal gut
  • Decrease circulating levels of ghrelin, thus resulting in decreased appetite.
  • Increased levels of GLP-I and PYY ( Ileal brake hormones ). These hormones stimulate the pancreas to secrete more insulin resulting in improved glucose homeostasis and cure of diabetes

Laparoscopic Banded Roux- en – y Gastric Bypass:

It has been found and reported that some patients with a laparoscopic roux-en-y gastric bypass will have progressive weight regain after two years of follow up. There are many causes for weight regain such as overeating, irregular follow up etc. This results in dilatation of the gastric pouch with increase in the gastric reservoir and increased calorie intake.

In this operation, staples are applied and a smaller gastric pouch is created. Then,at about 4-5 cms below the esophagus a ring is applied around the stomach pouch and fixed with stitches to the stomach. In our patients who have undergone this procedure, we have found that laparoscopic banded roux-en-y gastric bypass results in greater weight loss and also helps in maintaince of lost weight.

Banded Procedures

Banded Sleeve:

It has been found and reported that 30 to 60% of patients with a sleeve gastrectomy will have progressive weight regain after two years of follow up. There are many causes for weight regain following sleeve gastrectomy such as overeating, irregular follow up etc. This results in dilatation of the sleeve with increase in the gastric reservoir and increased calorie intake.

In this operation, staples are applied and a sleeve gastrectomy operation is performed.Then at about 4-5 cms below the esophagus a ring is applied around the sleeved stomach and fixed with stitches to the stomach. In our patients who have undergone this procedure, we have found that laparoscopic banded sleeve gastrectomy results in greater weight loss and also helps in maintaince of lost weight.

Banded Bypass:

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Ileal Interposition

In this procedure a segment of ileum is interposed to jejunum or duodenum.This results in rapid exposure of the the ileal endocrine cells to undigested nutrients. This in turn results in marked increase in the synthesis of PYY and GLP-1.These stimulate the pancreas to produce more insulin and improved insulin sensitivity.

The ileal interposition is also combined with sleeve gastrectomy.If the ileum is interposed to duodenum it is called as Duodeno ileal Interposition with Sleeve Gastrectomy and if it is interposed to the jejunum it is called as Jejuno ileal Interposition with Sleeve Gastrectomy.

Duodenojejunal bypass (DJB)

This procedure is also combined with sleeve gastrectomy.Laparoscopic duodenojejunal bypass with sleeve gastrectomy is safe and effective in achieving durable weight loss and excellent resolution of co-morbidities. It is proposed as an ideal alternative to Roux-en-Y Gastric bypass.

In this procedure a sleeve gastrectomy is performed. Then the small intestine is divided in its first part. The proximal part of the intestine is divided and joined to the first part of intestine. Finally intestinal continuity is restored.

This procedure acts by eliminating ghrelin and thus decreasing appetite . Since the proximal part of intestines are bypassed,the nutrients reaches the distal part of intestine faster, resulting in increase production of GLP-1 and PYY. These hormones stimulate pancreas to secrete more insulin, resulting in resolution of diabetes.

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Mini Gastric Bypass (MGB)

As the name suggests, Minigastric bypass is a simplified version of Roux-en-Y Gastric bypass.

 Mini gastric bypass usually bypasses much more of the intestine than a standard gastric bypass which could lead to more vitamin and mineral deficiencies.

Unlike gastric bypass surgery, digestive enzymes and bile are not diverted away from the stomach after mini gastric bypass. This can lead to bile reflux gastritis which can cause pain that is difficult to treat. Bile reflux gastritis may also increase the risk of cancer in the stomach pouch.                                                                          

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