Removing 80% of the Stomach

weight loss surgery or what's more properly known as bariatric surgery has become increasingly common over the years in both the United States and worldwide of all the available procedures the one that's being performed the most frequently these days is what's known as a sleeve gastrectomy which more or less turns your stomach into the size of a banana so in today's video with the help of the cadavers here in the lab we're going to see exactly what happens during this procedure we'll see what they cut how they cut it and discuss the repercussions of removing around 80 percent or so of your stomach it's gonna be bananas let's do this let's start off by discussing the relevant necessary Anatomy to understand the procedure itself so what you're looking at here is going to be the stomach as it transitions into the small intestine now when you first digest food it's obviously going to travel into the stomach via the esophagus and you can see this right here is the lowermost aspect of the esophagus and that will transition into the first area of the stomach which is known as the cardia I'm just circling it with my probe here it's called the cardia because it's in close proximity to the heart which would essentially be right around this area here then I'm going to use the probe to kind of do my best to show you this next area that I'm now circling which would be called the fundus fundus translates to end so this is essentially the end of the esophagus or at least that's how I've always taught it then the rest of the still not the rest but the vast majority of the stomach I should say is what's known as the body and I'm kind of Fanning over the entire distance and the body is the highly expandable portion of the stomach I mean the whole stomach will expand but I think you can imagine how many other structures are around here that you just don't want the stomach expanding into but in this area there's not much going on so it makes sense that the stomach can start pushing here as it's getting filled up next we have what's known as the antrum antrum translates to cave and this is essentially where digestive material is first going to interact with the stomach so as it drops from the esophagus it's going to land in the antrum and then that's going to pretty much kick off the Cascade of digestive processes that the whole stomach will then engage in then you have what's known as the pylorus pylorus translates to gatekeeper and it's called that because inside of it is the pyloric sphincter which is an extraordinarily strong sphincter that prevents the premature release of digested contents into the duodenum or the first part of the small intestine now the duodenum also is going to have connections from other accessory digestive organs the liver is going to be right next to the stomach and actually in front of the stomach and so that's actually going to be important because they have to retract and lift the liver in order to see the stomach during the procedure but the liver is going to drop along with the gallbladder bile into the duodenum and then behind the stomach is what's known as the pancreas and the pancreas is going to contribute pancreatic enzymes into the duodenum which is also combined with the bile and the hydrochloric acid all of it's going to contribute to further aid in digestion and then the last things I want to bring your attention to and then we can actually talk about the procedure are going to be these two curvatures here this smaller curvature is called the Lesser curvature and this is where you're going to have like fatty apron that's going to help connect the stomach to the liver itself as well as to the duodenum but this longer one is the more important curvature called the greater curvature and hanging off of it would be a large fatty apron called the greater omentum that would drape over the small intestine they're going to have to cut that away during the procedure so just make sure to keep that in mind now in order to receive a sleeve gastrectomy or any bariatric surgery for that matter there are a specific requirements that the patient will need to abide by and these are given down by the specific institutions but typically what you're going to have to do is demonstrate that you've been unable to lose weight despite exercising and making dietary changes as well as having a BMI or a body mass index of 40 or above now they can lower that down to 35 or higher but then you're also going to have to to have another comorbidity with it such as type 2 diabetes sleep apnea or maybe even high blood pressure so when it comes to the actual procedure the patient is going to be given an IV and then they're going to go underneath general anesthesia which probably makes a ton of sense to you this is not something you want to be awake or coherent for in any capacity but once that's happened the surgeons will then perform five laparoscopic incisions so laparoscopic incisions are small incisions that allow for very precise surgical technique and it makes it so you don't have to create this gigantic injury open up the body just so you can see what you're looking at right through these tiny incisions you can insert cameras and other surgical equipment it just makes things a lot easier in terms of recovery and lowering risk for the patient in one of those laparoscopic incisions they'll insert a port which is essentially just a tube then they will insert what's known as a varus needle a varus needle will then deliver carbon dioxide gas into the abdominal cavity creating a purposeful pneumoperitoneum what this means is you just have gas going inside there and separating the tissues now you can have a non-purposeful pneumoperitoneum and that is a very serious condition but in this case you're just lifting the tissues away from one another so you can actually see what you are looking at in order to perform the surgery now they'll initially increase that pressure to quite a high amount and then they're going to draw it back once they know they've got everything in place now in another one of those laparoscopic incisions they will then insert a retractor that can lift the liver out of the way so they can see the stomach at all another one of those incisions will be where they will pull out the the stomach or the portion of the stomach that they have dissected away and then those last two are going to be where they can insert the surgical instrumentation to perform the surgery itself now once they've kind of expanded