Bariatric surgery

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Bariatric surgery is a field of general surgery dealing with the treatment of II and III degree obesity.

Bariatric surgery involves introducing such changes in the gastrointestinal tract to improve disturbed mechanisms of neurohormonal regulation of food intake and, as a result, lead to reduction of excessive body weight. 

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The basics of bariatric surgery were created in the 1950s.

However, the development of obesity disease to the scale of the global pandemic caused that bariatric surgery is currently one of the most dynamically developing surgical domains in Poland and around the world. How was bariatric surgery born and what bariatric surgeries are currently being carried out, ie what does a bariatric surgeon do? 

Let’s start with the definition.

Bariatrics is a branch of medicine that deals with diagnosing, determining the causes, prevention and treatment of overweight and obesity, including surgical methods. The term was created in 1965, and comes from the Greek language (βάρος-ἰατρός, weight-medicine). Interestingly, in recent years, the name derives from Greek for a new, derived from English. The field of medicine dealing with the treatment of obesity is increasingly called obesitology (obesity – obesity), but surgeons who treat obesity with a scalpel are still referred to as bariatric surgeons. 

The pioneer of bariatric surgery is Dr. Linnear

In the 1950s observed that patients who have a part of the stomach or intestines removed after such surgery also lose a lot of weight. Linnear then performed the first anastomosis of the jejunum and ileum. In this way he obtained a shorter so-called passage, or the passage of food. In the following years, successive surgeons modified Linnear’s method by creating a group of bariatric procedures, which are still called shutters. The best known, named after the names of surgeons who developed them and implemented this procedure Payne – de Winda and Scott treatment. 

These methods, although they were effective in the form of significant weight loss, however, had many side effects. In patients who were subjected to exclusion at the time , the disorder absorbed fats and vitamins, and consequently to the so-called avitaminoz and also to cholelithiasis. Patients also complained of severe diarrhea, which led them to severe dehydration. And because clinical results and patient satisfaction were not satisfactory, they gave up (for some time) from performing disabling operations. 

 

At the beginning of the 1960s, the basics of the second group of bariatric procedures were developed – the so-called restrictive operations.

Their idea was to reduce the volume of the stomach involved in the digestive process. The first such treatment was the so-called horizontal gastroplasty according to Paceya and Carrey. With the help of so-called staplers, or special staples, in the 1/3 of the upper part of the stomach, this organ was sewn together, but without cutting it and leaving a small hole so that the food could get to its further part. In this way, a small, just 30 ml reservoir was created, which during eating was filled first. Unfortunately, stomach movements caused the staples to propagate. The patient after the initial weight loss, after some time again returned to the exit. 

However, surgeons decided that it is worth continuing work on restrictive procedures, because they do not cause such a large side effect as exclusion. It was also tried to combine both types of treatments. Among other things, the Rouxen Y gastric by-pass procedure (RYGB) was developed, which is currently one of the most commonly used bariatric operations. 

Bariatric surgery is also performed in patients with 2nd degree obesity who suffer from obesity complications, e.g. type 2 diabetes, hypertension and sleep apnea. They are also performed in patients without obesity, but only with type 2 diabetes. Therefore, bariatric surgery is also called metabolic surgery. 

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You can read also: Diet and exercise as one of the main ways to lose body fat

Posted on: June 7, 2019

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