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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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