With procedures such as the tube stomach, bariatric surgery limits the maximum possible food intake of severely overweight patients between the ages of 18 and 65 who can demonstrate either a BMI over 40 or a BMI over 35 and secondary diseases such as diabetes. Prior to the procedure, patients must demonstrate in a consultation that they have already exhausted all conventional weight loss methods without success and do not suffer from addiction problems or psychoses. During the one-hour, restrictive and minimally invasive procedure, the physician removes most of the stomach, leaving only a tubular stomach remnant that helps the patient lose weight by limiting the amount of food they can eat.
What is the tubular stomach?
The tubular stomach is a bariatric surgery procedure designed to help individuals with severe obesity lose weight by limiting maximum food intake to a minimum. The tubular stomach is an obesity surgery procedure designed to help people who are severely overweight lose weight by keeping their maximum food intake to a minimum. The procedure is one of a total of four recognized standard bariatric surgery techniques and is often combined with one of three other surgical options. Tube stomach surgery is a minimally invasive surgery that belongs to the restrictive procedures of bariatric surgery. Restrictive in this case means that the maximum possible food intake is minimized by reducing the volume of the stomach. The tubular stomach has become extremely popular in the 21st century and, according to statistics, was even able to overtake gastric bypass in 2012. The procedure can be expected to reduce obesity by 70 to 80 percent and, equivalently, minimize the risk of obesity-related secondary diseases. In addition, the patient’s general well-being usually increases after the operation.
Function, effect, and goals
The goal of a tube stomach is to limit the volume of the stomach. The smaller the capacity of the stomach, the less food the patient can eat. He will therefore be less hungry and weight reduction will be easier as a result. In the end, however, in addition to food intake, the tube stomach also regulates the risk of secondary diseases in people who are extremely overweight. The procedure is often performed in combination with another bariatric surgery. Tubular stomach surgery is particularly common in the form of revision surgery with previous implantation of a gastric band. Apart from this, the tubular stomach is also known as the first procedure of the two-step method, which is supplemented by a biliopancreatic diversion according to Scopinaro after about two years. This supplement combines the limitation of the maximum possible food intake with a restriction of nutrient intake. The physician places the patient under general anesthesia to perform a tubular stomach surgery and then operates in a minimally invasive manner. To do this, he cuts the stomach with an ultrasound dissector at the large curvature. This incision is made just below the esophagus, where the stomach can be disconnected from the network connecting it to the spleen. Along a calibration tube at the small curvature, the physician removes most of the stomach with staple cutting instruments and laparoscopically sutures the tubular remainder of the organ. In this way, the physician reduces the stomach volume by about 80, sometimes even 90 percent. The surgery takes about an hour in total, and the doctor usually checks the tightness of the stomach remnant before completing the procedure.
Risks, side effects and dangers
Obesity surgery procedures such as the tubular stomach are preceded by an in-depth consultation in counseling centers set up specifically for this purpose. In this consultation, the respective benefits and risks of the surgery for the patient are clarified. For overweight people, surgery is generally associated with higher risks than for those of normal weight. However, minimally invasive techniques keep the risk to a minimum. Therefore, the complication rate for the tube stomach is only one percent. In the preceding consultation, the patient must prove that all conventional methods of weight reduction have already been exhausted without success, despite these now acceptable risks.A Body Measure Index above 40 is also considered a prerequisite for surgery. Alternatively, a BMI above 35 in combination with obesity-related diseases such as diabetes is also sufficient. The extreme overweight must also have existed for at least three years, and the patient should have a biological age between 18 and 65. Apart from that, the procedure does not take place on people with psychoses or addictions. Even after the procedure, the patient is assisted by a counseling specialist who provides guidance on how to slowly rebuild the diet. Substitution therapies with vitamin B12, for example, are generally and permanently indicated after gastric resections. Health insurance companies only cover the costs of a stomach tube in individual cases. The patient must therefore be able to credibly and convincingly demonstrate the necessity of the operation if he does not want to or cannot bear the costs himself. The tubular stomach does not require intestinal detour, which makes the procedure suitable for people with chronic inflammatory bowel diseases such as Crohn’s disease. Unlike most other bariatric surgery procedures, the ability to absorb medications in the gastrointestinal tract is preserved with the tubular stomach. However, the loss of the removed portion of the stomach is irreversible, so the procedure must be well considered for this reason alone. Patients are always admitted as inpatients for the operation and stay in the hospital for between about two and four days. Postoperative bleeding, thrombosis, or leakage of sutures sometimes occur, which may require a longer hospital stay.
