Before Gastric Sleeve Surgery

What You Should Know Before Having Weight Loss Surgery

减肥手术,插图
PIXOLOGICSTUDIO/SCIENCE PHOTO LIBRARY / Getty Images

If you are consideringweight loss surgery,你可能知道胃套手术,治疗肥胖的永久性手术选择。胃套,也称为垂直套筒式胃切除术,是目前最流行的减肥手术,with over half of patients electing this type of surgery for their treatment.

胃套手术是,quite simply,a procedure to dramatically reduce the stomach's ability to hold food. By reducing the size of the stomach to about 20 percent of its original size,一顿饭所能吃的食物数量显著减少。对于大多数患者来说,减重是可以食用的食物数量显著减少的自然结果。

历史

胃套最初是作为一个更复杂的手术的第一部分进行的,称为duodenalswitch (DS). The duodenal switch was often done in two stages,with the gastric sleeve portion of the surgery being done first to decrease the size of the stomach. Then,weeks or months later,the rest of the surgery was performed,a procedure that decreased the amount of small intestine that is able to absorb food.

Surgeons found that patients who had the first portion of the surgery completed lost weight,even when they didn't have the second stage of surgery performed.他们还注意到,在进行套管手术和第二次改变小肠的手术之间的数周或数月内,患者体重减轻。

Noting these outcomes with the gastric sleeve surgery,外科医生开始研究这项手术,将其作为治疗肥胖的独立手术。The sleeve was particularly of interest because the procedure is less risky than the intestine diverting portion of the surgery.The sleeve also has fewer complications than the lap-band and about the same long-term weight loss as the more invasive and high risk gastric bypass procedures.

While ten year data is not yet available,the early results are excellent and indicate that the gastric sleeve is among the safest bariatric surgeries with the lowest long term complications when performed without the duodenal switch portion of the procedure.

手术原因

The gastric sleeve procedure is a permanent alteration in the size of the stomach with the intent of causing a dramatic change in an obese individual's excess weight. Weight loss alone is not the only reason the procedure is done,因为减肥的副作用可能是一些人的目标。

In addition to achieving weight loss,一些人也经历这些变化:

  • 不健康的低密度脂蛋白(LDL或不良胆固醇)随着高密度脂蛋白(HDL或高胆固醇)的显著增加,HDL的改善也归因于大多数胃袖患者术后运动量的增加。
  • High blood pressureis often controlled or even completely cured by weight loss after bariatric surgery. The change in diet along with a decrease in excess weight often means that blood pressure medication is no longer necessary for keeping levels under control or at normal levels.
  • 2型糖尿病与1型糖尿病不同,减肥和改变生活方式更容易治疗甚至治愈。如果患者不生产胰岛素,需要以药物形式使用胰岛素,type 2 diabetes can treated effectively by lifestyle changes in many cases.Even patients who are not cured after surgery typically find their disease far easier to control after weight loss.
  • Sleep apnea,使人在睡眠中反复停止呼吸的情况,通常完全通过减肥来治愈。对于达到正常体重或减掉足够体重被认为是超重而不是肥胖的患者,睡眠呼吸暂停不再需要治疗。As an added bonus,snoring often goes away entirely or is notably improved.
  • Joint pain is frequently improved by reducing the load placed on the joints,which means weight loss is one of the best things that can be done for chronic joint aches and pains.

失重

虽然胃套确实减少了一个人在一顿饭中可以吃的食物量,the gastric sleeve procedure works in additional ways that may not be as obvious as the reduction in stomach size.

Most patients report a decrease in feelings of hunger due to the surgery,which can alter howghrelin,饥饿激素,is released. They no longer have the feelings of hunger or have those feelings less frequently or with less intensity after surgery.此外,大多数人比手术前吃的食物少得多。

设定期望值

典型的胃袖患者手术后可能会减掉50%到80%的超重。Excess weight is weight they are carrying that is over and above their calculated normal body weight.

例如,如果病人的正常体重是150磅,体重是350磅,they have 200 pounds of excess body weight.They can expect to lose 50-80 percent of their excess body weight,这意味着在手术后的两年内估计损失了100到160磅。

The patient has significant control over the total weight loss after surgery. Those who start an exercise plan and stick with it are more likely to lose a higher percentage of excess weight,as are those who closely monitor their food intake through tracking,measuring,and weighing their food.

资格赛

If you are wondering if you qualify for gastric sleeve surgery,start by calculating yourBMIBMI,or body mass index,is a measurement used to assess weight.The BMI is not a good tool in very muscular individuals,但对于试图确定适当目标体重或确定肥胖严重程度的超重个体来说是可靠的。

A calculator is available在这里,or you can use this formula: multiply your weight in pounds by 703.Divide this number by your height in inches x your height in inches.

