Procedures of Intra-gastric Balloon

For patients who are overweight but are still indecisive about undergoing surgery, endoscopic intra-gastric balloon is an option. A saline-filled balloon will be placed inside the top of the stomach, reducing stomach volume and giving a sensation of satiety. This is only a TEMPORARY treatment, as the balloon cannot be placed in the stomach for more than 6 months. Patients should maintain a balanced diet and exercise regularly for effective weight loss.

 

Procedures of Intra-gastric Balloon

Placement of gastric balloon is relatively simple compared to other surgeries. Patients will be sedated and a balloon will be placed inside the stomach with the help of an endoscope. Saline with blue dye will then be injected into the balloon via a catheter. The volume to be injected depends on the patient’s condition, which is about 400-600ml in general.

The procedure takes around 30 minutes and hospitalization is not usually required. Fluid diet is usually advised for the first week after procedure. Also during the first week after balloon placement, patients may experience stomach discomfort or pain, vomiting and abdominal distention.

 

Benefits of intra-gastric balloon

• Low risk: Intra-gastric balloon is a non-invasive and low risk procedure. Patients can experience quick recovery, and no general anesthesia is required.
• Improved eating habits: Patients will easily experience fullness during food intake and thereby reducing volume. The speed of food intake is also important and needs to be adjusted. Dietitian will be instructing you on various eating habit changes.
• Reversible: Placement of the balloon is only a temporary measure. Patients need to continue with their eating habit changes to maintain their weight loss.
• Widely applicable: Patients with lower BMI may also consider to undergo this low risk procedure.

Risks of intra-gastric balloon

• The balloon may break and cause leakage and bowel obstruction.
• Intra-gastric balloon may cause gastric ulcer, although this is rare.
• Some patients may experience severe discomfort and vomiting.

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

 

胃摺疊手術

簡介
     

將大胃囊以摺疊方式縫合，使胃容量存留約 100 c.c.，藉由胃囊摺疊減去過多的體重，此為可逆性手術。

併發症

• 死亡。全世界的統計數字顯示減重手術引起的死亡率約為1/200，一般來說，手術死亡的定義為手術後三十天內。
• 胃食道逆流。有些病人接受手術後會出現胃食道逆流或嘔吐的現象發生，此時應回門診。
• 心臟病發。肥胖病患常有高脂血症引起動脈硬化，容易引致心臟病發作，手術前醫師會安排一系列的心血管檢查。若有血管阻塞的問題，一般會建議先處理心臟疾患。
• 肺炎。腹部手術的病人因為活動力下降因此容易出現痰多不易清除的現象。但因為現今都是腹腔鏡手術，下床活動通常不受限制，因此很少見到。
• 維生素缺乏。會教導你如何從食物的補充。
• 胃囊破裂。胃部血液循環差而造成感染破裂，需再次手術。
• 胃套疊。摺疊胃出現阻塞，此情況甚少發生，若出現須手術矯正。

參考資料: www.antifat.tv/
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的外科醫生查詢，而不應單倚賴以上提供的資料。

減重手術常見問題 (三)

Ｑ：請問胃繞道手術是否會造成脫髮的後遺症？如果會，是因為什麼樣的原因呢？


Ａ：胃繞道手術偶爾是會造成輕微的掉髮的後遺症，因為手術後，減重速度快導致維生素與稀有元素吸收減少與蛋白質攝取缺少而發生，一般在術後3－6個月較為明顯，通常透過門診的飲食指導便會改善。



Ｑ：如果術後減重速度緩慢，這該怎麼辦？


Ａ：如果術後減重速度緩慢，代表你的飲食種類與熱量平衡大有問題，如高熱量的飲品、蛋糕，或是欠缺運動習慣的培養，術後我們會安排回診與營養師衛教，可減少此情況產生。



Ｑ：何謂術後黃金期？

Ａ：「術後一年的黃金期」是指術後一年內減重效率最佳，一年後減重效率會逐漸減緩。因為小胃囊是會逐漸變大的，因此食量也會逐漸增加，因此應該把握這一段時間的黃金期，少吃高熱量的食物，少碰甜食，並配合營養師的指導。



Ｑ：健保局對減重手術規定為何？有無給付？


Ａ：健保局對減重手術規定如下，實施胃隔間術應符合下列各項條件：

 - 年齡在18－55歲。
 - 飲食或藥物控制半年無效。
 - 無嗜酒或異常之精神疾患。
 - 非因藥物、代謝性疾病或內分泌疾病引起的病態性肥胖。
 - 肥胖超過五年以上。
 - 病態性肥胖：BMI達35並己合並有因肥胖引起之合並疾病或BMI達40的。
 - 健保局目前只給付胃隔間手術，但胃隔間因為復胖機會較高，此手術已是被醫界淘汰術。




