Chirurgie de l'obésité : la gastroplastie - Bariatric Surgery

La gastroplastie est le nom donné à l'intervention chirurgicale visant à traiter l'obésité.

NB: Cette opération peut se faire par la chirurgie robotique. Il s'agit de poser un anneau gastrique.

Une fois cet anneau posé, le patient devra veiller à ne jamais engloutir d'importantes quantités de nourriture : les conséquences seraient très graves et mettraient sa vie en jeu ! Les obèses boulimiques qui décident de subir cette opération chirurgicale prennent ainsi une décision radicale : après l'opération, le traitement contre la boulimie (suivi psychologique, etc.) passera ou cassera ! Et si ça casse, tant pis pour le patient...En Europe, certains chirurgiens refusent de pratiquer ce genre d'intervention.



Aux USA, certains hôpitaux américains ont pu être sauvés de la faillite grâce à cette mine d'or que représente le traitement chirurgical de l'obésité par l'anneau gastrique. Les bénéfices (spectaculaires !) dégagés par cette activité ont permis à ces hôpitaux d'alimenter des budgets carrément anémiés, comme ceux des urgences,
en procédant à une redistribution salvatrice. Un mal pour un bien ?

Understanding Bariatric Surgery:
Gastric Bypass Roux-en-Y:

"According to the American Society for Bariatric Surgery (ASBS) and the National Institutes of Health (NIH), Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is also one of the most frequently performed weight loss procedures in the United States.

Gastric Bypass Roux-en-Y reduces the capacity of the stomach by creating a smaller stomach pouch. The small space holds only one ounce of fluid. The procedure also constructs a tiny stomach outlet, which slows the speed food leaves your stomach. So you will feel full after eating a small amount and you will stay satisfied for a long time.

Here's how it works:
Staples are used to create a small (15 to 20cc) stomach pouch.

The rest of the stomach is not removed, but is stapled completely shut and divided from the stomach pouch.

The newly formed pouch empties directly into the lower portion of the intestine--bypassing calorie absorption.

The small intestine is divided just beyond the duodenum, brought up, and connected to the newly formed stomach pouch.

The other end is connected into the side of the pouch limb of the intestine (creating the "Y" shape that gives the technique its name).

Advantages of the Gastric Bypass Roux-en-Y Procedure:
Average excess weight loss is usually higher than with purely restrictive procedures.

One year after surgery, weight loss can average 77% of excess body weight. After 10 to 14 years, some patients have maintained 50-60% of excess body weight loss.

96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved according to a 2000 study of 500 patients.

Risks Specific to the Gastric Bypass Roux-en-Y Procedure:
"Dumping syndrome" When stomach contents are literally "dumped" rapidly into the small intestine. Sometimes triggered by too much sugar or large amounts of food. Dumping syndrome doesn't pose a health risk, but its symptoms aren't fun: nausea, weakness, sweating, faintness, and diarrhea. Some patients can prevent dumping syndrome by avoiding sweets after surgery.

Up to 20% of patients need follow-up operations to correct problems like hernias.

Up to 30% of patients develop gallstones after losing weight. You can reduce the risk of gallstones by taking bile salts for 6 months following surgery.

Leakage of the connection between the pouch and the intestine. This is very rare, but potentially dangerous.

Diminished effectiveness. The success of the procedure can be reduced if the stomach pouch is stretched and/or left larger than 15-30cc (1/2 to one ounce).

Poor views of internal organs. The bypassed portion of the stomach, duodenum, and segments of the small intestine are difficult to see using X-ray or endoscopy. This only becomes a problem if the patient develops ulcers, bleeding, or malignancy. Gastric bypass does not cause cancer.
Nutrient deficiencies: Almost a third of patients develop nutritional deficiencies because the duodenum is bypassed in this procedure. So the body doesn't absorb iron, calcium and other nutrients efficiently after surgery. Fortunately, these deficiencies can usually be controlled with proper diet and vitamin supplements.

Iron deficiency anemia. Because the duodenum is bypassed in this procedure, the body doesn't absorb iron and calcium very well after surgery, which can lead to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during menstruation or from bleeding hemorrhoids.

Osteoporosis. Because the body doesn't absorb calcium properly after surgery, there is a greater risk of developing osteoporosis.

Metabolic bone disease. Also caused by bypassing the duodenum, some patients experience bone pain, loss of height, humped back and fractures of the ribs and hip bones.

Chronic anemia. A type of anemia caused by a deficiency of vitamin B12. Can usually be managed with pills or injections."

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