  • If your BMI number is 40 or greater,根据你的体重,你有资格接受胃套手术。
  • If your BMI number is between 30 and 39.9,you may qualify for gastric sleeve surgery if you have an additional issue that is caused or worsened by obesity,比如高血压,type 2 diabetes,sleep apnea or other conditions.
  • 如果你的体重指数是29.9或更低,you do not qualify for gastric sleeve surgery or other types of bariatric surgeries.

Qualifying for surgery and being approved for surgery,or being a good candidate for a procedure are very different things. Qualifying is the first step for becoming a candidate for a bariatric procedure,but that does not mean surgery is appropriate.为了确定你是否是一个好的手术候选人,你需要和一个减肥外科医生谈谈。

找个外科医生

A great bariatric surgeon is a combination of gifted surgical skills and a desire to help people,除了对肥胖者的感受感同身受外,外科医生还必须为患者提供一支超出手术范围的医疗团队,并提供患者手术后所需的工具。

Without great education from the healthcare team,you may not have a great outcome. Without skilled hands you may experience more complications than other patients,其中一些并发症可能是严重的,甚至危及生命。

出于这些原因和许多其他原因,it is important tochoose your surgeon wisely. First,you will be looking for a surgeon who has performed not dozens or hundreds of gastric sleeve surgeries,but thousands.Next,你将寻找一个长期和短期都有很好的成功患者记录,并且并发症很小的人,比如术后感染。

当然,问问你的朋友和家人他们推荐谁,but be sure to check with the medical board in your state for any disciplinary action.也,make sure the surgeon has been properly trained to perform weight loss surgery by completing a fellowship in bariatric surgery.

成本

The cost of the gastric sleeve procedure will vary widely with insurance coverage and the area of the country where surgery is being performed. The price of surgery can vary by more than $20,000 from one state to the next,保险单的承保范围也各不相同。

Some insurance policies have a bariatric surgery exclusion,meaning that weight loss surgeries are never paid for by the policy,不管资格如何。您可以通过拨打保险卡背面的号码并询问保险范围来确定您的保险单是否包括这些手术。

If insurance will pay for surgery,平均来说,病人还需要支付几千美元的现金。如果没有保险,费用通常会超过20000美元。典型的病人通常会发现,随着健康状况的改善,手术会在几年内为自己支付医疗和药物相关费用的减少。

Recovery Time

如果病人的工作只需要轻微的活动,那么一般病人可以在手术后两到三周恢复工作。大多数人将无法恢复他们的全部活动,特别是剧烈的运动,for four to six weeks following surgery. Once the recovery phase is completed,exercise is encouraged to maximize the long term success of the procedure and enhance weight loss.

During the initial phases of recovery,food is limited in both quantity and type. Initially,极少量的液体是唯一允许的食物,and over the next several weeks,regular food is reintroduced into the diet.手术使与肠道的连接保持完整,因此倾倒综合征不像其他手术那样是一个问题,but simple carbohydrates are still avoided during this time.

The Procedure

胃套手术是在全身麻醉并且完成了腹腔镜检查,using minimally invasive techniques.Once the patient is asleep,手术至少从三个小切口开始,包括一个隐藏在肚脐里的灯。摄像机和手术器械被插入这些小切口,外科医生切除了大部分胃,leaving a portion of stomach shaped like a banana to connect the esophagus to the first part of the intestine called the duodenum.

切除胃的切口线用订书钉缝合,并检查缝合线以确保没有渗漏。多余的胃组织通过其中一个切口被切除。The surgeon removes the instruments,在大多数情况下,用胶带封闭切口,and the patient is allowed to wake from anesthesia in the recovery area.

风险和并发症

所有手术都有风险,and the gastric sleeve is no exception.虽然胃套手术比其他减肥手术风险小,there are potential side effects and complications that can happen in the days or even years after surgery.In addition to the knownrisks of anesthesia,以及general risks of surgery,the gastric sleeve procedure can lead to additionalside effects and complications.

