The document discusses various types of bariatric surgery procedures including gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion. It explains the mechanisms, risks, outcomes, and complications of each procedure. While all procedures aim to induce weight loss, they differ in degree of restriction and malabsorption. Complications can include leaks, strictures, nutritional deficiencies. Emerging trends include endoscopic and neuromodulation approaches with the goal of less invasive weight loss treatments.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
PARASTOMAL HERNIA : An ostomy is an artificial opening through the abdominal wall for the intestine or ureter in order to discharge feces or urine. Hernias that are associated with colostomies, ileostomies, jejunostomies or urostomies, where viscus penetrates the abdominal wall are called as paraostomal hernias
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Presentation describing surgical technique and principles of anastomosis, factors for good healing in the post operative phase, risk factors for leak and the role of staplers in modern day surgical practice, advantages over hand sewn anastomosis.
basic principles of hepatic resection including liver anatomy, segmentation and vascular control techniques. also adjuncts to successful and safe liver resection, blood loss management techniques and more. the aim is to provide guidelines for safe hepatic surgery and apply the recent adjuncts.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
OPEN RIGHT HEMICOLECTOMY- STEP BY STEP OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openrighthemicolectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Open Right Hemicolectomy .
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch all my teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
PARASTOMAL HERNIA : An ostomy is an artificial opening through the abdominal wall for the intestine or ureter in order to discharge feces or urine. Hernias that are associated with colostomies, ileostomies, jejunostomies or urostomies, where viscus penetrates the abdominal wall are called as paraostomal hernias
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Presentation describing surgical technique and principles of anastomosis, factors for good healing in the post operative phase, risk factors for leak and the role of staplers in modern day surgical practice, advantages over hand sewn anastomosis.
basic principles of hepatic resection including liver anatomy, segmentation and vascular control techniques. also adjuncts to successful and safe liver resection, blood loss management techniques and more. the aim is to provide guidelines for safe hepatic surgery and apply the recent adjuncts.
Rivision surgery after laparoscopic sleeve gastrectomyIbrahim Abunohaiah
Revision Surgery After Laparoscopic Sleeve Gastrectomy
Introduction to bariatric surgery
When to Revise a Weight Loss Surgery?
Options for redo surgery.
Laparoscopic Roux-en-Y gastric Bypass.
Weight loss surgery - is it the right choice? By TruweightTruweight
If you think that you are too busy to follow a healthy way to lose weight then you need to at least consider the risks associated with Weight Loss Surgeries and their side effects.
Gastric bypass surgery makes the stomach smaller and causes food to bypass part of the small intestine. You will feel filled more quickly than when your stomach was its original size. This reduces the quantity of food you can eat at one time. Bypassing part of the intestine reduces how much food and nutrients are absorbed. This leads to weight loss
A presentation by Dr Jacob Chisholm on Developments In Gastrointestinal Therapies.
Jacob Chisholm is an upper gastrointestinal and general surgeon with an interest in weight loss and metabolic surgery. Jacob received his undergraduate degree (MBBS) from the University of Adelaide, a postgraduate research degree (Masters of Surgery) from Flinders University and is a Fellow of the Royal Australasian College of Surgeons. He trained in surgery at the Royal Adelaide and Flinders Medical Centre before completing a bariatric fellowship in 2007. Jacob was appointed chief surgical resident at Flinders Medical Centre in 2008 and has been a consultant surgeon at that institution since 2010. Jacob joined the Adelaide Bariatric Centre in 2010.
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. LEARNING OBJECTIVES
At the end of seminar student should be able to
• List the type of bariatric surgery and their
component
• Explain about the choices of surgical methods
• Discuss the result expected from bariatric surgery
• Explain the complications from bariatric surgery
• Get a glimpse of future of bariatric surgery
3. INTRODUCTION
• There is no perfect operation
• What the end point of bariatric surgery ?
– Maximum weight loss regardless of risk ?
– Just enough weight loss to alleviate comorbidities
at minimum risk?
Maximum weight loss with least risk and side
effects
8. 1. GASTRIC BANDING
PROCEDURES DETAILS • Putting an adjustable band around the
upper stomach
• Inserted as a day-case procedure
MECHANISM • Provide restriction to gastric
• Controlled by the amount of fluid injected
into the subcutaneous port.
WEIGHT LOSS • Around 45–50 % of excess weight with
intensive follow up
RISK • Least risky procedure (0.1 per cent
perioperative mortality)
10. ADVANTAGES • Safe, adjustability and reversibility
DISADVANTAGES • Requires a lot of patient compliance
• Need for continual band adjustments
in the early postoperative period and
occasional long-term adjustments.
COMPLICATION (band failure) • Due to prolapse of the stomach
through the band or the band can slip
up or down from its initial position.
• Bands erode into the stomach.
