Sleeve gastrectomy

Under a stomach tube or a gastric tube formation (English: Sleeve gastrectomy ) refers to a surgical technique from the spectrum of bariatric surgery. According to S3 guideline "Surgery of Obesity " the sleeve gastrectomy is one of the recognized standard techniques and is accordingly only when exhausted conservative treatment options in question.

Surgical Principles and effects

The principle of operation is that the gastric volume is reduced to approximately 80-90% by a longitudinal gastrectomy along the small curvature of the stomach. Accordingly, the amount of food is reduced, therefore it is called a restrictive surgical procedures. In addition to reducing the amount of food neurohumoral mechanisms of action are discussed, as it (eg ghrelin ) comes after surgery to measurable changes in plasma levels of various gastrointestinal hormones. Typically a reduction of excess weight of approximately 70-80% after about 1-2 years is achieved. Since the technique of gastric tube formation was standardized only in recent years, no final statement with regard to the long-term results can be made. The favorable effect on obesity- associated comorbidities ( eg, diabetes mellitus II, hypertension, sleep apnea syndrome ) is comparable to the results of Roux -en- Y gastric bypass surgery. It must be permanently substitution of a need for vitamin B12, as for other gastric resection, is assumed.

Surgical technique and complications

The surgery is performed under general anesthesia in the so-called minimally invasive technique. The stomach is separated closely along the greater curvature to below the esophagus from the large network and the connections to the spleen with an ultrasonic dissector. The gastric resection itself is done with clip - cutting instruments along a calibration tube which was placed close to the lesser curvature. After resection, a leak test by injecting fluid (100-150 ml) in the gastric tube ( gavage ) is usually performed. The resected stomach portion is removed through an extraction bag, then done the ex-situ volume measurement. The surgery takes about an hour and the hospital stay is limited in a uncomplicated course of about 2-4 days. Complications in the early postoperative period arising, among other from rebleeding, seam leakage (leakage, insufficiency), thrombosis and embolism with a frequency of about 1-2%.

Current Rating

The sleeve gastrectomy surgery has in the last 5 years enormously increased in importance and expanded the range of surgical treatment options for severe obesity. From the frequency of intervention, the Sleeve Gastrectomy surgery is now well ahead of the gastric bypass ( Federal Statistical Office 2012: Sleeve Gastrectomy 3351 versus 3157 gastric bypass). An advantage over the Roux -en- Y gastric bypass surgery is that no intestinal rerouting is required and therefore, this method eg is more suitable for patients with inflammatory bowel disease Crohn's disease or bowel adhesions. In addition, absorption of drugs is undisturbed. However, the disadvantage is the irreversible loss of a large proportion of the stomach. The sleeve gastrectomy surgery is also known as revision surgery after previous gastric band implantation.

Swell

  • Guideline for the Surgery of Obesity. Association of the Scientific Medical Societies in Germany (AWMF ). Accessed on December 25, 2011.
  • RA Weiner: Bariatric surgery: surgical technique, complications management follow-up, Urban & Fischer Verlag, 2009, p.79 ff, ISBN 3437230255
  • M. Busing, M. Utech, J. Holder, et al. Gastric tube formation in the treatment of morbid obesity study results and first experiences with the transvaginal hybrid NOTES technique. The surgeon. 82 (8), 675-683, 2011
  • M. M. Hutter, B. D. Schirmer, D. B. Jones et al.First Report from the American College of Surgeons Bariatric Surgery Center Network, May 26, 2013 ( UTC) Laparoscopic Sleeve Gastrectomy Has Morbidity and Effectiveness Positioned Between the Band and the Bypass. Annals of Surgery 254 (3 ), 2011
  • MD'Hondt, S. Vanneste, H. Pottel et al. Laparoscopic sleeve gastrectomy as a single -stage procedure for the treatment of morbid obesity and the Resulting quality of life, resolution of comorbidities, food tolerance, and 6 -year weight loss. Surg. Endosc. 25 (8), 2498-504, 2011
  • R. Parsley, R. E. Steinert, B. Wölnerhanssen et al. Metabolic and hormonal changes after laparoscopic Roux -en- Y Gastric Bypass and Sleeve Gastrectomy: a randomized, prospective trial. Obes. Surg. 22, 740-748, 2012
  • O. Martini: Bariatric Surgery in Germany & Europe - care quality in comparison. 6 Obesity Symposium 2013, Norderstedt 21 - 22nd February 2013
  • Http://www.aerzteblatt.de/nachrichten/49874/Schlauchmagen-behebt-Typ-2-Diabetes-mellitus
  • M. Utech, H. Shaheen, J. Holder, R. Riege, A. Knapp, E. Wolf, M. Busing: gastric tube formation as revision surgery after gastric band failure. Zentralblatt of Surgery, published online, August 2013
  • Operative treatment procedures
  • Therapeutic procedures in gastroenterology
  • Stomach
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