everything in there they will then insert a nasogastric tube and that is a tube that will go in the nose through the nasal cavity and then down the throat down the esophagus and then enter into the stomach itself and what they'll do is they'll use that to decompress the stomach you don't want any air or gas or anything inside of here you want the stomach completely collapsed from there they're then going to have to cut away that greater momentum that fatty apron we talked about now the greater momentum has many blood vessels that will actually be providing blood supply to this greater curvature so what they'll do is when they're cutting it away they're doing something called ligation where they're actually sealing off the blood vessels preventing blood loss so they're not only just it's not like they're just snipping it away because then you'd have blood going everywhere they're preventing blood loss and ligating the blood vessels once they've done that this is where they'll insert what's known as a calibrating bougie a calibrating bougie is essentially just a cylinder that they will insert that will go through the esophagus and go into the stomach and it will actually Trace that lesser curvature and go down towards the pylorus now there's different sizes of bougie's and it just kind of depends on the institution but just understand there's going to be a cylinder that is going to be traveling here and this is going to be necessary for the surgeons to understand just how narrow of a sleeve they're going to create right so I've got my trusty banana here and if you think of the bougie I mean the banana is going to be larger than um the bougie would be but you can kind of understand that we want to create this shape on the stomach so by inserting the bougie into the stomach that gives them an area to trace so once they have that in there they're then going to take a really cool surgical instrument called a powered stapler and what this does is it simultaneously cuts through tissue and then delivers Staples on either side of what it's cutting so what they're going to do is they're going to come in at the antrum and when they come in and they cut the Antrim and start stapling they're then going to if I put the banana back that they're coming at an angle here they want to create like a flap you don't want to just like come in because then it's too narrow here and that can create some complications we'll talk about in a moment so they'll come in kind of like at this angle creating this flap at the Antrim and towards the pylorus and then they're going to go right alongside that bougie and as they're doing that it's delivering Staples to the side that they're cutting away which is going to be all of this portion of the stomach and their stapling this side that has the bougie and this is going to probably make a ton of sense to you that you don't want to just cut the stomach and then Sutra afterwards because the stomach even though it's been decompressed even though they put the nasogastric tube in there there can still be hydrochloric acid as well as blood I mean you're cutting into an organ there's going to be blood that's going places so by stapling as you're cutting all at the same time you're preventing blood loss and gastric juices from emptying in to that abdominal cavity so really cool thing so what they'll do is then they trace and go alongside that bougie until they get up top towards the fundus and again what they don't want to do is create two narrow of an area here otherwise you run the risk of creating what's called a stricture a stricture is just when it's too narrow and something can't pass I mean if you cut away the majority of the stomach and you have too narrow of a space well now it's non-functional and nothing can get through you have a serious problem on your hands it's not like you can regrow stomach here so what they'll do is when they get to the fundus they will actually create another flap up here which they call a dog ear so again bringing the banana back they come in they trace along and then when they get here they create a little dog ear that will provide just a little more space then once they've done that they then have a fully separated area at this point they've cut away 80 percent of the stomach they've essentially cut off the body of the stomach right they came in at the Antrim and then they left a good portion of the fundus not all of it but a good portion of the fundus the majority of the stomach that has been removed is going to be the body what they will then do is take that body and remove it from one of the ports in one of those laparoscopic incisions that we discussed now what they also can do is remember that that greater momentum was attached to the stomach and what you don't want is this newly sleeved out stomach and if I hadn't made this clear I'll make it clear now the reason why it's called a sleeve gastrectomy is that the sleeve portion you've this is the sleeve right we've created this gastric sleeve here what you don't want to do is rotate and turn on itself so one option they have is to actually take that greater momentum and they will actually suture it to this new greater curvature to prevent the stomach from flipping on itself some surgeons will elect to just leave it there so it's just going to kind of hang out but that is something that is is an option but they will then take that portion of the stomach remove it and then that's when they can then decompress they can remove all the carbon dioxide from the abdominal cavity getting rid of that pneumo peritoneum and they can then put the liver back in place they can suture everything up and the procedure is essentially done now the reason why this procedure is so effective really comes down primarily to two things and the first is going to be a reduction in the amount of a hormone called ghrelin ghrelin is a hormone that's involved in hunger as well as satiation or feeling full and just the overall breakdown and processing of energy in the body now ghrelin is going to to be produced by the cells of the stomach so if you remove 80 percent of the stomach I mean I don't want to say you get rid of 80 percent of the ghrelin but you are going to be removing a significant amount of it which is why patients who've had a sleeve gastrectomy will even say you know I just don't really feel hunger like I did second reason is I mean if you've removed eighty percent of the stomach and you have this narrow sleeve then obviously it's going to fill up