Weight Reduction Procedures

Risk of Surgery

Who Need Surgery

Choice of Procedures

Metabolic Surgery

Life after Surgery

Choice of Procedures


Intragastric Balloon  胃內水球
  Laparoscopic Adjustable Gastric Banding  腹腔鏡束胃帶手術
  Laparoscopic Sleeve Gastrectomy  腹腔鏡縮胃手術
  Laparoscopic Gastric Bypass  腹腔鏡胃繞道手術

 

Bariatric Procedures Endoscopic Treatment
(Temporary)
  Surgical Treatment
(Permanent)
 
Type of Procedure Intragastric Balloon Laparoscopic Adjustable Gastric Banding Laparoscopic Sleeve Gastrectomy  Laparoscopic Gastric Bypass
Anatomy A 500cc balloon is inserted through the month into stomach. An adjustable silicone right (band) is placed around the top part of the stomach creating a small 1-2 ounce (15-30cc) pouch. Long narrow vertical pouch measuring 2-3oz (60-100cc).

No intestinal bypass performed.
Small 1 ounce pouch (20-30cc) connected to the small intestine.

Food and digestive juices are separated for 3-5 feet.
 







Mechanism Reduced stomach volume.

Induce satiety.
Moderately restricts the volume and type of foods able to be eaten.

Only procedure that is adjustable. Delays emptying of pouch.

Creates sensation of fullness.
Significantly restricts the volume of food that can be consumed.

NO malabsorption

NO dumping
Significantly restricts the volume of food that can be consumed.

Mild malabsorption.

"Dumping Syndrome" when sugar or fats are eaten.
Procedure time 30 min 60 - 90 min 60 - 90 min 120 - 180 min
Average Hospital stay 0 - 1 day 2 - 3 days 4 - 6 days 7 - 9 days
Average weight loss loss 10 - 12 kg in 6 months
(BMI ~5 kg/m2 loss)
loss 20 - 30 kg in 2 years
(BMI ~10 kg/m2 loss)
loss 25 - 35 kg in 2 years
(BMI ~12 kg/m2 loss)
loss 30 - 40 kg in 2 years
(BMI ~15 kg/m2 loss)
Behavioral
Adjustment
Small meal size

Avoid liquid calories

Regular exercise

Remove in 6 months, able to maintain healthy dietary habit
Small meal size

Avoid liquid calories

Regular exercise

Follow-up adjustment of band
Small meal size

Avoid liquid calories

Regular exercise
Small meal size

Avoid liquid calories & fatty food (dumping syndrome)

Regular medication (vitamin)

Regular exercise
Advantage No surgery

Reversible
Low risk surgery

Reversible

Adjustable
Faster weight loss

No foreign material

No need adjustment
More effective weight loss

Better control in diabetes
Disadvantage Possible weight rebound after removal balloon (70%) Slow weight loss

Less effective in superobese & poor complicance patients

Presence of foreign material

Possible failure & require removal (10%)
Irrevesible

Slightly higher risk surgery
Ireverisble

High risk surgery

Need life-long medication

Risk of mal-nutrition
Patient Choice Not accept / suitable for surgery

Willing to reduce meal size

Can comply dietary advise
Accept surgery (lowest risk) & Presence of foreign implant

Willing to reduce meal size

Can comply dietary advise
Accept surgery (moderate risk)

Removal part of stomach

Willing to reduce meal size

Can comply dietary advise
Accept surgical (higher risk)

Control severe diabetes

Willing to reduce meal size

Can comply dietary advise
Our recommendation Lower BMI (< 35 kg/m2)

High operative risk

Can use to loss weight before major surgery
BMI < 50 kg/m2

More disciplined patients in dietary restriction & exercise program
BMI > 40 kg/m2

First stage procedure for superobese (BMI > 60)

Limited long-term result
High BMI (> 50 kg/m2)

Diabete patients

Second stage procedure for revisional surgery



減重程序 內視鏡治療
(暫時)
  外科治療
(永久)
 

種類

胃內水球

腹腔鏡束胃帶手術

腹腔鏡縮胃手術

腹腔鏡胃繞道手術

減重原理

減少食量

減少食量

減少食量和減低食慾的荷爾蒙

減少食量和減少營養吸收

手術時間

30 分鐘

60 - 90 分鐘

60 - 90 分鐘

120 - 180 分鐘

住院日數

0 - 1

2 - 3

4 - 6

7 - 9

平均減去
BMI

5 kg/m2

10 kg/m2

12 kg/m2

15 kg/m2

病患選擇

食量大,能配合減低食量,不願接受手術。

食量大,能配合減低食量。願意接受手術及永久放置束胃帶。

食量大,但較難控制囗慾的病人。願意接受手術及可能的併發症。

食量大,有減重意願,「甜食愛好者」或有糖尿病,願意接受手術及可能的併發症。

病患配合

維持小份量固體食物,避免高熱量流質,需運動。須
6個月內取出水球。

維持小份量固體食物,避免高熱量流質,需運動,須覆診調節束帶。

保持均衡飲食,避免高熱量流質,需運動,建議定時覆診。

保持均衡飲食,須每日服用維生素。其中以鐵及鈣的補充最重要
,需運動。建議定期覆診。

優點

可還原,不用手術。

可還原,可調節束帶控制食量,風險低。

減重成效高及顯著,不用放置外來物。

減重成效高及顯著,治療第二型糖尿病非常有效。

缺點

部份患者不能長期維持減去體重

減重速度較慢,
5-10%患者將來可能需要把束胃帶取出。

不可還原,手術風險較高。

不可還原,手術風險高。必須每日補充維生素,鈣及鐵。




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