FAILURE RATE • Band failure is relatively low (<5 per
cent)
• Long term failures due to insufficient
weight loss , up to 30 per cent of
patients
11. REVISION PROCEDURE INDICATION • Poor weight loss
• Adhesions and gastric wall thickening
SUITABLE PATIENT • Relatively easy operation to perform in
most patients who have a BMI <50
kg/m2
• Should be avoided in binge eating
patients
• Should be avoid in eating habits
involve excessive sweets and chocolate
NOT SUITABLE IN • Poorly selected patient
• Poor quality of their follow up
12. 2. SLEEVE GASTRECTOMY
PROCEDURES DETAILS • New operation
• Less postoperative monitoring
• Does not require any adjustments
MECHANISM • Removes the grehlin-secreting area of
the stomach, beneficial effect on
reducing appetite
WEIGHT LOSS • Around 65 per cent excess weight loss
at two years
• As good as gastric bypass without any
mal-absorption issues
RISK • Riskier procedure than gastric banding
(0.2 per cent operative mortality)
DISADVANTAGES • Tendency for the sleeve to expand
over time
13.
14. COMPLICATION • The long staple line can leak despite
various manoeuvres to avoid leakage
FAILURE RATE • Regain weight post gastrectomy
• Probably around 10–20 per cent
REVISION PROCEDURE INDICATION • A re-sleeving procedure (sleeve
expand)
SUITABLE PATIENT • Initial procedure in super-obese (BMI
>50kg/m2)
• To induce enough weight loss to make
bypass surgery feasible
NOT SUITABLE IN • Still unclear and more long-term data
are needed
15. True Place For Sleeve Gastrectomy As A
Primary Bariatric Procedure?
• Still unclear and more long-term data needed
• But this procedure is accelerating at a
remarkable rate largely
– Relative technical ease of doing the procedure
– The lack of potential mal-absorption problems
– Option of doing a relatively safe second-stage
procedure if needed.
16. CONCEPT ??
• Bariatric surgery as a staged procedure
– first stage being a sleeve gastrectomy
– second stage, a gastric bypass or BPD with a
duodenal switch.
• The second stage in most cases will not be
needed.
17. 3. ROUX-EN-Y GASTRIC BYPASS
PROCEDURES DETAILS • A very effective weight loss procedure
• Variety of techniques
MECHANISM • Very effective for alleviating and curing
permanently type II diabetes (80% of
patient)
• Result almost immediate and
independent of weight loss.
WEIGHT LOSS • Around 65–75 per cent excess weight
loss
RISK • A higher risk of around 0.5 per cent
perioperative mortality
DISADVANTAGES • Many variations in the actual gastric
bypass technique
18. 30ml proximal
gastric pouch
1cm
anastomosis
• Small reservoir
• Small passage
• Bypass distal stomach,
duodenum and
jejunum
ROUX LIMB (length correlates with
degree post operative weight loss
• Standard : 75 cm
• Superobese : 150 cm
19. THEORIES ON MECHANISMS OF HOW A GASTRIC BYPASS/BILIOPANCREATIC
DIVERSION AMELIORATES DIABETES
Foregut hypothesis
• Bypass of proximal duodenum and
jejunum
• Reduces stimulated secretion of anti-
incretin factors (anti-incretin factor
inhibit insulin secretion)
• Thus stimulate insulin secretion
Hindgut hypothesis
• Rapid delivery of small bowel content
into the distal jejunum and ileum
• Exaggerates stimulated incretin
(glucagon-like peptide-1 and peptide-
yy) release
• Thus stimulates insulin secretion
• Banding and sleeve gastrectomy
• Dependent on weight loss to resolve the diabetes
20. Variations In The Actual Gastric Bypass
Technique
• Antecolic versus retrocolic roux limb
placement
• Varying alimentary and biliary limb lengths
• Additional banding of the gastrojejunal
anastomosis to prevent dilatation
• Varying methods of doing the gastrojejunal
anastomosis
• Varying methods of closing potential hernia
spaces .
26. 4. Varying methods of doing the
gastrojejunal anastomosis
• Different method for gastro-jejunal
anastomosis
– hand-sewn (HSA)
– circular-stapled (CSA)
– linear-stapled (LSA) anastomotic techniques
• Differ in terms of stricture rates and their
impact on subsequent weight loss.
https://www.ncbi.nlm.nih.gov/pubmed/24595472
32. 4. BILIOPANCREATIC DIVERSION (BPD)
PROCEDURES DETAILS • Biliopancreatic diversion (BPD) with or
without a duodenal switch (DS)
MECHANISM • Rapid effect as a gastric bypass for
alleviating diabetes independent of
weight loss
WEIGHT LOSS • Most effective with 75–85 per cent
excess weight loss
RISK • Highest perioperative mortality of 1–2
per cent
DISADVANTAGES • Extreme malabsorption of all
operation
• There is a need for a high protein
intake of around 90 g/day
33. STANDARD BPD DUODENAL SWITCH VARIATION
Approximately two-thirds of the distal
stomach is removed
Vertical sleeve gastrectomy
Anastomosis made to the stomach Anastomosis is made to the first part
of the duodenum
35. B-P-D?
1. A sleeve gastrectomy is performed. A large portion of the stomach
is removed with a stapling instrument, leaving a narrow tube, or
sleeve, from the top to near the bottom of the stomach. With less
stomach to fill, feel full more quickly and eat less food and fewer
calories.
