Definition
A tubular stomach is the result of a surgical reduction of the stomach. During the procedure, the hollow organ is reduced to about one tenth of its original volume. It is a procedure that may be considered in cases of extreme obesity, when all non-surgical weight reduction measures have been performed in vain.
The surgical production of a tube stomach results in a feeling of satiety after only a small amount of food has been consumed. This drastically reduces the calorie intake and the affected person can usually lose a lot of weight. The tubular stomach operation is the most frequently performed operation in Germany for treating extreme overweight by means of stomach reduction.
Indications for tubular stomach surgery
Tubular gastro surgery is only indicated in cases of pathological overweight (obesity per magna). In order for there to be a medical justification for the operation, a few additional conditions must be met. On the one hand, serious concomitant symptoms must be associated with the overweight.
These can be diabetes mellitus (“diabetes”) or degenerative joint disease, for example. Furthermore, all non-surgical measures to reduce body weight should have already been tried in vain. A high degree of suffering on the part of the patient as well as low chances of success of non-surgical measures can justify from a medical point of view a tube stomach operation at an early stage.
However, an important prerequisite for the indication is always the motivation and cooperation of the patient. These aspects must be assessed by the treating physician. If there is any doubt, this may result in a contraindication (contraindication) for the operation.
In order to establish the indication for the procedure, it is usually a prerequisite that the extreme overweight has existed for at least five years and that the patient is not older than 65 years. The general condition must also be good enough for the operation to be performed without increased risk. The first step in the preparation before a tube gizzard operation is to check whether the operation is justified from a medical perspective.
Furthermore, the patient is informed about the procedure, consequences and risks of the operation. The information must be provided in a way that the patient can understand and sufficient time should be allowed for consideration. As before every operation, various examinations are carried out before a gastro-tube operation, such as a blood test to determine the coagulation ability and the concentration of the red blood pigment haemoglobin.
Further examinations may be necessary for the patient depending on the circumstances. In some cases, an ECG is performed to evaluate the heart function. In addition to examinations, pausing or changing some medications may be another important step before performing a gastroschisis.
A gastro-tube operation is always performed under general anesthesia during an inpatient stay. In most cases, the procedure is performed minimally invasive using the “keyhole technique” (laparascopic). The surgical instruments and a camera are inserted through several small skin incisions into the abdomen, which is inflated with carbon dioxide gas.
The first step of the operation is to separate the so-called large net (omentum majus) from the stomach. In addition, a gastric tube is advanced over the throat and a stapler is inserted along this. This device is used to remove most of the stomach and at the same time suture it.
The separated part of the stomach is removed from the abdominal cavity through a small incision, which is usually made in the middle abdomen. Only the narrow tubular stomach remains, which is located between the esophagus and the duodenum. Once the actual procedure is complete, the carbon dioxide is drained off again, the surgical instruments are removed and the abdominal incisions are sutured.
The anesthesia is slowly drained until the patient wakes up. After performing a gastric banding operation, certain post-operative steps are necessary. First, examinations are performed to rule out the possibility of complications.
The function of the gastrointestinal tract is also checked after the operation. Another important part of the post-operative treatment is the careful mobilization of the patient as early as possible. Already one day after the operation the patient should get out of bed for the first time if possible.On the second day after the operation, a so-called gastrographin swallow is also performed.
During this procedure, the patient must drink a solution with contrast medium and is then x-rayed. This allows possible constrictions or leaks in the tubular stomach to be detected. The most time-consuming aspect of post-treatment after the creation of a tube stomach is the gradual build-up of the diet over weeks and months.
In the process, there is an increase from initially liquid, easily digestible food to normal food in small portions. The approximate duration of a tube stomach operation is about two hours. However, the time required depends on several different aspects and is only a rough average figure.
On the one hand, patient factors can influence the duration. For example, in cases of extreme obesity and previous operations in the abdominal cavity, the time required is higher. In addition, the duration of surgery depends on the experience of the surgical team and the center where the procedure is performed.
If there is a complication such as bleeding due to injury to a vessel, the procedure can also take significantly longer than two hours. The length of hospital stay due to a tube gizzard operation can vary greatly from individual to individual but usually ranges from a few days to two weeks. On the days following the operation, a few more examinations are performed.
In addition, the patient must be slowly mobilized. The length of stay in hospital also depends on how quickly the patient can take care of himself again and how well the wounds heal. If there is a disturbance in wound healing or another complication such as a leaking gastric suture, further surgery may become necessary and the duration of the hospital stay may be delayed accordingly.
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