Stomach Surgeries

 

Laparoscopic Partial Gastrectomy

  • Usually performed for benign or low grade tumours such as lipase or gastrointestinal stromal tumour (GIST)

Open Radical Gastrectomy

  • Indicated for gastric cancer after careful patient staging
  • Appropriate treatment algorithm based on stage (gastroscopy, CT scan and laparoscopy) and multi-disciplinary cancer meeting assessment
  • Patients often have pre-operative chemotherapy followed by surgery
  • Surgery is usually open surgery

Laparoscopic sleeve gastrectomy

  • In this procedure approximately 80% of the stomach is removed leaving a banana shaped stomach.
  • The surgery is done laparoscopically and results in a 2-3 day hospital stay.
  • Patients return to work in two weeks.
  • Weight loss is rapid and complete in about 12 months.
  • The average weight loss is 75% of excess weight.
  • The surgery works by restriction (smaller stomach) and gastro-intestinal hormonal changes.
  • There is a dampening (reduction) in the hunger hormone grehlin and an increase in satiety hormones such as GLP-1 and PYY.
  • The end results in less hunger and earlier satiety with a meal.

Advantages

  1. Rapid and significant weight loss in 12 months
  2. No foreign body
  3. No intestinal surgery
  4. Both a restrictive and hormonal procedure
  5. Good quality of eating.

Disadvantages

  1. Non-reversible
  2. Potential micronutrient deficiency
  3. Gastro-oesophageal reflux in 15% of patients

Laparoscopic gastric bypass (RYGB)

  • The surgery like the sleeve works with a restrictive component and a gut-hormone component.
  • Again, hunger hormones are dampened and satiety hormones enhanced.
  • Patients are less hungry and sated with small amounts of food.
  • Weight loss is significant and rapid occurring over 12 months.
  • The average weight loss is 75% of excess weight.

Advantages

  1. Long-track record
  2. Reversible
  3. Good weight loss
  4. Good quality of eating

Disadvantages

  1. Risk of small bowel obstruction
  2. Risk of stomal ulcer
  3. Dumping syndrome
  4. Risk of micronutrient deficiencies

Laparoscopic adjustable gastric band

  • Placing an inflatable band around the upper portion of the stomach creating a small gastric pouch above the neck of the stomach.
  • The AGB works by reducing hunger.
  • The mechanism for this is not well understood.

Advantages

  1. Very safe to insert
  2. Short hospital stay (24 hours)
  3. Reversible
  4. Low risk of micronutrient deficiencies

Disadvantages

  1. Slow weight loss
  2. Poor weight loss in many
  3. Food intolerance, reflux, vomiting
  4. Device failure
  5. High re-operation rate