A bariatric operation is in other words a surgical treatment of obesity.
To perform it, the surgeon must get inside the body. It can be done by laparotomy or laparoscopy. We advise on what laparotomy is and what laparoscopy is on.
Bariatric surgery is a method of treating obesity disease in people with body mass index (BMI) 35+ and diseases that are complications of obesity, such as, for example, type 2 diabetes, osteoarthritis or hypertension, and in people with BMI of 40 and more. Bariatric surgery consists in limiting the capacity of the stomach. Bariatric operations include sleeve gastric resection (the so-called sleeve) and an adjustable gastric band. The second type of bariatric surgery is so-called restrictive, that is, those that disturb the absorption of nutrients (mainly fats and carbohydrates) in the small intestine. This group of operations includes gastric by-pass and gastric by-pass.
Bariatric surgery is a serious, complex surgery.
To perform it, the surgeon simply has to put the patient to sleep and get inside his abdominal cavity. It can be done with the help of two so-called operational techniques. The first is laparotomy and the second is laparoscopy. We advise on how to perform a laparotomy and how to perform a laparoscopy. What determines that the surgeon chooses one or the other surgical technique?
Laparotomy is a surgical procedure that involves opening the patient’s abdominal cavity by cutting the skin, muscles and peritoneum, or the serous membrane, which lines the abdominal cavity and the pelvic cavity. The cut is usually performed through the center of the abdominal plane, from the navel to the navel, or in the place nearest to the organ, which causes the patient ailments.
Laparotomy is performed in the following situations
In the case of a curative planned laparotomy (eg a bariatric surgery) the patient is placed in the hospital in advance. How many days before it depends on the diagnostic tests that you need to perform and the process of preparation for surgery. Before the planned bariatric surgery, if the results of detailed tests are clear, the patient is admitted to the hospital one day before the procedure.
The patient must be fasting for 10 to 12 hours before the procedure. It can only take water at this time. Bariatric surgery is performed on the digestive system, therefore before the surgery it must be thoroughly cleaned of food debris.
Laparotomy is performed under general anesthesia, therefore, the day before the surgery, the patient is consulted with an anesthesiologist who conducts the interview, including about the anesthesia that the patient has been performing so far, comorbidities (especially those related to the circulatory system) and medicines for which the patient is allergic.
Depending on the type of surgery and the type of the disease, laparotomy lasts from several dozen minutes to even several hours. The size and location of the cut depend on the patient’s discomfort.
After cutting the abdominal wall, the surgeon carefully inspects the organs and then proceeds to the main surgery. After the procedure, the patient is sewn up, woken up, transported to the post-operative room, where he is constantly monitored for one day after surgery and then returns to the patient room. The patient usually comes to full fitness about 4 weeks after the procedure.
During or after the laparotomy surgery, complications may occur such as an allergic reaction to medicines given during anesthesia, difficulty in breathing, as well as infections, bleeding, hernia in the postoperative scar. The latter may occur especially in patients with obesity, as well as diabetes, taking steroid medications and smoking cigarettes. Laparotomy is not used in patients of advanced age, or with cardiorespiratory insufficiency, myocardial dysfunction, haemorrhagic diathesis, peritonitis.
Laparoscopy, or colonoscopy, is a procedure during which a few incisions are made in the abdominal wall first. Then, special devices are placed in them. trocars, and through the trocars, a laparoscope and other surgical instruments are inserted. The laparoscope is equipped with an optical system and its own light source. Thanks to the camera placed in the laparoscopic camera, the image of the abdominal interior is received on the computer screen.
Laparoscopy is performed in cells
Laparoscopy is also performed under general anesthesia, therefore the procedure is preceded by an interview with an anesthetist. Depending on the type of surgery, its complexity and the patient’s state of health, laparoscopy may last from several minutes to several hours. On the day before the procedure, only light and liquid meals are given to the patient.
As with laparotomy, the patient is placed on the operating table on the back and covered with sterile sheets. The first stage of the procedure is anesthesia. In the second stage, the surgeon performs several incisions in the abdominal shells of the patient, introduces trocars and then surgical instruments. Then, the peritoneal cavity is filled with carbon dioxide, i.e. forms the so-called pneumothorax. The abdomen is then reminiscent of an inflated balloon, and in the middle of the abdominal wall the organs are separated. As a result, the surgeon can more closely observe the so-called operational field and operate tools freely.
Surgical instruments for laparoscopy are long, because they are 20-30 cm, but their most important part, i.e. the ends are small. They only measure about 1 cm. It may happen that the disease change is so large that it can not be removed with small tools, so the surgeon must remove the tools and perform the laparotomy. However, such situations do not occur in bariatric operations performed laparoscopically.
After cutting out a specific organ or a part of it, eg a fragment of the stomach at the sleeve gastrectomy, it is removed from the abdominal cavity by additional incisions in the skin. After the operation, the pneumoperitoneum is removed, the trocars are removed from the patient’s body and the wounds sewn and secured with a sterile dressing.
Laparoscopy is a procedure and invasive examination affecting the skin’s coat as well as internal organs, so there is a risk that complications will occur after it. Thus, pneumothorax, subcutaneous pneumothorax, mediastinal emphysema, gas filling or puncture of the gut or stomach, abdominal wall vessel damage, local bleeding may occur. Laparoscopic surgery is contraindicated in the elderly, hypertension, heart disease (eg, failure, rhythm disturbances, after heart attack), as well as in pregnant women over 12 weeks. Laparoscopy is certainly not carried out and people with peritonitis, impaired homeostasis, i.e. the ability to maintain constant parameters in the body and severe circulatory-respiratory failure.
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