Obesity Surgery in Tunisia
Stapling Techniques

In addition to the adjustable gastric band, there are methods of reducing extomac. As the discussion of technical choice, the indications vary.

Currently there is often a matter of school, with a surgical indication "empirical" frequently asked independently of BMI or eating behavior before surgery.

 

Techniques By Stapling

We must respect the rules of indication for surgery (making and collective responsibility) and a strict postoperative follow-up to get a real efficiency of this recent surgery.

Schematically:

  • Vertical banded gastroplasty is indicated for adults rather hyperphagic, without major disorder of eating behavior, although there is a hiatal hernia with gastroesophageal reflux disease (GERD) not severe. Payment may be made a gesture antireflux. This gesture is also proposed to patients refusing an adjustable gastric band.
  • The "BYPASS" Gastric (gastro-jejunal short circuit) will be offered to adult super-obese (BMI> 50kg / m²) with eating disorders (compulsive), hiatal hernia with GERD associated with severe esophagitis. It will be proposed as second-line in case of failure of interventions gastric restriction.
  • Parietal Gastrectomy technique in Gutter with biliopancreatic diversion should be reserved for super obese (BMI> 60 kg / m² and Prader-Willi).
  • Longitudinal Gastrectomy in the cuff, the adjustable gastric banding or vertical banded gastroplasty can lose weight "super obese" before offering surgery malabsorption second-line and with less risk laparoscopic surgery.

MASON / McLEAN : vertical banded gastroplasty

This procedure involves stapling the stomach so as to define a small proximal gastric pouch where the food came very quickly give a feeling of satiety.

It communicates with the rest of the stomach by a small diameter orifice. Its calibration is done by an inextensible ring whose effect is to create a "pseudo pyloric" that will slow the drain "néogastre".

This surgical procedure requires neither visceral anastomosis, or opening of the digestive tract. This results in low morbidity and mortality.

Failure to comply with food hygiene and a good compliance with postoperative follow-up will lead to postprandial vomiting.

The Gastric Bypass

This technique consists of a vertical cross-section of the stomach creating a pocket proximal to limited capacity in which the food arrived, connected directly to the jejunum (by a loop in Y).

Food passes into the intestine, bypassing not only a large part of the stomach but also the duodenum and proximal jejunum.

The principle is to reduce the small bowel to 40-50 cm of bowel function, the remainder being excluded, which has the effect of causing weight loss by malabsorption controlled.

Representative techniques models

Vertical banded gastroplasty
obesity surgery in Tunisia - Techniques by stapling
The Gastric Bypass

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