faster meaning you're going to physically feel full quicker and that means you're going to consume less calories and at the end of the day that's really how weight loss occurs I mean it's just the laws of physics right if you consume less calories than you're actually burning then you are going to lose weight it's not as though you know where in this procedure you're getting liposuction or lipoplasty in the end of the day what really comes down to is just you're not going to want to eat as many calories and then you can't physically eat as many calories at least in early stages now I don't want to make it seem as though someone still can't over eat the stomach once it's healed is still going to be capable of increasing in size I mean it's not as though if we've created the sleeve the stomach can grow back to its normal size if you continually overeat and over indulge but it still can increase in size which means it's going to be super important after this procedure to then continue making Lifestyle Changes right in terms of exercise and those dietary changes right and you're going to have to control your portions and things of that nature because while this can lower obviously the amount of calories that you're consuming I mean over time you can start building up especially if you're eating more calorically dense foods now in terms of recovery the patient can expect to spend around two to four days inside of the hospital now during that time they're going to be testing for leakages because obviously if they were leaking anywhere along where the Staples are that's a bad thing you don't want stomach acid or any of the digestible contents you've been consuming to leak out into the abdominal cavity assuming there are no leakages they'll then be giving the patient water tea soups and then they can leave the hospital and then move to eating more juicy type foods for the next two weeks then after that they can start eating more soft like foods but they'll be eating pretty much only juicy soft liquidy diet for pretty much an entire month and then after that they can start moving to more of solid foods now as with any surgery there's going to be potential complications and risks now we've already spoken about leakages being one of those but another one is going to be acid reflux so if we think about it again you have this narrow sleeve now there's less space for the stomach acid it's possible for that to more easily and readily go into the esophagus and create the oh so fun feeling of heartburn like we already mentioned too it's possible for the stomach to move now and because it's now less anchored to the body and potentially move into an area you don't want to creating a type of hernia we also already mentioned stricture being a possibility right you don't want if it's too narrow as possible it could get blocked and that could create a significant issue as well blood clots are also a possibility with any surgery I mean when you're cutting through blood vessels you're creating injuries so again though the surgeons are planning for this and they're doing and they're educated they're doing whatever they can to limit this as much as possible but it is still definitely possible but the despite all of this from my understanding a sleeve gastrectomy is still considered at least at this point in time to be not only the safest but the most effective form of bariatric or weight loss surgery generally speaking and the reason why I say generally speaking is because each individual is different and this is only one of many different types of bariatric surgeries that can be performed and each of them have their own sets of pros and cons some of them will actually be more or rather say better for certain comorbidities so for instance if your goal is not only weight loss but also to combat type 2 diabetes a sleep gastrectomy might not be the best option for you which is why you'll want to speak with your bariatric specialist to ensure that you know you're going to be if you're going to go under the knife that you're going to be going at it you know in a way that's going to be you know just give you the best set of possibilities but generally speaking this one is the least invasive the least amount of complications the least amount of risk and it has pretty good outcomes I mean at the end of the day again you're just limiting those calories by a tremendous amount so I still feel like it's probably okay to say that this is indeed generally speaking the safest and most effective bariatric surgery out there it is mind-blowing to me that we as humans have come up with a procedure such as this one I mean the powered stapler alone is ridiculously cool I mean simultaneously cutting and stapling bolts how cool is that it takes a special mind come up with Solutions and tactics and tools for complex problems like that and it's something that I personally am always striving to do so myself I mean I may not come up with new surgical techniques but finding new tools and tactics for complex problems is something I'm constantly striving for which is why I'm proud to say that the sponsor of today's video brilliant is helping me along that path brilliant.org is the best way to learn math science and computer science interactively they have thousands of lessons and are adding more each and every month I personally use their app every single day and I'm currently trying to tackle their course on scientific thinking to help me intuitively navigate the complexities of this very job I mean learning how to communicate science to the masses is especially challenging for me but I'm doing everything I can you see the courses over at brilliant are amazing to me because they are both interactive as well as fun the lessons are bite-sized yet still challenging enough to really get you thinking I'm constantly recommending 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Channel: Institute of Human Anatomy

Views: 453,316

Keywords: losing weight, weight loss surgery, sleeve gastrectomy, bariatric surgery, is weight loss surgery safe, how weight loss surgery works, stomach surgery, how stomach surgery works, what happens during stomach surgery, lose weight, lose weight fast, quickly lose weight, body mass index, what is body mass index, how weight loss works, veress needle, laparoscopic surgery, stomach anatomy, pylorus, esophagus, body of stomach, human stomach, duodenum, laparoscopic sleeve gastrectomy

Id: Taw9qa8Z25M

Length: 19min 36sec (1176 seconds)

Published: Sat Jan 07 2023