Honored doctor of Russia, candidate of medical sciences, doctor of the highest category, chief non-staff specialist in endoscopic surgery of the Samara region HealthMin, head of the surgical Department of SBHI "V.D. Seredavin Samara regional clinical hospital" in Samara Region. Surgical experience is 31 years. Member of IFSO (International Federation of obesity and metabolic surgery). Member of the Russian bariatric surgeons society.
Installing an intragastric balloon is an outpatient procedure that allows the patient to lose weight in a short time. It does not require any hospitalization, it helps to keep the diet and achieve good results. A cylinder filled with liquid takes up most of the stomach and leaves a little space for food. As a result, the feeling of satiety comes faster, the portions are being reduced, and the weight gradually decreases by 10-30 kg.
Operation: Intragastric balloon - 60 thousand rubles
Indications and contraindications for intragastric balloon installation
The intragastric balloon is used in the battle against obesity without surgical treatment and at the preparatory stage for it.
It is set at the following body mass indexes:
- Up to 30 kg / m2 - in the absence of indications for surgery, while trying to lose weight with the help of various diets and the lack of a lasting effect, to develop a right diet.
- Over 50 kg / m2 - with an extreme obesity degree and the presence of the concomitant signs for preoperative preparation.
The volume of the cylinder is 700 - 1500 ml and is selected individually on the basis of the patient’s weight.
Installation has a minimum of contraindications. These are: a peptic ulcer in the exacerbation stage, acute infectious diseases, mental disorders and life-threatening conditions.
Preparation for the procedure and installation method
Manipulation does not require special training, examinations, or being in the hospital under observation.
The procedure is performed under intravenous anesthesia and conditionally divided into three stages:
- Fibrogastroscopy is performed to evaluate the stomach condition.
- An intragastric balloon folded into a stomach tube is inserted into the stomach.
- The cylinder is filled with a solution to a specified volume.
After the manipulation, there may be slight pain in the upper abdomen, nausea, retching. Discomfort disappears in 3-5 days.
The intragastric balloon is removed as easily and quickly as it is installed. It is made of latex and is absolutely harmless. A physiological saline solution colored with methylene blue is used as a filler, which changes the urine color in case of premature balloon wall destruction and gives a sign to the patient that the balloon must be removed. An intragastric balloon is being put for a period of 6 months, which allows to get used to the diet in small portions.
The results of the intragastric balloon use
The effectiveness of obesity treatment and weight correction using an intragastric balloon depends largely on your motivation and discipline. Six months is enough to develop a new nutrition scheme. You just have to stick to it and consolidate the success.
One of our patients decided to install the balloon with a weight of 98 kg and a height of 168 cm. Up to the ideal body mass index, she lost weight in 3 months. The balloon was removed early, as the desired effect was achieved.
Gastric banding is laparoscopic surgery, which helps the patient to get rid of extra weight. This surgery is physiological and does not disrupt the work of the digestive system. The bandage assumes a restrictive function and narrows the esophagus at the point of transition into the stomach. Food requires chewing thoroughly, slowly going through a small lumen. As a result, even small portions quickly cause a feeling of satiety, you gradually lose 50-60% of extra body weight.
Operation: gastric banding - 110 thousand rubles.
Indications and contraindications for gastric bandaging
Adjustable bandaging is recommended for young patients up to 35-40 years old with a up to 40-45 kg / m2 body mass index. The surgery is not effective with greater weight - patients will not be able to change the diet, which will lead to the development of complications.
The bandage setting is contraindicated in case of an ulcer in the exacerbation stage, acute conditions and infectious diseases, severe mental disorders.
Preparation for surgery and bandage installing method
Preparation takes a minimum of time and consists of a simple routine examination. You can undergo an ECG and a complex of laboratory tests - you can take a biochemical, clinical analysis of blood and urine - in our inpatient facility in one day.
During the operation:
A bandage is applied to the upper part of the stomach - a controlled ring with an inflated inner surface.
In the left hypochondrium, a small port is installed deep under the skin and is connected to the bandage.