參考資料: www.antifat.tv/
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的外科醫生查詢，而不應單倚賴以上提供的資料。

減重手術常見問題 (二)

Ｑ：做胃繞道手術後會有幾個小傷口？另外胃就被切除掉嗎？還有一段沒用到的腸子閑置，會因太久沒用而壞死嗎？

Ａ：做胃繞道手術後，會有五個1公分的小傷口，而胃或腸並沒有被切除掉，只是把它分成二套系統。胃和腸子都會有各自的功能，有些分泌消化液，有些吸收，有些運送食物，不會有開置或壞死的問題。



Ｑ：做了胃繞道手術後，是否一輩子都只能吃4顆水餃的食量，永遠吃不多，造成營養不良，永遠都得補充維他命過活？

Ａ：做了胃繞道手術後，並不是一輩子都只能吃4顆水餃的食量，胃容量會逐漸增加，一般來說，一年後可以吃7－8成飯量，因此並不會造成營養不良，但是需要長期補充維他命。



Ｑ：減重手術後會有那些症狀？


Ａ：前2周因為飲食量大幅減少會有容易頭暈的症狀，第一個月則因為未適應食量改變，會偶有打日商或嘔吐現像，因此須聽從醫師及營養師的飲食指導及維他命補充。大概1至2星期後，可恢復一般上班族正常的工作，手術後1個月可以開始做一些有氧運動。



Ｑ：做了胃繞道手術後會有得癌的風險嗎？


Ａ：做了胃繞道手術後，因為食物不經過大胃，得胃癌的風險並不會升高，只是不易檢測。



參考資料: www.antifat.tv/
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的外科醫生查詢，而不應單倚賴以上提供的資料。

減重手術常見問題 (一)

Ｑ：如果還沒滿18歲，能動胃繞道手術嗎？


Ａ：一般而言，減重手術的年齡健保限定在18～55歲，主要是身心成熟與減重效率的考量，當然還是以醫師評估為主。在歐美執行手術的範圍已經放寬至14～65歲。



Ｑ：我是女生，有甲狀腺低下，可以進行胃繞道手術嗎？


Ａ：肥胖有一小部分是因為甲狀腺低下的內分泌失調所引發，所以應該先以調整甲狀腺功能為先。當然也必須知先釐清肥胖的真實成因，一般來說，如果甲狀腺功能回復正常，仍不能減輕體重，則是手術介入的時機。



Ｑ：我長期有吃減重藥，如果要做手術的話，有沒有要停藥多久以後才能開刀？


Ａ：吃減重藥的問題在於影響肝腎功能以及停藥後的反彈性復胖，做手術與停藥多久並沒有直接的關聯，但手術前須先予以詳盡身體功能評估，以暸解藥物是否造成傷害。



Ｑ：胃繞道手術完成後，除了把胃變成大胃跟小胃，還有腸做繞道以外，裡面還有遺留東西嗎？例如釘子之類？


Ａ：胃繞道的手術過程中，須切割與接合腸胃道，都會使用自動縫合釘。手術後，會有小釘留存於體內，但並不會影響身體健康。



參考資料: www.antifat.tv/
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的外科醫生查詢，而不應單倚賴以上提供的資料。

Type II DM Control after Bariatric Surgery (2)

Bariatric surgery VS conventional medical therapy [3]

In another randomized, single-center, non-blinded, controlled trial, 60 patients with BMI over 35, a history of type II diabetes for over 5 years and HbA1c level over 7.0% were given either conventional mediation therapy or bariatric surgery. Two types of bariatric surgery were selected in the trial, which are gastric bypass and biliopancreatic diversion. The rate of remission of diabetes after 2 years was selected as the primary end point of the trial, defined as fasting blood glucose level less than 5.6mmol/L and HbA1c level less than 6.5% without the use of medication.

After two years of follow-up, bariatric surgery had resulted in better glycemic control than medication therapy alone. For the primary end point, one of the patients in the medical therapy group had any diabetes remission, compared with 75% in gastric bypass group and 95% in the biliopancreatic-diversion group. (Figure 2) Also, the average glycated hemoglobin level had decreased in all groups, though surgical groups had the most significant degree of improvement.



(Figure 2)

 

 

Efficacy of bariatric surgery

As reported in a meta-analysis published in 2004, bariatric surgery is shown to be effective for the majority of morbidly obese patients in terms of weight loss, as well as resolving or achieving complete resolution in obesity related co-morbidities, such as diabetes, hyperlipidemia, hypertension and obstructive sleep apnea.

The effectiveness of bariatric surgery has received recognition in the medical field. The International Diabetes Federation had recommended physicians to include bariatric surgery in the treatment plan for obese patients with type II diabetes and BMI over 35, or as a treatment option for those BMI ranged 30-35 in uncontrolled type II diabetics. On the other hand, recommended BMI should be lowered by 2.5 for Asians due to strong genetic predisposition.

