Suprun Alexey * Bariatric Surgeon * Suprun Alexey * Bariatric Surgeon

Suprun Alexey * Bariatric Surgeon

Longitudinal gastric resection is by far the most popular bariatric surgery in the world, including in our country.

It accounts for about half of all bariatric surgeries performed through 2022.

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    Bariatric surgeri - Suprun Alexey
    Bariatric surgeri - Suprun Alexey

    About the doctor

    Suprun Alexey

    D. thesis in 2012 on “Clinical and pathogenetic features of diagnosis and treatment of pulmonary contusion in severe combined trauma”.

    Author of 36 printed works and 1 methodical recommendation. 5 articles were published in the journals recommended by VAK.

    Longitudinal resection

    What are the indications and who gets a longitudinal gastric resection?

    Indication for longitudinal gastric resection as well as all other bariatric surgeries is a body mass index above 35, i.e. obesity of the second degree or obesity of the first degree – body mass index above 30 in the presence of one of the components of the metabolic syndrome such as type 2 diabetes mellitus arterial hypertension or other components of the metabolic syndrome.

    Sleeve gastrectomy

    How does longitudinal resection work
    and why does weight loss work?

    This surgery is considered restrictive – that is, it limits the amount of food eaten at one meal. Reducing the volume of the stomach makes it easier to get full quickly from small amounts of food.

    For my patients it is 90-100 ml as I perform this operation using the “tight drain” method on a narrow 33 Fr probe. However, on average it is 150 ml. If you eat more than this, you will experience discomfort, pain and vomiting. This is the restrictive mechanism.

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      Sleeve gastrectomy

      Longitudinal resection

      However, this is not the only mechanism for weight loss with this surgery

      The cells in the cardio-fundal part of the stomach produce the “hunger hormone” – ghrelin. It is this part of the stomach that is removed along with the greater curvature, and therefore the level of hunger hormone drops critically.

      In my opinion, this is why patients report that they have an aversion to certain foods that they previously favored. Another mechanism of action of this operation is to accelerate the passage of food through the stomach and as a consequence insufficient fermentation or digestion. This can be attributed to the hypoabsorptive or bypass effects of the operation.

      Surgery

      How is this surgery done?

      During the operation, a laparoscopy is performed and a special calibration probe is inserted into the stomach. Mobilization of the large curvature of the stomach is performed – it is freed from the large omentum. By the way, it is on the diameter of the calibration probe depends on the capacity of the stomach after surgery. Different surgeons use probes of different sizes from 31 to 45 French.

      I use a narrow 33 Fr probe to maximize the restrictive effect of the surgery.

      Sleeve gastrectomy
      Sleeve gastrectomy

      When the stomach is mobilized, the stapling device is calibrated with the probe so that the diameter of the gastric tube is the same throughout the new small stomach. Next, the entire greater curvature of the stomach is cut off with the stapling device, resulting in a tube with a volume of 70-80 and sometimes 100 ml.

      At the end of surgery, I personally always suture the stapler line by hand additionally – in my opinion, this reduces the risk of bleeding from the suture line and strengthens it to prevent insolvency.

      Risks

      It’s the most popular surgery!
      Can there be complications?

      Bariatric surgeri - Suprun Alexey

      Longitudinal gastric resection has gained popularity as a result of its apparent ease of performance and great potential for weight loss. However, this surgery only appears simple…

      Complications – and so, in addition to the standard complications of all laparoscopic surgeries such as bleeding, infection of the area of surgical intervention, damage to abdominal organs, one specific complication is characteristic of longitudinal resection – it is staple line failure. In fact, it is a point defect or a hole in the staple suture line after stitching with the device, which occurs on the 2nd-5th day after surgery.

      It should be understood that the stomach as a result of the operation is greatly reduced in size, becoming a high-pressure vessel clamped by two sphincters on both sides pyloric at the exit and cardinal together esophageal-gastric junction. Through the defect of the stapler line the gastric contents escape under pressure!!!

      Therefore, it takes quite a long time to heal – it can take from 1.5 to three to four months, and sometimes even a year, depending on the chosen method of treatment. Thank God today the technique of performing operations has been thoroughly developed and quality stapling devices are available. The incidence of such complications is now less than 0.5%.

      To summarize, longitudinal gastric resection is a great way to treat obesity and metabolic syndrome!

      For many of my patients, it has become the doorway to a new life without excess weight.

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        Results

        Before and after operations

        * photos posted with the permission of patients.