BARIATRIC SURGERY
Obesity has experienced and is experiencing a dizzying increase in incidence, both globally, where 1.7 billion people are considered to be overweight, and in Romania where about 1/3 of Romanians are obese.
In an attempt to combat this evolution of “extra pounds”, bariatric surgery, which is the only one that can provide lasting results in the treatment of this disease (140,000 bariatric interventions are performed annually in the US) has come to meet it with a wide range of therapeutic means, modern, fast, with a low rate of complications on the patient in the long term, among them laparoscopic longitudinal gastrectomy.
Dr. Lucian Alecu is one of the great professionals in Romania in the operation of reducing the stomach and more. Currently, he is the head of the Clinical Department of General Surgery of SCU Prof. Dr. Agrippa Ionescu from Bucharest since 1999, and in private practice, for cases of gastric sleeve, he collaborates with the Legacy Med Clinic. He is a member of 11 surgical companies in the country and abroad. He is the author of 6 monographs, as well as many chapters in surgical treatises. He has published 22 articles in ISI indexed journals and 79 articles in BDI indexed journals as first author or author. He is the author of a number of 156 papers presented at specialized scientific events in the country and abroad.
Dr. ALECU LUCIAN:
● Primary Care Physician General Surgery
● Doctor of Medical Sciences, with 2 completed doctorates
● Overspecialization in liver surgery and liver transplantation
● Competence in laparoscopic surgery and bariatric surgery
● Competence in health services management
● Specialization in robotic surgery
Dr. Lucian Alecu has a vast background in the gastric sleeve branch, having a rich experience and many satisfactory long-term results, so we talked to him and he shared useful information about this intervention.
Obesity increases the risk of certain diseases, including diabetes or heart disease
Bariatric surgery aims at sustainable weight loss, with improved health, reduction or disappearance of comorbidities. Its purpose is to make the patient eat as little as possible, thus leading to a significant, safe and long-term weight loss.
Obesity surgery is a medical field that includes all surgical methods to treat this condition. Surgery is usually performed only on the gastric tract, but in individual cases can extend to the intestinal tract.
The purpose of obesity surgery is to reduce the weight of those affected, which can be achieved through two basic principles. One component is to reduce the size of the stomach so that less food can be consumed. Another principle of obesity surgery is the shortening of the intestinal tract. Thus, the body is supplied with fewer nutrients and calories.
Obesity surgery is used only if other curative methods have not led to the desired success and have a body mass index (BMI) of 40 kg/m2 or higher.
Longitudinal gastrectomy is a bariatric surgery, which removes 60-80% of the entire mass of the stomach along the great curvature, taking the form of a wedge shaped tube. The first such intervention was performed by Gagner in 1999, the method quickly gaining ground in the field of bariatric surgery, both due to the high speed of execution and the low rate of postoperative complications.
In Romania, this type of surgery was performed for the first time in 2005 in the General Surgery Clinic of the Clinical Hospital “St. Ioan ”from Bucharest.
Why laparoscopic longitudinal gastrectomy?
The first and most important advantage is represented by the simplicity and efficiency of the method, the patients losing in the first 6 months postoperatively on average, 49.1% of the excess kilograms; Thus, the rest of the comorbidities that are so frequently associated with obesity, such as hypertension, hyperlipidemia, or diabetes, are corrected simultaneously, which remits in 46% of cases at 6 months postoperatively, according to literature data. Due to the simplicity of the method and the use of the laparoscopic approach, the duration of hospitalization is significantly reduced by an average of 2.8-8 days, compared to other bariatric interventions such as GBP which has an average hospitalization of 3.4 ± 4.4 days.
The pylorus is preserved, thus eliminating the risk of dumping syndrome, which is present in 42% of patients who have undergone a GBP type intervention. The entire upper part of the gastrointestinal tract remains perfectly accessible to the endoscopist, which is not the case with GBP or DBP-DS due to intestinal anastomoses and the way the segments of the digestive tract are rearranged. No foreign bodies are implanted (such as the intragastric balloon or gastric “ring”) which over time can lead to specific complications.
Laparoscopic longitudinal gastrectomy offers many benefits, such as reduced hunger, small amounts of food and as a safe, stable and important weight loss effect with a normal life, without restrictions, after surgery.
Foods are absorbed qualitatively normally, but quantitatively little, the risk of secondary malabsorption complications being lower. In fact, complications of this type that require postoperative follow-up are megaloblastic anemia, which develops secondary to B12 avitaminosis due to intrinsic factor deficiency secreted by the parietal cells of the gastric fundus and iron deficiency, thus requiring prophylactic administration of both iron supplements. as well as vitamin B12.
Another great advantage of this surgical method is that no intestinal anastomoses or reorganization of the digestive tract segments are required, unlike GBP or DBP-DS where multiple anastomoses are required, with the necessary risks of fistulas.
It is important that the patient undergoing such an operation be able to adapt his lifestyle, otherwise he cannot be considered a candidate for this type of bariatric intervention. The patient will need to make changes in diet and lifestyle by avoiding excesses and exercising daily.
For 3 months, the postoperative diet will be mainly liquid and with finely chopped food. Long term postoperative monitoring will be done in close contact with the nutritionist in order to meet any deficiency complications. The purpose of the diet is to let the stomach heal and help a good adjustment with the “new” stomach.
Preoperative interdisciplinary consultations should not be neglected. In the case of laparoscopic longitudinal gastrectomy, it is essential to consult nutrition both preoperatively and postoperatively during the “follow-up” period, the patient’s evolution to an ideal weight being largely influenced by the diet recommended by the nutritionist who must be in permanent contact with the operating surgeon.
In the case of very high preoperative weight and the rapid rate of loss of extra kilograms, postoperatively, one year after bariatric surgery, plastic surgery may be necessary to correct the excess skin left on the abdomen and limbs.
Laparoscopic longitudinal gastrectomy is a surgical method currently used successfully in the treatment of obesity. The intervention must remain the prerogative of surgical clinics with experience in advanced laparoscopic surgery.
In order to obtain the best results, it is especially important to establish the correct operative indication, to observe the obligatory preoperative consultations, the postoperative monitoring together with the nutritionist and to correct the aesthetic deficit by the plastic surgeon at least one year after the operation.
On the occasion of laparoscopic longitudinal gastrectomy, other operations for associated diseases can be performed by the same approach.
A future pregnancy is possible after a bariatric surgery, but it is recommended to wait until the weight stabilizes (12 to 18 months after the surgery).
In the first year, on average, about 2-4 kg per month are lost. There are plateau periods when it does not weaken at all, these being normal. Gastric sleeve leads to weight loss safely and long term.
A few years after the stomach reduction operation (gastric sleeve), weight loss stops and depending on eating habits and physical exertion, the weight curve stagnates or may increase slightly. However, the weight you had before the operation will never be reached. It is necessary to control certain tests at 3, 6, 12 months after gastric sleeve. Depending on the results, vitamins may or may not be needed.
Dr. Lucian Alecu can be found for consultations at the Legacy Med clinic in Bucharest.
