Treatment Of Morbid Obesity Essay

1958 words - 8 pages

The conventional way to treat morbid obesity via bariatric surgery has changed as medicine has evolved over the years. In 1973, Dr. Ward Griffen first performed an open gastric bypass surgery utilizing a modified version of the Roux-en-Y gastrojejunostomy (Smith et al., 2004). This procedure created a 50 mL gastric pouch that had a Roux-limb (Smith et al., 2004). However, in 1999 the medical world changed again when a laparoscopic version of the Roux-en-Y surgery was adopted after Drs. Wittgrove and Clark performed the first one (Smith et al., 2004). Today, the conventional and most commonly preformed bariatric surgery is the laparoscopic Roux-en-Y gastric bypass; this method is favored over an open route. In 2005 alone, Weller and Rosati found that over 75% of gastric bypass surgeries performed that year were laparoscopic surgeries (Banka et al., 2012). According to Suter et al, the laparoscopic option is becoming more appealing due to its lower postoperative complications and quicker recovery time as compared to open gastric bypass surgery (2003). In addition to having a quicker recovery time, laparoscopic surgery tends to result in shorter hospital stays and less blood loss during surgery (Siddiqui et al., 2006). Although the Roux-en-Y gastric bypass procedure is a fairly complicated procedure, skilled surgeons can accomplish the surgery with little-to-no mortality.

The typical laparoscopic Roux-en-Y gastric bypass surgery technique is described as follows. However, there are many variations and many preferences are left up to surgeon’s choice, such as the type of stapler used for the gastrojejunostomy (circular vs. linear). There are three main steps in the Roux-en-Y bariatric surgery: creation of the gastric pouch, creation of the jejunostomy, and anastomosing the jejunum to the pouch, also known as the gastro-jejunostomy (Higa et al., 2001). However, these steps are not necessarily done in that order; some surgeons prefer to divide the jejunum and create the jejunojejunostomy first before creating the gastric pouch. No significant difference in outcomes is seen if the gastric pouch is made first versus if it is made second (Dorman & Ikramuddin, 2012).

Before port placement of the trocars and instruments, initial set up is done. The patient is initially placed in a supine position with the arms laid out and the operating table is at a neutral position (Schauer et al., 2003). The patient is given a general anesthetic and a bladder catheter is placed (Schauer et al., 2003). The surgeon stands on the right of the patient and an assistant stands on the left, however in some cases the surgeon may stand between the patients legs; this is left up to the surgeon and what he is comfortable with (Higa et al., 2001). After the initial set up, a pneumoperitoneum is performed in which carbon dioxide is insufflated into the abdominal cavity with a Veress needle at the left upper abdominal quadrant until the pressure is 15 mm Hg (Shauer et al., 2003)....

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