Gastric surgery is a surgical procedure on the stomach that is used for severely overweight people. The aim of this operation is to reduce the size of the stomach on the one hand and to reduce the feeling of hunger on the other. Both measures complement each other and increase the chances of the patient losing weight sustainably.
Stomach surgery to reduce the size of the stomach makes sense if you are morbidly obese and several attempts to lose weight have failed.
Every surgical procedure is a violation of bodily integrity and can, in the case of incorrect indications and complications, be a bodily injury.
This is important in the case of surgery, reduction or removal of healthy organs, including stomach surgery to treat obesity. Only excessive obesity and a risk to the body justify stomach surgery.
Being overweight is a significant health risk. The key indicator for overweight is the body mass index (BMI).
The BMI is defined as follows:
The clinical pictures of overweight and obesity have the following gradations
Doctorsdo not yet performsurgery for mild/moderate obesity. The focus here is on lifestyle, dietary changes and sufficient physical activity.
In the severe obesity stage (BMI > 40), stomach reduction surgery is justified. The costs are normally covered by health insurance.
For intermediate degrees of obesity, doctors decide on an individual basis and recommend that all conservative measures (diet and exercise) be exhausted first.
The body mass index (BMI) is the most common measure for assessing weight; other values apply for children @ Ali /AdobeStock
The purpose of stomach reduction surgery is to reduce the filling volume (the amount of food and drink that the patient ingests). The effect is to reduce food intake and calorie intake.
This is achieved by reducing the stomach 's absorption capacity. The earlier onset of a feeling of fullness is also important. This is why severely overweight and obese people in particular benefit from stomach surgery. These are usually people who consume large amounts of food without feeling full.
The following surgical procedures are used:
Gastric banding is used most frequently. In common parlance, it is often called gastric banding, which comes from the English term gastric band.
During gastric surgery, doctors attach a silicone ring to the lower part of the oesophagus or the upper part of the stomach. This narrows the access to the stomach and reduces the size of the entrance.
Doctors also refer to the initial part of the stomach as the gastric fundus (or in Latin: fundus ventriculi). This greatly narrows the diameter of the stomach.
The gastric band consists of a silicone tube that can be filled with fluid. This can be filled more or less if necessary.
This allows the absorption capacity of the stomach to be changed, even after the operation. This is done by connecting the tube to a chamber (port) located under the skin in the chest area. This chamber is visible from the outside through a small protrusion. It is easy to feel and pierce.
Gastric banding is a relatively minor procedure and can be performed through laparoscopy without major incisions.
The great advantage of gastric banding is that doctors can easily fill and empty it from the outside. They can also easily remove it again.
As the stomach remains the same shape and size, the organ remains the same after removal of the band. This does have the disadvantage that it is possible to gain weight again as soon as the band is removed.
Consequential damage caused by partial stomach removal (as with other techniques) is extremely rare with banding. Scarring, ulcers or leaking sutures are extremely rare or never occur with banding.
Doctors sew a loop of small intestine into the forestomach (where the band is located), thus eliminating the remaining stomach. In this way, doctors achieve a "functional stomach reduction". Functional means that only the function of the stomach is reduced, but not the structure of the organ.
As a result, the stomach processes fewer substrates from food. Doctors call this malabsorption (restriction of digestion).
As a result, the patient eats less solid and liquid food because they feel full earlier. In addition, patients do not digest a greater or lesser proportion of their food or digest it significantly less well than normal.
In gastric bypass, the left part of the stomach is cut off along the entire length of the stomach, leaving a tube-shaped stomach @ sakurra /AdobeStock
In this treatment method, doctors reduce the stomach's intake volume by around 80-90 percent. The surgical procedure is performed through the abdominal wall in the form of a laparoscopy.
Doctors narrow the stomach, which has a hemispherical shape, lengthwise using a stapling device. It is then no longer semi-circular but elongated.
The result is an approx. 20 cm long tube with a diameter of 4-5 cm and a filling volume of approx. 100 ml.
Weight loss of up to 50 kg (and more) is possible. Strict and consistent restriction of food intake is an important prerequisite.
Ultimately, the staple sutures may also burst, especially in the event of uncontrolled bouts of ravenous appetite. A rupture of the staple suture can lead to serious complications, such as inflammation of the abdominal cavity due to leaked stomach contents.
In extreme cases, this makes an emergency laparotomy (emergency surgery with opening of the entire abdominal cavity) necessary.
Patient counseling by attending physicians includes detailed nutritional advice before and after gastric surgery. The change in diet after the operation is carried out under medical supervision. The patient must follow the instructions precisely for the first four to six weeks after the stomach operation.
Medical supervision prevents the greatly reduced food intake from causing deficiency symptoms such as muscle atrophy or iron deficiency.
During the medical patient consultation, patients learn that eating too much after gastric surgery can cause heartburn and vomiting. In extreme cases, the stomach sutures may leak.
Comprehensive aftercare and close monitoring after gastric surgery should prevent complications. Experience has shown that the patient's primary goal is reliable weight loss.
But it is even more important to prevent complications.
Modern medicine offers adequate options in the field of stomach reduction surgery for severely overweight people.
People with obesity in particular benefit from the possibilities of stomach reduction. Treatment methods include gastric bypass, gastric sleeve and gastric banding.
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