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Tag: Gastric Sleeve Surgery

Childhood obesity and adolescent obesity is linked with many serious health issues in adulthood.  Unfortunately, there is little evidence that preventive measures such as lifestyle interventions and pharmacological treatments are effective.  There are several surgical procedures for children and adolescents but the long term effects remain uncertain.

Researchers from University College of Gjovik and the University of Oslo, Norway in a paper “Bariatric surgery for obese children and adolescents:  A review of the moral challenges” concluded that surgery on children’s healthy organs to discipline their eating behavior in order to help them to be socially acceptable or to compensate for poor parenting is ill advised.  There needs to be more evidence on outcomes and risk factors.  There also needs to be a valid consent or assent.

In making a decision on bariatric surgery for children and adolescents, parents need to look at the moral implications with regard to values, viewpoints and arguments before they make the decision to go forward.

bariatric surgery child obesity

Long Term Outcomes and Benefits of Bariatric Surgery for Children

There is little evidence on the benefits of bariatric surgery on youngsters.  The overwhelming research has been on adults and those results don’t necessarily generalize to a children and adolescents.  If, after 100 – 150 procedures there are few complications then it might be permissible to perform this procedure, but only in specialized, high volume centers where the doctors have plenty of experience.

Much consideration needs to be given to how this procedure might affect psychological and social development.  Few studies address these issues.  The other moral consideration is informed consent.  Should a parent make the decision for a child, or is a child or adolescent mature enough to have a say?  Surgery should not replace self discipline.

Studies show that one third of obese adults were sexually abused as children.  So as part of the assessment process for children and adolescents, this should be addressed.

Preconceptions on Bariatric Surgery for Youth

Overweight children and adolescents are often the target of discrimination and prejudice.  And medical practitioners are known to also discriminate against the obese, by assuming they are ill prepared to take care of themselves.  So, few referrals are made for surgery among this population.  But should this social problem be addressed with surgery anyway?

Bariatric surgery poses particular questions for minors because it uses medical interventions to alter everyday behavior when there are other solutions available such as dieting, exercising, and cognitive behavioral therapy that pose no risk to healthy organs in the body.  Also this surgery does not address the many unknown causes of obesity.

In conclusion these researchers posed the following questions that need to be addressed when making a decision such as bariatric surgery for a child or adolescent:

  • Who to operate on
  • When to do it
  • Who is to decide
  • How to decide
  • Who is to operate
  • How best to prepare
  • How to follow-up

 

And the most important question would be how to generate more high quality evidence in a morally acceptable manner.

I would love to know your option on this topic of Childhood Obesity and Bariatric Surgery. Please Comment!

 

 

The gastric sleeve procedure has become very common in terms of weight loss surgery.  In spite of its recent popularity among patients and surgeons it’s still controversial, especially regarding bougie size.

 

What is a Bougie?

 The bougie (BOO-zhee) is a measuring device in the form of a long, flexible tube. Surgeons use it to guide them when dividing the stomach.

During the surgery the bougie is inserted through the mouth and guided through the esophagus and stomach to the pylorus.  The tube creates a bulge that the surgeon uses to guide the stapler in dividing the stomach.  After the sleeve is formed the bougie is removed.

Bougies come in various sizes and the unit of measurement is called a French, abbreviated F.  1F = 0.333 mm or 1/3 mm.  A 40F bougie is equal to ½ inch for example. Standard bougie sizes in the U.S. range from 32 – 50F.

Generally, the smaller the bougie used, the smaller the new stomach size.  But the same size bougie doesn’t always create the same size stomach.  A lot depends on the surgeon and whether he/she over sews the staple line, and if so by how much.

There is no unanimous agreement on the ideal bougie size for a given patient.  This is a challenge because each procedure requires the surgeon to find the size that will be the safest, yet allow for the most amount of weight loss.

The smaller the bougie that is used, the smaller the sleeve and the resulting stomach restriction.  But there is a greater risk of leakage and instances of stricture.  A stricture occurs when scar tissue develops and interferes with the normal movement of food and liquids into the stomach.  It can only be corrected with surgery.

On the other hand, if a larger bougie is used, there is less risk but then maybe less weight loss as well.

Gastric Sleeve Surgery

 

2008 Gastric Sleeve Bougie Study

 This study showed a very minor difference in weight loss results when using a 40F bougie vs a 60F bougie.  At 6 months the difference was less than 2% and at 12 months the difference was less than 6%.

Study: Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes. Surg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33. doi: 10.1016/j.soard.2008.03.245.)

