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Gastric reduction risks, costs and indications
contents
- The last option
- Only with extreme overweight
- No substitute for a diet
- Diseases are an indicator
- Mental stability required
- Controlled living is necessary
- Reduction or bypass?
- The tube stomach
- The gastric bypass
- Biliopancreatic Diversion (BPD)
- Pays the health insurance for gastric reduction?
- How big is the success?
- pitfalls
- Psychological help
- Changed relationships
- The skin apron
- Conclusion
The last option
This intervention is the last option. Anyone who suffers from "normal" obesity, does not change his diet, does not exercise, takes in too much sugar, indulges in alcohol and generally likes hearty food, is not advised by a responsible doctor or a serious doctor to stomach reduction.
After all, it is an intervention that can not be undone. Target group are rather morbidly obese people - it refers to the pathological not on eating disorders that have a mental cause.
If all other approaches have failed, surgical measures such as gastric reduction can help morbidly overweight people lose weight. (Image: max dallocco / fotolia.com) Only with extreme overweight
Some people suffer from a body mass index over 40, which has mainly biological origins: they store a disproportionate amount of fat in the body and also suffer from severe overweight, if they eat a balanced diet.
No substitute for a diet
Without concomitant diseases, a doctor advises even in severe obesity only to a gastric reduction, when all conservative therapies are exhausted. This means that the patient has changed their diet over the long term, they are physically active in the context of their overweight. Nevertheless, her weight has remained at a level for at least three years that severely restricts a normal life.
Diseases are an indicator
Comorbidities such as high blood pressure, sleep pauses and diabetes as a result of being overweight are harsh medical indicators, and doctors recommend surgery even if the BMI is over 35.
Mental stability required
In addition, those affected must firstly be of age, secondly emotionally relatively stable, third, they must have neither mental disorders nor abusing substances. This is particularly important because after surgery, doctor-patient collaboration plays an important role.
Controlled living is necessary
The operation is not enough. Anyone who continues to shed alcohol or take drugs that are harmful to the metabolism, those who consume sugar in high doses, etc., does not suffer from obesity as before, but he puts a strain on the residual stomach burdened by the procedure serious illnesses can be the result.
Reduction or bypass?
In principle, surgery has two options for reducing extreme overweight. First, to shrink the stomach. A smaller stomach can consume less food, and sufferers are more saturated faster.
The urge to eat without limits, which many people with morbid obesity, is thus stopped. Possible surgeries are the tube stomach and the gastric band.
A bypass bypasses a part of the digestive tract, thus limiting the absorption of nutrients.
A commonly performed procedure in bariatric surgery is the peritoneal surgery. In this, a large part of the stomach is removed, so that the patient can absorb less food. (Image: bilderzwerg / fotolia.com) The tube stomach
This stomach reduction bears her name because the result has the form of a tube. The residual stomach takes up less than a tenth of the amount of a normal stomach, so about 150 ml instead of two to three liters.
Not only can those affected absorb less, they also do not produce the starvation hormone ghrelin, because the part of the stomach in which it is produced is removed. So you feel full faster in every way.
This can not be done without complications: it can not be done without complications: the tubular stomach no longer produces enough intrinsic factor, which promotes the absorption of vitamin B12 in the small intestine, and patients must take vitamin B 12 supplements on a permanent basis.
The operation is difficult, as the gastric sutures must be absolutely leak-tight, as through a hole gastric contents could enter the abdomen and this would lead to the dreaded inflammation of the peritoneum.
The gastric bypass
A gastric bypass is much more complicated than a stomach. The big advantage is that it not only reduces the intake of food, but also the absorption of nutrients.
Patients with morbid obesity often suffer because their body does not adequately utilize nutrients.
The disadvantage is that patients usually suffer from nutrient deficiency after surgery. They have to eat vitamins, protein and trace elements until they die.
The operation is performed under general anesthesia and is a serious procedure. The doctor first shrinks the stomach and then sutures it with a loop of small intestine to exclude the duodenum from digestion. As a result, however, the patient does not get enough calcium, iron and vitamin B 12 in the long run. These must therefore be supplied artificially.
Gastric bypass relocates the gastric outlet and connects it directly to the small intestine. As a result, the ingested food no longer passes through the duodenum, but passes directly into the lower small intestine. (Image: bidaya / fotolia.com) Biliopancreatic Diversion (BPD)
With the BPD a higher capacity is preserved than with the classical gastric reduction, namely up to 300 ml. The surgeon links the gastric remnant as with the gastric bypass with a small intestine loop and thus avoids the upper thin and the duodenum.
But the BPD also redirects the digestive juices, which provide for the absorption of nutrients - for the surgeon puts the small intestine. Thus, the juices from bile, liver and pancreas continue to do their job, but the distance is reduced seriously.