2. Reroutes food away from the upper part of the small intestine,
which is the natural path of digestion. This cuts back on how many
calories and nutrients body is able to absorb. The small intestine is
divided and a connection is made near the end of the small
intestine.
3. Last procedure changes the normal way that bile and digestive
juices break down food. This cuts back on how many calories
absorb, causing still more weight loss. One end of the small
intestine is connected to the duodenum, near the bottom of the
stomach
36. BPD
• Will induces a state of decreased absorption,
patients will likely experience
– more frequent and looser bowel movements
– increased flatulence
– need to be very closely monitored for vitamin,
mineral and protein levels
37. Duodenal Switch- DS?
• Duodenal switch preserves the outlet muscle
(pylorus)- controls emptying of the stomach
• So dumping syndrome is unusual.
• Duodenal switch results in
– the greatest, most reliable and longest lasting
weight loss of all the weight loss procedures.
38. COMPLICATION (failure) • Severe risk of many deficiency
syndromes.
• Protein calorie malnutrition, anemia,
dumping syndrome, marginal ulcer
FAILURE RATE • -
REVISION PROCEDURE INDICATION ?
SUITABLE PATIENT • Patients with a very high BMI.
NOT SUITABLE IN • Patient does not adhere to their
vitamin and micronutrient
supplementation regime
41. • Outcomes indicators
– Achieved weight loss
– Improved quality of life (comorbidities)
• Successful weight loss?
– Losing at least 50 per cent of the excess weight in the first 12–24
months.
– Excess weight = their current weight - their ideal body weight (at BMI
25 kg/m2).
• Comorbidities?
– Improved with only 10–20 per cent of excess weight loss
Thus the end point of removing as much weight as possible may not always
be necessary from a health and longevity point of view.
42. In general terms
• Strive for an effective operation.
• Resolve or ameliorate any of the
comorbidities which are linked to obesity
43.
44. Drawback?
• Weight regain
– Difficult to manage
– Result in revisional surgery that more risky than a
primary procedure.
• Patients often ‘move the goal posts’
– Wanting a better result than the surgery promises.
– So we need clear understanding of the end point of
surgery must be agreed before
– Must have a plan written down and agreed
preoperatively to avoids misunderstandings
postoperatively.
45. WHAT OPERATION TO GET AND
RIGHT AT THE FIRST TIME FOR
AN INDIVIDUAL?
46. • Its doctor responsibility
• Need a thorough understanding of what risks, what outcome and
patient preparedness for it.
• Vary from patient to patient.
– Those patients who are very risk averse, often young with young children,
will understandably often want an operation with the least postoperative
mortality even though it may not result in as much weight loss as another
more risky procedure.
– Conversely, a patient without children who is older and much heavier may
be keen to undergo a more risky procedure to maximise their weight loss.
• It is a considerable judgement on both the patient and surgeon’s part
• Desirably
– Discussion at a bariatric MDT
– Every member has a chance to express their views about the suitability of
any particular procedure for the patient
48. COMPLICATIONS
• Most common
– General risks, such as bleeding and infection
– Specific risks in relation to the actual surgical
procedure will vary from procedure to procedure
• Obese patients
– Generally is more risky than surgery in lean patients
– No matter what type of surgery
– More likely to suffer from cardiorespiratory
comorbidities
– Often hypercoagulable
49. Cont.
• Perioperative mortality
– Should be minimal
– But higher in those
• With the most severe comorbidities.
• Severe unstable cardiovascular disease (absolute
contraindication to bariatric surgery)
• Super-obese (BMI >50 kg/m2) males also have a higher
risk of perioperative mortality
• Patients with a past history of pulmonary embolism.
50. Cont.
• Laparoscopic surgery
– Leaks from resection margins, anastomoses site
– Off-camera injuries with internal hernias
52. Clinical Implication
• When suspected complication
– Carry out investigations immediately
– Don’t delay
– As morbidly obese patients often have relatively few
clinical signs and symptoms despite overt peritonitis.
• Laparoscopy to assess the situation rather than
wasting time doing other investigations.
• Have strategies to minimise risks during and
following surgery.
– Be part of well established bariatric team
– Adequate training and throughput of surgical patients.
56. 1. Neuromodulation using gastric-implanted
electrodes
2. Vagal blocking using electrodes around the
abdominal vagus
3. Endoscopically placed intraluminal sleeves
4. Endoscopic gastric restriction procedures
5. Improvements in the current operations (less
abdominal wall trauma)
1. Single incision
2. Transvaginal approaches.
57.
58.
59. SUMMARY
List the type of bariatric surgery and their
component
Explain about the choices of surgical methods
Discuss the result expected from bariatric
surgery
Explain the complications from bariatric
surgery
Get a glimpse of future of bariatric surgery