SURGICAL TREATMENT OF OBESITY

  1. SURGICAL TREATMENT OF OBESITY
     
     Surgical treatment

    That after failure of all other methods like diatery changing exercises and activity behavior changes and medical treatment and also in superobseity and if obesity start to make complication so it should be  interfere


    Are all obese people suitable for operations

    Sure no because that need for certain criteria like 1- no other unrelated disease that may increase the risk of operative interferance 2-absence of correctable and endocirnal causes for obesity because these can response to medical treatment and surgery has role because you don not remove the reasons 3- people must be co-operative pre and post operative 4-presence of complications 
    what we can do before operation ?1-the patients must take high protein diet for three weeks preoperative 2-bowel preparation because we will do resection and anastamosis 3-give anticoagulation like subcutenous
    heparin to avoid deep venous thrombosis and also avoid pulmonary embolism even which can happened during or postoperative 4- give prophylactic antibiotic then we

    Type of operations

     there are historical operations not done now like trunkal vagotomy without drainge operation 2- lipectomy 3- dental splintage but currently we used these operations which can be classified to 1- gastric operations 2- intestinal operations 3- combined operations

     A- gastric operations 

    like 1-small or large gastric pouch

    gastrojejunoestomy with proximal pouch what is side effect of this operation?leads to iron and calcium and vitamines b12 deficieny so what the treatment by oral supplement of these deficiency 2- gastroplasty procedures like 1- partial transverse stomach incision 2- magenstrass and mill by narrow lesser curve is created around 34 fr. bouge as conduit of food to the antrum of the stomach 3- other like vertical band gastrolpasty and subtotal gastrectomy
     
     B-Intestinal operations

    Which aiming to malabsorptive proceduers like 1- jejuno-clic bypass which 35 cm of the jejunum anastomosed to the transverse colon but rare or not used 2- jejuno-ileal bypass which done in the operations as 1- payne 35 cm of the jejunum anastomoses to end to side to about 6.5 cm of the terminal ileum but not effective due to blind loop 2- scott which 30 cm of the jejunum anastomoses end to end to about 30 cm of the terminal ileum and the blind loop is connected either to the transverse colon or sigmoid colon 3- joffe 36 cm of the jejunum anastomosed  end to end to about 4 cm of the terminal ileum and the blind loop connected to ascending colon

    C- combined operations

    As 1- bilio-enteric diversion 2- duodenal switch operation then after operations has been done what is postoperative care? 1- respiratory care  in intensive care unit for 48 hours 2- ryle,s tube for 5 days and do gastrograffin meal before oral feeding 3- control diarrhea by lomotil for example 4- regular follow up for body weight and liver function 5- anticoagulant till ambulation 

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