Surgeries

Sleeve gastrectomy is a restrictive procedure. It greatly reduces the size of your stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass your intestines. After eating a small amount of food, you will feel full very quickly and continue to feel full for several hours.

Sleeve gastrectomy may also cause a decrease in appetite. In addition to reducing the size of the stomach, sleeve gastrectomy may reduce the amount of “hunger hormone” produced by the stomach which may contribute to weight loss after this procedure.

The “Roux-en-Y gastric bypass” (RYGB) is considered the “gold standard” for weight-loss surgery by the American Society for Metabolic and Bariatric Surgery and the National Institutes of Health.

RYGB works by restricting food intake and by decreasing the absorption of food. Food intake is limited by a small pouch that is similar in size to the adjustable gastric band. In addition, absorption of food in the digestive tract is reduced by excluding most of the stomach, duodenum, and upper intestine from contact with food by routing food directly from the pouch into the small intestine.

The operation, usually performed laparoscopically, involves making five to six small incisions in the abdomen through which a small scope connected to a video camera and surgical tools are inserted. The surgeon staples the top portion of the stomach so it is separated from the bottom to create a small stomach pouch. This small pouch restricts food intake. A section of the small intestine called the jejunum is then attached to the small stomach pouch permitting food to bypass the lower stomach, the duodenum. This bypass reduces the amount of calories and nutrients the body absorbs,  called malabsorption.

Gastric bypass surgery is an operation that creates a small pouch to restrict food intake and bypasses a segment of the small intestine. In the gastric bypass procedure, a surgeon makes a direct connection from the stomach pouch to a lower segment of the small intestine, bypassing the duodenum (the first part of the small intestine) and some of the jejunum (the second part of the small intestine), delaying the mixing of ingested food and the digestive enzymes.

Roux-en-Y gastric bypass is the most common type of bariatric surgery. The surgeon begins by creating a small pouch by dividing the upper end of the stomach. This restricts the food intake. Next, a section of the small intestine is attached to the pouch to allow food to bypass the duodenum, as well as the first portion of the jejunum. The small intestine is re-connected 150 centimeters from the pouch to allow ingested food and digestive enzymes to mix.

How Is Gastric Plication Performed?

We perform the gastric plication as a laparoscopic procedure. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (laparoscope) and long instruments that are placed through these small incisions.

Laparoscopic gastric plication, involves sewing one or more large folds in your stomach. During the laparoscopic gastric plication the stomach volume is reduced about 70% which makes the stomach able to hold less and may help you eat less. There is no cutting, stapling, or removal of the stomach or intestines during the Gastric Plication. The gastric plication may potentially be reversed or converted to another procedure if needed. The gastric plication procedure is minimally invasive and takes approximately one to two hours to complete. Most patients stay in the hospital for 1-2 days after the procedure.

How Does Gastric Plication Cause Weight Loss?

Gastric plication is a restrictive procedure. It greatly reduces the size of your stomach and limits the amount of food that can be eaten at one time. It does not cause decreased absorption of nutrients or bypass your intestines. After eating a small amount of food, you will feel full very quickly and continue to feel full for several hours. Gastric plication may also cause a decrease in appetite.

• SADI-S (SLEEVE)
• SADI-P (GASTRIC PLICATION)

The single-anastomosis duodenal switch, also called stomach intestinal pylorus sparing surgery (SIPS), or the single loop DS, is very similar to the standard duodenal switch operation, except that the small intestine is only transected at one point instead of two. With this operation, the majority of the most stretchable portion of the stomach is permanently removed but basic stomach function remains the same. In addition, roughly half of the upper small intestine is bypassed, resulting in a moderate decrease in calorie absorption. Weight loss is achieved both through restriction of food consumption and malabsorption, which results in very good long-term weight loss maintenance.

Tummy tuck surgery, also known as abdominoplasty, removes excess fat and skin and, in most cases, restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.

An arm lift is a cosmetic surgical procedure to improve the appearance of the under portion of your upper arms.

During an arm lift — also known as brachioplasty — excess skin and fat are removed from between the armpit and elbow. The remaining skin is placed back over the newly repositioned contours to create a more toned look.

A cholecystectomy (koh-luh-sis-TEK-tuh-me) is a surgical procedure to remove your gallbladder — a pear-shaped organ that sits just below your liver on the upper right side of your abdomen. Your gallbladder collects and stores bile — a digestive fluid produced in your liver.