The bandage is regulated through the port by a given amount of saline with a simple injection through the skin.
The installation does not cause discomfort to the patient. The bandage is made of medical silicone, safe and put for life. If necessary, it can be removed, and the banding is converted to another operation.
The patient is in the hospital under the supervision no more than for 2-3 days. There are various accommodation options - in a single, double or triple patient room with all the conveniences, which allow you to choose the best option.
The gastric banding results
Regulative banding has been a widespread operation since the early 2000s. Today, other methods have been implemented in order to replace it, and it is performed selectively.
One of the reasons is the development of “remote” complications in a few months or years: bandage slipping, the esophagus expansion and erosion. In practice, these complications occur up to 25%.
Successful bandage installation helps not only to adjust the weight, but also to control the situation. The bandage diameter is regulated by the amount of the solution introduced through the port in order to enhance or weaken the effect.
An illustrative example is the patient who has been wearing a bandage since 2004. Before the operation, she weighed 90 kg with height of 170 cm, now she has an ideal body weight. For all the time, only one adjustment was made, which helped to maintain a good effect.
Longitudinal resection, sleeve gastrectomy or sleeve gastroplasty is a physiological restrictive surgery, which goal is to reduce the amount of food consumed and to treat obesity. The stomach is reduced in size to a thin "tube" with a diameter of 14 mm and a volume of about 40-60 ml, but continues to function properly. Small portions quickly cause a persistent feeling of satiety, you get rid of 60-70% of extra weight.
Surgery: longitudinal resection (sleeve resection / sleeve) - 200 thousand rubles.
Indications and contraindications for longitudinal gastrectomy
The surgery is indicated with a body mass index of more than 30 kg / m2 and it is carried out with different obesity degrees. An intragastric balloon is being put to the patients, who have a very large weight during the preparatory stage. This allows you to minimize the risk of complications and reach a good result.
Contraindications to longitudinal resection - gastric ulcer in the exacerbation stage, acute infectious diseases and circulatory disorders, mental disorders.
Preparation for surgery and resection technique
Patients without concomitant pathologies and supercoagulation undergo a routine examination. You can take a biochemical blood test, a clinical blood and urine analysis, you can make an ECG in our inpatient facility the day before the surgery. Additional examinations are appointed individually by the doctor’s decision.
During laparoscopic surgery:
- A large part of the stomach is removed, with preserving the physiological valves.
- A narrow even sleeve is formed using a special tube.
- A resected area is being removed.
This surgery is safe, it does not turn off the stomach from the digestive process and allows the patient to recover quickly. Within 5 days after resection the patient is in our inpatient facility. For accommodation, you can choose a single, double or triple patient room with all the amenities.
Longitudinal gastrectomy results
Longitudinal resection is effective and is made to a large number of patients. For the first six months, you actively lose up to 70% of extra body weight and continue to gradually lose weight over a period of 1-2 years, until the weight finally stabilizes.
In case of insufficient results of weight loss, the operation is supplemented by gastric bypass. This applies to cases occurring in 12-20% of patients - the stomach is stretched, and the person begins to gain weight.
A vivid example of efficiency is a 44-year-old man with severe breath shortness and heart failure, who weighed 278 kg with a height of 180 cm. At the first stage after the intragastric balloon installation, he lost 20 kg. After resection, the weight stabilized at around 120 kg, which allowed him to live a full life today.
Gaster sealing (gastroplication)
Gastroplication or gastric sealing - restrictive surgery and an alternative to longitudinal resection. It is being held without any expensive tools and it is more affordable. The stomach is maximally reduced in size to a volume of 40-60 ml. The food passage path does not change, but its quantity is limited. You lose up to 50-60% of extra weight, and as a result of the obesity treatment ,a lasting weight loss effect is achieved.
Surgery: gastric closure - 104 thousand rubles.
Indications and contraindications for gastric sealing
The operation for gastric sealing is indicated for patients with a body mass index of more than 30 kg / m2. It allows you to get rid of extra weight when it is vital, and has the way of proceeding, which is the same as the other "restrictive" interventions.
