commonly performed bariatric procedures in singapore
TRANSCRIPT
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Commonly Performed Bariatric Procedures in
Singapore
Lin Jinlin
Associate Consultant
General, Upper GI and Bariatric Surgery
Changi General Hospital
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Scope
1. Introduction
2. Principles of bariatric surgery
3. Roux-en-Y gastric bypass
4. Sleeve gastrectomy
5. Other procedures
6. Conclusion
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Introduction• Obesity has become a global epidemic, and is on the rise in
Singapore.
• This is contributed by an increasingly sedentary lifestyle and easy access to calorie-dense processed foods.
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Introduction• Many studies have shown that bariatric surgery provides safe,
effective and durable weight loss compared to dietary modification and exercise
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Principles of Bariatric Surgery1. Restriction
– Limits caloric intake by reducing the stomach’s reservoir capacity
– Induces a sense of satiety with reduced amount of food ingested
2. Malabsorption
– Decreases effectiveness of nutrient and caloric absorption by surgically decreasing the length of functional small bowel
3. Combination
4. Other effects
– Neuro-hormonal effects that act both on the gastrointestinal (GI) and extra-GI systems
– Not entirely well understood
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Principles of Bariatric Surgery
• All surgeries are performed laparoscopically under general anaesthesia
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Types of Bariatric Procedures
Restrictive Malabsorptive Combination
Sleeve gastrectomy Biliopancreatic diversion (with duodenal switch)
Roux-en-Y gastric bypass
Adjustable gastric banding
Jejunal-ileal bypass Single loop gastric bypass
Vertical banded gastroplasty
Sleeve gastrectomy and Roux-en-Y gastric bypass are the 2 most commonly performed bariatric procedures in Singapore
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Roux-en-Y Gastric Bypass
• One of the first few bariatric procedures to be proven to be safe and effective
• “Gold standard” procedure against which newer procedures are compared against
• One of the most common procedures performed worldwide, though numbers are on a downward trend
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Roux-en-Y Gastric Bypass
Restriction
Malabsorption
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Gastro-jejunal anastomosis
Gastric pouch
Small bowel
Small bowel anastomosisBiliopancreatic limb
Common Channel
Roux limb
Completed Gastro-jejunal anastomosis
Gastric pouch
Small bowel
Gastric pouch formation
Gastric pouch
Excluded stomach
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Roux-en-Y Gastric Bypass
• More effective and sustained weight loss, with higher rate of diabetic resolution compared to sleeve gastrectomy
• Suitable for patient with hiatus hernia / symptomatic reflux disease (which may worsen after sleeve gastrectomy)
• Longer surgery time, higher complication rates
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Sleeve Gastrectomy
• Initially offered as a “first-stage procedure” for patients who are super obese (BMI >60) to induce weight loss before undergoing Roux-en-Y gastric bypass
• Weight loss from procedure was so effective that many patients who underwent sleeve gastrectomy did not require second procedure
• Increasing popularity to become the most commonly performed bariatric procedure worldwide in the last 5 years
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Completed sleeve gastrectomy
Gastric sleeve
Greater curve resection
Gastric sleeve
Resected stomach
Stapling device
Greater curve mobilisation
Stomach
Omentum
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Sleeve Gastrectomy
• Mainly a restrictive procedure
• Also has effects on gastric emptying and hormones secreted by gastric fundus affecting satiety
• Increasing popularity due to simplicity of procedure, short operating time, effectiveness in weight loss and lower complication rates
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Other procedures
• Other procedures that are less commonly performed in Singapore include:1. Single loop gastric bypass (“mini” gastric bypass)2. Biliopancreatic diversion with duodenal switch3. Adjustable gastric band
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Single Loop (“Mini”) Gastric Bypass
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Adjustable Gastric Band
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Biliopancreatic Diversion With Duodenal Switch
Resected stomach
Duodenal-jejunal anastamosis
Long length bypassed small bowel / alimentary limb
Short common channel 75 – 100cm
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Conclusion
• Many procedures have been proposed in an effort to induce effective, durable and safe weight loss for obese patients.
• Procedure selected for patients has to be individualized based on patient profile, disease factor and surgeon expertise.
• The obese patient has to be managed by an experienced and dedicated multidisciplinary team, in order to achieve the best outcome.
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Thank You!