A cholecystectomy may be necessary if you experience pain from gallstones that block the flow of bile. A cholecystectomy is a common surgery, and it carries only a small risk of complications. In most cases, you can go home the same day of your cholecystectomy.

A cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. Doctors call this a laparoscopic cholecystectomy.

In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.

Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia.

The hiatus is an opening in the diaphragm — the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become “strangled,” or have its blood supply shut off.

Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

People with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. That’s why it’s so important to undergo testing and get properly diagnosed.

WHY COLON SURGERY IS SOMETIMES NEEDED

The colon is the large intestine where the small intestine empties the metabolic wastes of digestion that are not absorbed in the body. After absorption of water, the colon expels these wastes as faeces through the rectum at regular intervals. Common colon ailments include irregular bowel movements, growth of polyps, and colon cancer. Sometimes, surgical interventions are necessary to take care of these problems in the colon. As people grow older, often small outpouchings of the intestine form called colonic diverticuli. Diverticulosis and diverticulitis are conditions that arise from these outpouchings of the intestine and may sometimes cause bleeding and infection. If you have suffered multiple attacks then you may require an operation to remove the effected portion of the colon.

Cancer may sometimes develop in the colon therefore colonoscopy is a very valuable diagnostic tool and every patient should have a colonoscopy by age 50. The doctor will typically perform a biopsy if a polyp is seen in the colon and this will help decide whether surgery is indicated. Sometimes a suspicious looking intestinal polyp may be seen on colonoscopy which is too large or in too difficult a location for the endoscopist (your GI doctor) to remove. If colonoscopy is not indicated because of severe diverticulosis or the question of an obstruction or blockage, then a barium enema is another test which surgeons can use to look inside the colon and help them to decide on surgery. Sometimes, a CT scan of the abdomen may be a useful tool to decide if a colon surgery is needed. Laparoscopic colon surgery is a minimally invasive surgical procedure with which the surgeon can take out portions of the colon using a few small incisions. A CT scan may help provide information to help plan port placement and the approach for the operation. Many different procedures can be performed and therefore many factors determine the optimal procedure and time to return to normal activities.

Laparoscopic surgery: In this surgery, your abdomen is inflated with a harmless gas. This gives the surgeon a better look of your organs. He’ll make a few small incisions (cuts) near the hernia. He’ll insert a thin tube with a tiny camera on the end (laparoscope). The surgeon uses images from the laparoscope as a guide to repair the hernia with mesh. For laparoscopic surgery, you’ll receive general anesthesia.

Recovery is usually faster with laparoscopic surgery: On average, patients are back to their normal routine a week sooner than with open surgery.

Thyroidectomy is the removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that regulate every aspect of your metabolism, from your heart rate to how quickly you burn calories.

Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).

Laparoscopic pancreas surgery – Whipple procedure – allows candidate patients to minimize some of the standard risks and discomfort associated with a standard open operation. Laparoscopic surgery is typically performed using 3 or 4 half-inch or one-inch incisions, sparing patients a large incision. Fine surgical instruments are used to carve out a tumor or remove an entire section of the gland, after the nearby blood vessels are controlled.

For many years, a variety of obesity surgery procedures applied to the stomach or intestine have been used as a method of losing weight, and losing weight can help people manage their Type 2 diabetes.

More recently, medical research has shown that obesity surgery can also directly affect how the body uses insulin. In addition to the benefit of directly losing weight and improving blood sugar levels, this surgery itself assists people in managing their Type 2 diabetes. It can:

change how the hormones in your gut work, which in turn affects how your body makes insulin

increase the amount of bile acids that your body makes – these make your body cells more sensitive to insulin improve the way the cells use insulin, leading to lower blood sugar levels.

What are the different versions of Type 2 diabetes surgery?

There are various forms of obesity surgery, also known as bariatric surgery, that may be offered. Surgical options include removal of part of the stomach to reduce stomach size and consequently restrict appetite and food intake, or a surgical re-route of the digestive system to bypass the stomach.

Both treatments assist people in reducing their food intake due to requiring less food to feel full, but also beneficially affect how your body uses insulin. You can discuss surgery with your diabetes healthcare team, who will be able to give you further information.