Laparoscopic sleeve gastrectomy tutorial скачать в хорошем качестве

Laparoscopic sleeve gastrectomy tutorial

Dr. Jossart narrates a 5:37 slideshow presentation on the laparoscopic sleeve gastrectomy. Slide 2: The sleeve gastrectomy has increased 451% since 2011. Insurance companies started approving it in 2010 after comparing 5 year outcomes to the gastric bypass and adjustable gastric banding. Most patients started choosing the sleeve gastrectomy because of weight loss similar to the bypass and better than an adjustable band. The long term safety profile of the sleeve gastrectomy has also been appealing. Slide 3: The sleeve gastrectomy involves removing the left side of the stomach that can expand to consume large portions. The right side that remains is much smaller and restricts patients to very small portions. Slide 4: The new tube shaped stomach pouch limits patients to only 1-2 ounces of protein in the early months after surgery. Stretch and pressure receptors remain intact and help to create a sense of lasting fullness. The valves at the top and bottom of the stomach are preserved. The large greater curve of the stomach that allows for food to be consumed is removed along with many cells that produce the hunger hormone known as Ghrelin. Slide 5: You must always get in better shape for surgery. Losing weight and increasing mobility prior to surgery is what makes weight loss surgery so safe. You must have good control of your diabetes and high blood pressure by the day of surgery. You will receive a check list of items on page 13-18 in the Goal Weight Guide to go through in the weeks and months prior to surgery. Be sure to do them! Slide 5: We provide you with details on how to prepare for surgery but this is a list of things to do starting today! It is preparing well for surgery that helps you have a quick recovery. Slide 6: On the day of surgery, you usually arrive about 2 hours before the planned start time. The operation will take 1-2 hours and you will be in the recovery room for a few hours. Over half of patients leave the next day. Some patients need to stay two nights. We have you up and walking several hours after surgery and you start drinking liquids the morning after surgery. You remain on a liquid diet for the first 14 days. We see you in the office at one week after surgery. Most patients return to work in 1-2 weeks. Slide 7: On day 15, you start trialing very soft foods such as yogurt and on day 22 your start soft meats and produce. The goal is to consume up to 600 calories per day and portions that are only 1-2 ounces. This will allow for a weight loss of several pounds per week for several months. You must start increasing your activity and exercise as soon as you can tolerate. Pain is so mild that most patients can exercise quite well 2 weeks after surgery. The number one problem in the first month is hydration so be sure to focus on drinking liquids. Slide 8: After day 31, you should maintain a diet of up to 600 calories per day. This induces a mild state of starvation that will allow you to lose the excess fat at a rate of several pounds per week. Always start with proteins and limit portions to less than 2 ounces as eating more may result in vomiting and belching. Avoid liquid calories as even the smallest type of stomach pouch can’t stop liquids. Avoid starch such as breach, pasta and rice as that will slow weight loss. Once you lose all your excess weight, you may eat some starch again. Avoid alcohol and carbonation as they will slow your weight loss. Slide 9: The remaining slides offer some key tips for long term success. Slide 10: Calories must be limited to 600 per day until goal weight. Those who exercise more may need to go up to 800 per day. Portions should be limited to 1-2 ounces, so you don’t stretch your pouch. Start with protein to preserve muscle mass and keep carbs low to enhance the breakdown of fat. Carbs should be produce such as fruits and vegetables, not food from a box or bag. Most crunchy produce makes you feel full on less than 100 calories and satisfies you desire chew on something crunchy. It helps you avoid snacking on junk food! Slide 11: You must be aware that your sleeve pouch is basically a two way street. If you are eating too much, too fast or the food is too tough you may vomit. Signs that you are doing this include left shoulder pain, belching, burping, coughing, sneezing, runny nose, heartburn, lump in throat and a chest pressure sensation. Don’t overstuff your pouch. Reduce your portion size, speed of eating and toughness of the food by 20%.