Bariatric Procedures

WEBVTT 00:00:07.320 --> 00:00:10.820 There's going to be five procedures that we'll talk about today: 00:00:10.845 --> 00:00:15.840 lap band, gastric sleeve, gastric bypass, SADI-S, or the SIPS operation, 00:00:15.865 --> 00:00:18.940 and the duodenal switch. 00:00:18.965 --> 00:00:22.620 The laparoscopic adjustable gastric band was a very popular bariatric surgery. 00:00:22.645 --> 00:00:27.420 A band device was placed in the abdomen, placed at the top of the stomach, 00:00:27.445 --> 00:00:30.100 creating a small gastric food pouch. 00:00:30.125 --> 00:00:34.240 When the patient eats a very small meal, it gets to that small stomach, the small 00:00:34.265 --> 00:00:37.780 stomach talks to the brain, the patient feels full, 00:00:37.805 --> 00:00:39.900 they eat less food, and they lose weight. 00:00:39.925 --> 00:00:44.420 It's not particularly performed often as a primary bariatric surgery these days, but 00:00:44.445 --> 00:00:48.640 we do take care of a lot of prior band patients because they need the adjustments 00:00:48.665 --> 00:00:52.700 to the band to get their band to work well. 00:00:52.725 --> 00:00:56.735 The gastric sleeve surgery is done through small, tiny incisions. 00:00:56.760 --> 00:00:59.320 First step of the operation is to take down the attachment 00:00:59.345 --> 00:01:05.260 to the colon and to the spleen, and that will free up the stomach. 00:01:05.285 --> 00:01:10.290 A sizer is placed in the stomach, and then a staple line is completed, 00:01:10.320 --> 00:01:13.700 transecting the lateral portion of the stomach from 00:01:13.725 --> 00:01:15.770 the gastric sleeve that's left. 00:01:15.800 --> 00:01:18.210 What that does is two major things. 00:01:18.240 --> 00:01:22.900 A small stomach, a tiny little meal will make you full very quickly, 00:01:22.925 --> 00:01:27.960 and the even more important part, this is the part of the stomach that has a lot 00:01:27.985 --> 00:01:31.820 of those appetite hormones that that drive patients to eat, 00:01:31.845 --> 00:01:35.180 eat the wrong things, can eat them for the wrong reasons. 00:01:35.205 --> 00:01:39.080 Now that this part of the stomach is gone, the sleeve does an excellent 00:01:39.105 --> 00:01:41.460 job with head hunger. 00:01:41.485 --> 00:01:44.850 The gastric bypass done through small, tiny incisions, and 00:01:44.880 --> 00:01:49.290 the first step is to create a small gastric pouch up here at the top. 00:01:49.320 --> 00:01:53.020 The second part of the operation is this distal connection, where 00:01:53.045 --> 00:01:57.520 there's a unhooking and rehooking, and we bring this limb of intestine, and 00:01:57.545 --> 00:01:59.780 we connect it to that gastric pouch. 00:01:59.805 --> 00:02:05.100 That does is the food is now skipping a portion of the small intestine, 00:02:05.125 --> 00:02:09.340 which adds an element of malabsorption to the operation. 00:02:09.365 --> 00:02:14.220 Essentially, you don't quite absorb all the calories that you eat. 00:02:14.245 --> 00:02:19.220 The SADI-S operation basically combines the upsides of a gastric 00:02:19.245 --> 00:02:21.400 sleeve and a gastric bypass. 00:02:21.840 --> 00:02:26.450 Small little tiny incisions, take down our connections, make 00:02:26.480 --> 00:02:33.020 our sleeve operation, so time tiny little stomach, you feel full very quickly. 00:02:33.045 --> 00:02:37.500 It gets rid of the appetite hormones in that portion of the stomach. 00:02:37.525 --> 00:02:42.860 Then we bring up a loop and connect it to the first part of the duodenum. 00:02:42.885 --> 00:02:47.540 You get that really nice malabsorption with this operation, 00:02:47.565 --> 00:02:50.960 which makes it excellent for weight loss, and it makes it a very, very 00:02:50.985 --> 00:02:53.440 durable bariatric procedure. 00:02:55.000 --> 00:02:58.220 The duodenal switch operation. Small, tiny incisions. 00:02:58.245 --> 00:03:00.340 We start by making our sleeve. 00:03:00.365 --> 00:03:06.940 We take down the connections to the spleen and the colon, put our sizer in, 00:03:06.965 --> 00:03:10.820 run our staple line, make our small little gastric pouch to 00:03:10.845 --> 00:03:15.480 keep people full of very small meals, we remove the portion of the stomach that 00:03:15.505 --> 00:03:19.840 creates all those appetite hormones that keep people hungry and limit their weight 00:03:19.865 --> 00:03:24.320 loss, and then we bring up a wide connection, hooking it up to 00:03:24.345 --> 00:03:26.500 the first part of the duodenum. 00:03:26.525 --> 00:03:30.280 The duodenal switch is a very malabsorbtive operation, 00:03:30.440 --> 00:03:34.920 which makes it a very high weight loss operation, up to 80% and 00:03:34.945 --> 00:03:36.980 90% of excess weight loss. 00:03:37.005 --> 00:03:40.240 It's an ideal operation for people with a lot of weight to lose.