Prior to choosing the right technique, it is important to understand the changes made to the body when obesity occurs. In addition to external appearance, structural changes in the internal organs are induced: increase of the stomach and dome and cells producing ghrelin, increase in length and absorbance of the small intestine.
These basic changes affect the brain, the center of hunger, so people are more hungry and bulimic. To solve the vicious circle in the first phase, we must try to reduce the stomach. To achieve this, we use restrictive techniques, such as the gastric ring and the gastric sleeve.
The choice of technique co-decides with the obesity surgeon and depends on a number of factors related to the patient’s lifestyle and character. For example, if the patient’s place of residence is far from the place where the surgery is performed, or if the patient can not follow the instructions of the treating physician, the gastric sleeve is chosen, which is also considered as a selection method for a diabetic patient.
If the patient is willing to try and only needs a little help to lose extra pounds, or if he is afraid of the interventions the ring is the choice of choice. If a ring is fitted and the outcome of surgery is not expected, either due to bulimia, or stretching of the esophagus or slipping the ring, conversion to a gastric sleeve is the ideal solution. If the initial surgery is a gastric sleeve and recurrence occurs in a few years, we need to study whether the sleeve is wide or stretched, so the fold is applied, a simple, quick and safe operation.
If the size is typical and the patient is relapsed, the cholecogranial bypass should be completed, a technique that has great success rates. In any case, less invasive techniques, those that do not change the physiology of the patient and limit the time of recovery and return to daily activities are the initial choice. If these fail, mixed techniques are applied, which are extremely effective.