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The operation which we are going to describe briefly is the gastric bypass by laparoscopy.
This operation basically has two stages;
one of them is the reduction of the stomach,with the aim of reducing food intake
and the other is to change the circuit of the intestine , so that what is eaten is absorbed less.
In this diagram we can see how the operation works,
this is the reduced stomach , this is the intestine which has been moved to a different place,
and what comes through here is food without liquids,
and through this primitive stomach we get liquids without food.
When food without liquids meets liquids without food
from this point digestion takes place and food is absorbed.
Let's see, firstly what a laparascopic surgical theatre looks like,
and a surgical theatre to treat obesity by keyhole surgery.
In this photograph ,
you can see that the patient is lying on the operating table;
in the background we have the anaesthetist and two television screens,
the two surgical assistants, the technician and the surgeon, who takes up a position right between the patient's legs.
To be able to work comfortably ,we need space,
and this space, and this space is created by the introduction of
an inert , non-flammable gas into the abdomen which lets us
create a kind of arch to be able to move the intestine.
All surgical instruments
are going to be inserted through apparatus called trocars ,
which permit the apparatus to be inserted,but without allowing the gas to escape
so we do not lose the arch we have made.
Normally we use five pieces of these apparatus called trocars ,
and through them ,
we insert , firstly the optic cable,
through these two , the instruments operated by the surgeon's left and right hands respectively,
through this one , another grip and also through this one a separator for the liver.
and it is necessary to know that we are going to see the images magnified by 8 or 10.
Because the instruments we use have a diameter of 5 or 10 millimetres.
Going back to the diagram we showed at the beginning,
we can see the two stages of the operation;
one is the reduction in size of the stomach and the other
the elevation of this part of the intestine which moves to another place.
So, we start with the intestine , not the stomach.
We have started the operation
and the first thing we are going to do is move towards the small intestine and cut it,
To cut it as we wish to we use instruments called staplers
which fix three lines of staples on each side
and cut in the middle.
Once the intestine has been divided , we insert the furthest part,
meaning we choose between a metre and a metre and a half in length
and this part is the part we raise to be able to join it to the stomach which we later reduce in size.
In this moment, we join
that part of the intestine we have chosen, the closest edge ,
to that point which is one metre or one and a half metres away
from the edge which we later raise to join to the stomach.
In this image ,we can see that this is the closest part of the intestine ,
this is the furthest part of the intestine ;
the metre or metre and a half of intestine that we have chosen comes down here
and we join the two parts so that liquids and food pass from one side to the other.
What comes next is very important,and what's more
it is one of the most difficult phases of the operation ,
one of the most difficult techniques to perform by laparoscope
which is sewing the parts of the intestine together.
But you can see that these parts can be sewn together perfectly,
probably more precisely than if it were open surgery,
because we can see it all magnified by six or eight.
Now we have finished the link, or gastomosis , between two parts of the intestine.
In this image,we can see that this is now concluded.
All this yellow part , I should say , is fat.
We are now at the upper part , so to speak,and the stomach is not visible.
We only see the stomach when we have raised the left lobe of the liver.
That is when the entire length of the stomach appears
and what we are going to do now is cut the stomach,
first horizontally, then vertically so we can
create a small stomach to one side
and the large stomach stays on the other side.
We should emphasise in this moment
that nothing is removed , we only change the location , nothing is removed,
this means that this is a reversible operation.
You could say , put it back as it was , and it could be done.
To find out how we are going to make this stomach ,and for it to be always the same size,
we use a calibrator inserted through the mouth,
to ensure that the stomach we leave is practically the same in every patient.
What is going to change is the length of the intestine - by between one metre and a metre and a half.
In this photograph we can see that all the vessels are respected,
as are the nerves in the stomach , meaning that the stomach which remains is not redundant ,
but a stomach which is vascularised and which retains nervous activity.
Now we have finalised the creation of the reservoir ;
the reservoir is the small stomach which will be used for eating.
Next , we take that part of the intestine which we had left below
and we bring it up ,to join it with the reservoir.
we are now going to begin the most important phase of the operation
and also the most difficult , which is joining that small stomach with the intestine.
This phase is crucial , because how food passes depends on it,
and there must be no kind of loss or leakage at this stage in digestion
so the patient , finally , has a comfortable feeling when ingesting food.
Once we have finished this gastomosis , this linking ,
we have to check that its diameter is correct
and that there is no loss or leakage , either.
To do this we use the same tube we used to calibrate the reservoir.
we pass it through this loop to ensure it has an appropriate diameter
and we inject a dye , which in this case is called methylene blue
to check there is absolutely no leakage.
Once we have checked that this phase is complete , we finalise the operation
by positioning a drain , close to this linking ,
which will tell us if there is any complication in the post-operative period.
As you can see , we have performed successive checks to give this operation
the absolute safety it deserves ;
the day after the operation ,the patient , before drinking anything ,
goes to have an X-ray , having taken a sip of liquid contrast , and we check once more
that the whole process works properly.
From this moment , when we get the radiological confirmation that everything is correct , the patient can start to drink
and starts with liquids , moving up to semi-solids.
He or she will be allowed home on the third day after the operation
and the drain is removed on the sixth day.
With this presentation , we believe we give a good idea
of what a gastric by-pass by laparascope is like ,
the operation being performed with absolute safety.
From this moment, the patient will start to lose weight ;
in the first three months it is estimated that he or she will lose 40% of excess weight ,
in the first six months this rises to 60%,
and after a year approximately between 80 and 85% of excess weight.
Most of the associated illnesses from which they could suffer will disappear
and the quality of life they enjoy is absolutely , definitely normal,
with the self-confidence provide by a new look which is much more easily accepted by society.
We are here , precisely for this reason -
to give back their physical and psychological health to all those people who need it.