sleeve gastrectomy for weight loss
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Bariatric surgery for weight loss . For details plz visit https://drnitinjha.com/laparoscopic-bariatric-weight-loss-surgery/ for other deatils plz visit https://drnitinjha.com/
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sleeve gastrectomy for weight loss
- 2. Dr Nitin Jha (MBBS,MS,FIAGES) Consultant Laparoscopic,MIS and Bariatric surgeon FORTIS Hospital, Noida. INDIA drnitinjha@yahoo.com drnitinjha@yahoo.com
- 4. • Current definition – Body Mass Index (BMI): • Weight (Kg) / Height (m2) – Normal 20 – 25 – Overweight 25-30 – Obese 30 - 35 – Morbidly Obese 35 - 50 – Super morbid obesity 50 + 4drnitinjha@yahoo.com
- 6. • Type II Diabetes • Hypertriglyceridemia • Hypercholesterolemia • Fatty infiltration of the liver • Hypertension drnitinjha@yahoo.com • Sleep apnea • Congestive heart failure • Stress urinary incontinence • GERD • Long-term consequences of diabetes – Renal failure, stroke, amputation, etc. • Anxiety disorders • Depression • Social avoidance
- 7. BMI 35-40 with at least one co-morbidities ( DM, Obstructive sleep apnea,HT) BMI > 40 without co-morbidities Previous unsuccessful attempts at weight loss Age >18-65 with few exceptions Medically cleared for surgery Mentally & emotionally prepared and motivated ◦ No substance abuse, no active eating disorder ◦ Support system in place ◦ Realistic expectation regarding outcomes Has good understanding of the procedure and dedicated to lifestyle change drnitinjha@yahoo.com
- 8. • Active substance abusers • Noncompliant patients • Patients with severe psychiatric disorders – Schizophrenia – Severe depression – Borderline personality disorder 8drnitinjha@yahoo.com
- 9. carefully assessed by: ◦ Bariatric surgeon ◦ Physician ◦ Endocrinologists ◦ Social Worker/ Psychologist ◦ Dietitian ◦ Nurse drnitinjha@yahoo.com
- 13. AGB vs SG Wong S KH et al. Hong Kong Med J 2009; 15:100-9 drnitinjha@yahoo.com
- 14. Wong S KH et al. Hong Kong Med J 2009; 15:100-9 drnitinjha@yahoo.com
- 16. Small tubular stomach, Resistance to stretch due to absence of the fundus, Alterations in gastric motility and Substantial reduction in ghrelin-producing cells drnitinjha@yahoo.com
- 19. Leakage: can be treated easily by performing a second procedure that helps in strengthening the staple lines. Stapple line bleeding: Gastroesophageal Reflux: It might be happening because of the changes in the shape of the stomach. Gastric Fistula: may occur and another surgery may be needed to treat this condition. drnitinjha@yahoo.com
- 20. Narrowing of Stoma: A tube used for dilation is passed from the mouth to pass into the stomach as this expands the stoma. Hernia: Another surgery may be needed to repair this condition. Malabsorption of Vitamins and Minerals: 1. Anemia and vitamin B12 deficiency can cause neurological diseases. 2. Changes in the absorption of phosphates, calcium and oxalates can result in kidney stone formation. 3. Similarly, deficiency of vitamin D and calcium can also give rise to different disorders of the bone. drnitinjha@yahoo.com
- 21. Microbial infections : as pneumonia and intraabdominal abscess are most common. Deep vein thrombosis (DVT). Hair loss. Hair thinning. Mood swings. General feeling of weakness. Dry skin . drnitinjha@yahoo.com
- 22. First stage or definitive Sleeve Calibration (bougie size) Distance from pylorus to initiate sleeve Oversewing entire staple line? Staple line reinforcement ? Section shape at OG junction Routine use of intraoperative leak testing Routine versus selective upper GI series for leak test Higher rate of leaks after revisional surgery drnitinjha@yahoo.com
- 23. This generally means that the patient is off all hypoglycemic medications and/or insulin and that they have normal fasting plasma glucose, normal post prandial glucose excursions and normal HbA1c drnitinjha@yahoo.com