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Type II DM Control after Bariatric Surgery (1)

Type II diabetes is currently one of the fastest growing epidemics in known human history. It is generally agreed to be closely associated with obesity, with various clinical manifestations. Besides, multiple risks factors are involved in the causation of diabetes.
Moreover, diabetes has a progressive nature with no cure at present. Disease control is performed by continuous monitoring and re-assessment of diabetic management measures.
Prognosis of the disease usually leads to intensification of therapy with increasing dose of OHA, including insulin, according to the generally accepted algorithms provided by American Diabetes Association. [1]


ADA diabetes treatment algorithms suggested lifestyle modification for patients at risk of diabetes. Once patients are diagnosed, metformin mono-therapy is the recommended first line treatment, followed by additional second-line medications if HbA1C target levels has not been achieved. Eventually, it will be the use of insulin.


The application of bariatric surgery in diabetic control has been studied and its effectiveness is compared against conventional treatment, such as intensive medication therapy. Patients seemed significantly benefited from bariatric surgeries in combination with medication therapy.


Bariatric surgery VS intensive medication therapy - STAMPEDE Trial (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently)

In a randomized, non-blinded, one-center trial, the efficacy of intensive medication treatment was compared with the combination of medication and bariatric surgery, either Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrollable type 2 diabetes. The primary end point of the trial was the proportion of patients with glycated hemoglobin level (HbA1c) 6.0% or less at 12 months after treatment. Moreover, change in fasting plasma glucose, average numbers of diabetes medications and change in BMI were the second end points of the trial.


It is concluded that 12 months of combined treatment of medication and bariatric surgery could significantly achieve glycemic control than medication alone, as only 12% of patients were able to reach the first end point, versus 42% in the gastric bypass group and 37% in the sleeve-gastrectomy group. The results of the other end points were shown in Figure 1.





(Figure 1)

 

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Why do we need to treat obesity?

Why do we need to treat obesity?

Indeed, obesity does nothing to help you fit into fashionable outfits and affects your appearance and confidence. However, more importantly, it may cause many chronic illnesses that affect your health and may even be fatal.

Obesity is associated with diabetes, hypertension, heart disease, ankle degeneration, sleep apnea, hyperlipidemia, as well as menstrual irregularity and hormonal disturbances in women.

Central obesity also plays a major role in causing metabolic syndrome, which significantly increases the risk of stroke, cardiovascular diseases and diabetes. Compared with Caucasians, there are more cases of central obesity among Asians.

Diabetes is another prevalent disease among Asians and should not be ignored. It is associated with numerous complications, including glaucoma and heart diseases. However, most diabetic patients often ignore the problem of obesity, and do not consider obesity as a disease.

The problem is often left aside until they realize that medication and insulin injections are still unable to control their blood glucose levels. Many patients will then seek help from their GPs who refer them to specialists for laparoscopic weight loss surgeries.

Having a BMI of 25-29.9 means that patients are overweight, while those with a BMI over 30 are considered as obese. According to APMBSS’s recommendations, laparoscopic bariatric surgery is indicated for Asians with a BMI over 32 who are suffering from diabetes or obesity-related conditions such as hypertension, or those with a BMI over 37.

Various weight loss methods:

Exercise and dietary control are the basic fundamentals of weight loss. Under suitable conditions, certain patients could also take prescribed medication to reach a healthy weight. However, for those between ages 18 and 65 who cannot consistently lose weight even by taking medication, following nutritionists’ advice and doing exercise, as well as those with a BMI over 37, or those with a BMI over 32 who are suffering from diabetes or obesity-related conditions, laparoscopic bariatric surgery may be the way to go.

This includes laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, laparoscopic gastric plication and laparoscopic gastric bypass, as well as a procedure known as intragastric balloon. Patients under the age of 18 may also undergo the above surgeries with doctor’s approval.

 

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

Obesity - Obesity Problem, Obesity Cause

If you consider having a big, round tummy like the Michelin Man as the symbol of fortune, you may need to think otherwise. Obesity not only has a significant impact on your health, it is also associated with a number of chronic illnesses, including type 2 diabetes and metabolic syndrome. Currently, there are various laparoscopic bariatric surgeries available for patients suffering from morbid obesity. Together with diet control and altering the absorptive system, weight loss can be achieved with a holistic approach.

 

What is obesity?

Obesity is resulted by the deposit of excess fats in the body. This is caused by the over absorption and inadequate output of calories. In fact, many people are gaining weight every day due to binge eating, having a fatty diet and lack of exercise. You can find out whether you are overweight by calculating your Body Mass Index (BMI). The BMI is an internationally approved standard in assessing the weight of adults.

The BMI formula is: weight (kg) ÷ (height (m) x height (m))

 

Reference information:  http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.