Short term issues after gastric sleeve surgery include:

  • 缝合线断裂,一种严重的情况,胃部被切断并缝合在一起的线开始泄漏,允许胃内容物(包括食物和胃酸)泄漏到腹部
  • Blood clots can occur due to the patient being still during surgery for several hours,a known risk factor for clot formation
  • Bleeding is typically minor after surgery,但是如果有严重的并发症会更严重
  • 恶心呕吐
  • 感染手术部位的

Long term issues after gastric sleeve surgery:

  • 狭窄是指胃部狭窄的区域,使食物和液体难以通过,can form along the incision line in the stomach
  • GERD,or gastroesophageal reflux disease, is an issue where stomach acid moves backward,splashing up into the esophagus,经常引起胃灼热。This typically decreases with weight loss.
  • Vitamin and mineral deficiency is less likely to happen with gastric sleeve than other types of weight loss surgeries,但是由于食物消耗的减少,仍然是可能的。大多数人需要多种维生素,可能需要处方补充剂。
  • 胆结石是常见的快速减肥,and are most likely to form in the months following surgery when the weight loss is happening the fastest. Sudden,severe,进食后右上腹疼痛应向医疗保健机构进行治疗,可能表明正在发生胆囊病发作。
  • Sagging skin is more likely with larger and faster weight loss,and can lead to additional surgeries to have excess skin removed permanently once the weight has stabilized.

    Preparing for Success

    Weight loss surgery is in no way "the easy way" to lose weight,但它是一种永久性的工具减少一个人可以消费的食物总量即使这种工具也可能被滥用,长期过量饮食,胃的大小可以伸展以容纳比预期更多的食物。

    Long term success will depend entirely on a willingness to create new habits,停止导致肥胖的行为,为了长期保持这些变化。最成功的人通过与朋友密切合作,在他们的生活中建立起一个责任制度,relatives and even professional healthcare providers to maintain good habits day to day.

    患者在手术前后将首先与营养师或营养师合作,但有些人会坚持与营养工作人员的关系,以设定目标并维持他们的体重减轻。Among the recommended tools is daily tracking of food intake,比如网上日记或者食品日记。卡路里counting may also be necessary for those who tend to overeat or eat mindlessly.

    For many,participating in a bariatric support group on a regular basis is an excellent way to stay on track and find people sharing the experience of bariatric surgery and life after surgery. Friends and family can also provide support,但不能总是同情正在发生的变化。

    Exercise is a key component of weight loss and maintenance,and becomes a major focus for many patients. To stay on track,有些人使用私人教练,others have a set schedule for exercise,团体课可以使锻炼更多地成为一种社会经验。建立健身目标can be as important or more important than scale based weight loss goals.

    Emotional Issues

    重要的是要知道,任何类型的减肥过程都会伴随着重大的情感问题,and the following weight loss that occurs. For individuals who use eating as a coping mechanism,finding a new way to adapt and manage stress without food can be challenging.找到一个健康的压力源是很重要的,as patients are at risk for turning to unhealthy ways of coping including drugs and alcohol.

    For other patients,体重下降会导致关系不稳定,and bariatric patients do have a higher rate of divorce in the years following surgery than the average person.

    找到健康的应对方法,比如锻炼或者给自己留出充足的时间,will be key to long term success. Open and clear communication with friends and family can also be useful,as can bariatric support groups.一些压力源是可以预料的,such as the expense of replacing clothes repeatedly due to weight loss,while others,such as realizing that they were discriminated against while obese,很难处理。

    Many patients report feeling resentful when others express a romantic interest that was not present when they were obese. These issues,还有很多其他的,can come up with the months and years following surgery.使用您的减肥诊所提供的服务,如团体治疗,or even seeking out individual therapy may be useful when dealing with these issues.

    Weight Regain

    体重增加是减肥患者最害怕的事情之一。to have surgery,做几个小时的运动只是为了体验体重增加是悲伤和沮丧的来源。有些病人确实会增重,通常在手术后的三到四年。

    Five years after surgery most patients have maintained a weight loss of 50 percent of their excess weight,比完全不减肥要好得多,but this statistic is a source of fear for many.回到旧习惯,吃大餐,not focusing on clean and healthful foods and,特别地,摄入卡路里是体重增加的来源。

    体重增加不是永久性的,是可以克服的,即使是令人恐惧的减肥手术也会让患者感到恐惧。For most bariatric patients the battle against obesity—or at least the ongoing effort to eat mindfully—continues long after the recovery from surgery.

    A Word From澳门金莎国际网

    做胃套手术的决定很严重,这意味着一个永久性的改变,大部分胃被切除。这也是对健康生活方式的长期承诺,as surgery alone will not lead to long term good health.

    Surgery is a tool,but the true lasting weight loss happens when the patient chooses to adopt good habits and abandon bad ones for rest of their life. This can be challenging after surgery,但是大多数病人会告诉你真正的挑战是在手术后保持健康的体重,保持良好的习惯。

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