2013 Gastric Sleeve Surgery Study on Leaks

The results show that bougies of 40F and larger had incidents of leaks with virtually no change in weight loss.  Pending further research but caution is recommended in using the smallest possible bougie due to the risks outweighing the benefits.

(Study: The Effects of Bougie Caliber on Leaks and Excess Weight Loss Following Laparoscopic Sleeve Gastrectomy. Is There an Ideal Bougie Size? Obes Surg. 2013 Aug 3. [Epub ahead of print])

2012 Gastric Sleeve Study

Surgeons surveyed reported that in the range of 32F – 50F the most common size being used is 36F, (used by 32% of them).  Studies showed that the procedure is relatively safe while there are still variations in bougie size.

(Study: Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013 Aug 4. [Epub ahead of print])

What is the Best Bougie Size for Gastric Sleeve Surgery

Many variables determine bougie size including patient input, their height and weight and of course the surgeon.  It’s typically smaller when this is a stand alone procedure (32-50F) rather than a duodena switch (50-60F).

Depending on the bougie size the new stomach will be 60-80% smaller.  After surgery the new stomach will hold a meal of ½ cup to 1 ½ cups, rather than the normal 4 – 6 cups.

Before undergoing the sleeve gastrectomy procedure you must discuss bougie size with your surgeon.  You need to understand his reasons for recommending the size he intends to use.  It’s your stomach and you need to be comfortable.

The sleeve will help reduce hunger and limit food intake, but you need to follow a reduced calorie, nutrient-rich diet if you want to be successful.

Weight Loss Surgery and Gastric Sleeve Dumping Syndrome

 

What Is Gastric Dumping Syndrome

Causes of Gastric Dumping Syndrome

Gastric Dumping Syndrome is a common bariatric surgery issue, specifically with Gastric Sleeve and Gastric Bypass.  After having weight loss surgery the way a person eats changes dramatically.  Gone are the large meals because the stomach is reduced by approximately eighty to eighty-five percent leaving only a sleeve or tube that is the shape of a banana.  The new stomach you have after gastric sleeve surgery does function normally so you do not have as many food restrictions but you just cannot eat as much.

 

What is gastric dumping syndrome and why do you get it?

 

This is the problem that can develop, especially if there are foods eaten that are have a high content of sugar.  It is also referred to as rapid gastric emptying.  It is very common to have this after having gastric sleeve surgery.  Normally a person will experience it after eating but in some cases it will happen one to three hours later.  There are some people who have gastric dumping syndrome at both times.

 

When you have had gastric sleeve surgery the opening that is between your stomach and small intestine has been removed.  The opening at stomach, called the pylorus acted as a brake before surgery to help your stomach empty slowly.  Since there is no longer a “brake” the stomach contents just rushes into your small intestine. As a result your body reacts by adding a big amount of gastric juices to your small intestine.

 

What are the symptoms of gastric dumping syndrome?

 

Gastric dumping syndrome is actually a group of symptoms.  Some of these symptoms can include:

 

  • Gastrointestinal
    1. Nausea
    2. Vomiting
    3. Abdominal cramps
    4. Diarrhea
    5. Fullness feeling

 

  • Cardiovascular
    1. Flushing
    2. Feeling lightheaded and/or dizziness
    3. Rapid heart rate and/or heart palpitations

 

If a person has gastric dumping syndrome one to three hours after eating there are other symptoms that can happen.  These later symptoms are caused by dumping a large amount of sugar into their intestine.  The body responds by releasing a large of amount of insulin which is used to absorb this extra sugar.  This can cause hypoglycemia, which is a low level of sugar in your body.  These symptoms can include:

 

  • Hunger
  • Sweating
  • Feeling lightheaded and/or dizziness
  • Confusion
  • Fainting
  • Rapid heart rate and/or heart palpitations

 

In conclusion

 

Doing a study on more than one thousand people who have had gastric sleeve surgery, all have experienced gastric dumping syndrome at some point in time.  Two-thirds had the early symptoms while the other third had the later symptoms.  There were a few who had both symptoms.  As you can see, it is a common problem after having weight loss surgery.  It is not a life threatening condition and can be easily remedied by changing their eating habits such as

 

  • Eat smaller meals
  • Avoid drinking anything with meals
  • Limit your intake of drinks and food with a high sugar content
  • Increase the amount of fiber in your diet
  • Stay away from foods that are acidic
  • Lie down at least ten to fifteen minutes after eating