A maximum of one meter of the small intestine still absorbs fats, carbohydrates, vitamins and minerals. The goal is for patients to lose weight without suffering from a nutrient deficiency.
Pays the health insurance for gastric reduction?
Health insurance companies cover the costs of such stomach reduction only in individual cases and with a clear medical indication. In order to be reimbursed for an operation, it is necessary to undergo a multi-faceted therapy.
The team includes not only surgeons, but also internists and psychologists, exercise therapists and nutritionists.
Put simply, if the health insurance company suspects that you are performing surgery to avoid conservative treatment, it will not pay. It also does not pay if their obesity is firstly in the frame and secondly has no biological causes.
However, this coincides with the indication of the responsible physicians, and this means that if you have serious reasons to undertake such an operation, you are likely to get paid.
How big is the success?
The success of this operation is so great that most patients are happy to accept the lifelong support of vitamins and minerals.
However, you have to "play along" permanently. If you change your diet and develop an appropriate exercise program with advice from physical therapists, you will lose up to two thirds of your overweight in just two years.
pitfalls
But beware: the psychological and therapeutic support is not just an organizational framework. Anyone who is accustomed to consuming high calories can continue this (often addictive) behavior by supplying the stomach with small amounts but extremely high-calorie foods.
In addition, the tube stomach can be stretched again if you take large portions in the long term. There is a risk here that you "normalize" your eating habits - that is, you lose weight and get used to "eating like the others"..
After treatment, psychological support is important to breaking deadlocked behaviors and habits. (Image: VadimGuzhva / fotolia.com) Psychological help
For the aftercare belongs above all the psychological counseling. The victims had previously been established in their extreme overweight. Although the mental indication "eating addiction" is not essential for an operation, but a certain lifestyle, which is associated with the obesity (obesity), may and should no longer exist after the procedure.
For example, people with severe obesity have rarely moved. They were unable to perform many physical tasks, such as manual work, relying on the help of others.
Changed relationships
Mostly affected people have to learn after the operation, the physical participation of a normal-weight people in the social life again. This new independence is not only unknown to them, it also changes the relationship structure down to the partnership.
In marriage and the family, everyday life changes. Partners and partners, whose role was also to support the obese, do not have to and can not put these crutches and they often have problems with it.
Another danger is that those affected are over-committed. From long mountain hikes to danced nights, they then try everything they were physically unable to do before they had developed the necessary fitness.
Also, do not mess with "fake friends." Anyone who has made fun of you because of their body and now looking for their closeness is not worth a friendship.
Even in the circle of friends and acquaintances you should be skeptical with compliments that relate only to their appearance. Serious conversations about the operation, the changes in life, and subsequent comments on her changed body have a very different quality.
This also applies to sexual contacts. They work differently if you reduce their weight, but you are still the same person. Anyone looking for a (sexual) relationship with them will have the same similarities, problems and conflicts with them as before.
Be sure to share with other sufferers, because the problems you have after surgery will share other patients and they can give you good advice.
Last but not least, if you had problems before the operation, whether in the psyche, in the job or the finances, then they do not dissolve by a lower weight in the air. Even in the aftermath of the conflict, conflicts persist and you will continue to struggle.
The skin apron
Reputable doctors warn against equating surgery with an ideal body. Remains, however, usually a skin apron. The excessively stretched skin now hangs like an empty sack on the body, and patients suffer from not looking as aesthetic as they would like.
The greater the excess weight was before, and the more the patients lost weight, the larger is this skin apron but - there is no way around.
Follow-up operations are necessary, and the health insurance pay only for clear opinions - above all, the psychological assessment now plays a role, because in contrast to gastric reduction is tightening the fat apron is an aesthetic issue, not a medical.
After gastric reduction, additional surgery may be needed to remove the excess skin. (Image: bidaya / fotolia.com) Conclusion
A gastric reduction or gastric bypass should be considered very well - by all parties involved. Consult extensively with a variety of experts, surgeons, psychologists and nutritionists about a possible surgery.
Check if you have really exhausted alternatives. Many fat people know the "miracle", if you regularly exercise strength training and actually take in the long run vegetables, fruits, wholemeal bread, low-fat fish, etc..
In the first few months, you only lose a few pounds, then fall, without you suspected, in a "second phase" the pounds. The better-trained body now burns significantly more calories even when at rest, and moreover you move much more than before, often without realizing it.
On the other hand, if you've gotten used to a lifestyle that promotes fatigue, it's very hard to imagine another. You may now sincerely think you have done everything, but you never learned to reduce sugar in your daily routine or to integrate gymnastic exercises into your daily routine.
However, if an operation is really appropriate, then it is an intervention that is not easy - but with proper behavior it will bring massive weight loss. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)