Contraindications remain the same - acute infectious diseases and conditions, mental disorders and peptic ulcer exacerbation disease requiring treatment.
Preparation for surgery and methods of gastroplating
Before laparoscopic gastroplasty, a planned comprehensive examination is carried out. To save time, you can make an ECG, you can take clinical and biochemical blood and urine tests in one day when you are in.
During the surgery:
A “tube” is formed by immersing or screwing the gaster wall inwards.
Tightening seams from non-absorbable material are applied.
The surgery is less traumatic, has minimal risks of complications, a short recovery period and allows physical exertion one month after. The patient is under the physician’s supervision for 5 days. For the convenience of hospital accommodation, triple patient rooms with all conveniences are provided.
The results of the use of gastroplication
Surgery to close the stomach is carried out by surgeons with sufficient experience and skills, so its effectiveness is comparable with the results of longitudinal resection. Body weight decreases within 6 months, after which the weight stabilizes.
The positive dynamics and advantages of gastroplication can be seen in the example of our patient. A woman with a weight of 140 kg required a transplant of hip joints, which she was denied due to excessive body weight. Sewing up of the stomach allowed for six months to reduce the weight to the permissible 90 kg, change the joint and restore excellent health.
Gastric bypass surgery
Mini gastric bypass surgery is a modern bariatric surgery that solves two problems simultaneously. It is based on the mechanisms of restriction and malabsorption - the formation of a "tube" or mini-gaster and turning off the intestine from the digestive system, where carbohydrates and fats are actively absorbed. After the operation, up to 80% of extra body weight disappears, and the opportunity to gain weight again is minimized.
Operation: gastric bypass- 200 thousand rubles.
Indications and contraindications for mini gastric bypass
Mini gastric bypass is performed to patients with a body mass index of 30 or more kg / m2. It is used in the obesity treatment, including the cases of the absence of results from diet or fitness, and tin the cases of type 2 diabetes or even severe forms.
Contraindications are similar to the restrictions to other bariatric surgeries - acute infections and conditions, exacerbation of peptic ulcer, mental disorders.
Preparation for surgery and gastric bypass procedure
The operation requires a simple routine examination. To pass a complex of biochemical and clinical analyzes of urine and blood in one day, our inpatient facility enables us to make an ECG.
While conducting a mini gastric bypass
A separation of the gaster into two parts is made, the bigger part of which is not involved in digestion.
The formed small gaster is being connected with the small intestine, a part of which is about 2 meters long, is also excluded from digestion.
The main mechanisms of absorption of fat and partially carbohydrates are being excluded from the digestion without disrupting the function of the gaster and small intestine
The remaining parts of the stomach and intestines continue to function. Produced juices conduces to the digestion processes. Taking the fat-soluble medicine solves the problem of possible deficiency of calcium, iron, vitamins B1, B6, B12, D. The surgery takes little time, is safe and has a minimal risk of complications. Patients are under observation for no more than 5 days. The inpatient facility provides comfortable three-people rooms with all conveniences.
The mini gastric bypass results
Mini gastric bypass has proved to be effective in the obesity and type 2 diabetes treatment. The share of this operation is 80% of all bariatric operations performed; it can be performed even with normal weight of patients with type 2 diabetes. It allows you not only to get rid of obesity, but also to keep body weight in order.
Long-term remission of type 2 diabetes occurs in 82% of cases. The blood sugar level is normalized at 3-4 days after surgery. Patients get the opportunity to refuse from insulin and other glucose-lowering drugs, return to a normal diet and live the normal life.
The patients from America (a married couple) are the indicative example. The wife has undergone longitudinal resection and her husband - a mini-gastric bypass. As a result of the surgery, the man has completely got rid of severe diabetes.
Krichmar Alexander Mikhaylovich
Candidate of medical sciences, surgeon of the surgical Department of SBHI "V.D. Seredavin Samara regional clinical hospital" in Samara Region. He is involved in obesity surgery since 2014. He specializes in gastric banding and gastroplication.