A gastric ring fastening the upper part of the stomach, creating thus a gastric partitioning at the root of what is known as « hour glass».
For whom?
Obesity surgery by adjustable gastric ring is destined for a patient having had excess fat for 5 years, and having also experimented with all sorts of diets without success. The typical candidates of this surgery are patients:
- Aged between 18 and 65.
- Suffering from a severe obesity with CMI (Indicator of Corporal Mass) between 35 and 50 kg/m2.
- Ready to change their life hygiene.
- Not having too much alcohol or hyper caloric drinks.
Aims
The aim of this surgery which is completely reversible is to allow up to 60% loss of excess weight in a gradual fashion and the process spreads over 18 months.
The principle: To lose weight, one must eat less!
It is a must that one should combat excess weight and obesity. . The only and unique way to do it is to reduce or/and to increase caloric consumption, that is to eat less and better and to move around more. There are physical means to reduce the caloric input: it is to reduce the size of the stomach through the use of a gastric ring.
The gastric ring acts as an hour glass. It leads to changing habits, and better chewing. The number of meals will be greatly reduced because the pocket on top of the ring and storing ingested food will get full rapidly, but will only allow the passage of the content progressively. The caloric inputs will therefore be immensely reduced, forcing thus the organism to draw upon existing fat reserves to convert them into calories. If the diet recommendations are observed, there will be no shortage in protein or vitamins. The partitioning of the stomach enables the patients to savor all meals in small amounts. It is the principle of quantitative restriction in food rather than real frustration.
The application of a gastric ring constitutes an adjustable operation since the latter will be inflated several times after being put in place. The tightening of the ring is carried out after an interval of time from the operation (1 month after) by the surgeon or radiologist. It is carried out through a simple percutaneous puncture every time the loss of weight stops over a 15 days period.
The gastric ring is in no way mutilating; it simply consists in "putting in place" one element that has a restrictive mechanical role. It is therefore a reversible method; it can easily be deflated in case of pregnancy for example.
Before the operation
Your medical examinations
Between one week and one month prior to your operation, you must make an appointment with a medical tests laboratory in order to undergo a full pre-surgical check-up. The tests results must be sent to us (by fax, or by e-mail) so that they can be seen and read by our anesthetist doctor. Depending on the test results, other examinations may be required. If you are unable to carry out your examinations before your departure to Tunisia, there is always a possibility to do that on the spot, the day before the operation. It must be known that if there is a contra-indication to your operation, the anesthetist doctor has the right to put off or cancel the operation. No medication containing aspirin should be taken at least 10 days before the operation. You must mention any type of medication you may have taken. It is essential that you refrain from eating, drinking, and smoking for 8 hours before the operation.
With regard to your luggage, you must bring loose and comfortable clothes that are not tight at the level of thighs and the stomach.
Getting ready for the operation
You will be taken to your clinic the night of the operation, the time to get settled in your room, to take a shower if needed and to meet with the medical team: your surgeon, the anesthetist doctor, and all the health care staff. The operation takes place the following morning. Very often, the night before the operation, the nurses will give you a kind of pre-medication in the form of a light tranquilizer to make sure that slightly anxious patients to face the operation with more fortitude. You will have to take a shower with an antiseptic medication (betadine) before the operation.
Type of anesthesia
The application of a gastric ring can be carried out under full anesthesia.
Duration of the hospital stay
The stay at a clinic is 48 hours.
Total duration of your stay in Tunisia
The length of your total stay in Tunisia is 6 nights/7 days.
Operation
It is an operation that is carried out under coelioscopy. The coelioscopy consists in inflating the abdomen under full anesthesia using a kind of gas to insert an optic through a 1cm orifice, connected to a camera that sends an image on a screen.
The operation is carried out using very fine instruments that are inserted through orifices of 5 or 10mm.
Duration of the operation
The operation lasts at least 1 hour.
After the operation
The wires are removed after one week, a period during which the post-surgical pains will vanish. During the first two weeks, the patient should favor a soft diet. The aim is to avoid any movement of the non-fixed ring through scar healing. A month after the operation the surgeon will initiate the first inflation via simple syringes that are not so painful through the skin, in the membrane of the injection case of the ring.
Surgical aftereffects
The post surgical pains are minor. They will be extenuated over a week, at which time the threads or wires will be removed.
The first inflation will only take place, at the earliest, after one month. The first 15 days melting and mixed food is recommended, then the mouthfuls to chew are gradually inserted with great precaution, so as not to run the risk of causing any movement to the ring while it is not fixed through the healing process.
The inflation consists in one simple syringe using a fine needle cutting through the skin in the membrane of the injection case of the ring. This is not very painful.
It is fundamental to regularly pay visits to the radiologist during the first months in order to adjust and regulate the inflation and monitor through x-ray and in the surgeon's presence that there isn't a developing dilatation.
Gastric ring and pregnancy
A pregnancy is absolutely possible with a ring; by contrast, however, obesity is at times a contributing factor to sterility. But the ring must be unfastened as soon as there are the first signs of pregnancy for fear of causing any movement to the ring following vomiting and also to avoid any kind of nutritional deficiencies. For this reason, we recommend that no pregnancy should be considered during the initial period of slimming.
Results
Experience has shown that gastroplasty is extremely effective for weight loss less than 50 kg (which is considerable). The maximum weight loss is achieved within two years.
Complications
Long term dilatation:
This is the most frequent complication. It may result in an ill adapted diet behavior that can be very fast, with insufficient chewing and frequent vomiting. But this mainly the consequence of an excessive fastening. This is not forcibly well noticeable at first because one has been used to an important difficulty in food going down the throat and the dilatation develops progressively and without showing any signs of its evolution. The deflation process of the ring will then be mandatory, say even its ablation in all emergency in some cases when the "strangling" of the pocket becomes enormous. The only way to avoid such complication is to observe the follow-up that has been prescribed.
The irreversible dilatation:
- The pocket has then become floppy, strained. You must completely deflate the ring, but the digestive tube cannot recuperate good contractions, even several months after deflation and the ring will be retightened..
- This is to say how important in this case to confide and get back into the caring hands of the dietician and the psychologist:many kilograms have been lost due to wearing the ring, and now that we are unable to retighten it, it is essential that we will not regain them.
- It happens that the strained pockets "capsize"/fall through and do evacuate only through the overflow pipe with regurgitations during many hours after a meal, feeling compelled to feed on what goes down the throat more easily (soups, soft hyper caloric sweet and melting food) until one day the strangling of the pocket occurs, having become enormous, and leading forcibly to the ring ablation in all urgency.
- Similarly, if we go through a difficult period, a source of great anguish and anxiety, the ring becomes like a "knot at the stomach", forcing the patient to jump some meals, causing vomiting. It will then become essential to go back to a doctor for examination in order to unfasten it a little bit, say even deflate it at a later date.
The ring migration:
Another complication, less frequent, is the mucous ulceration in contact with the ring, causing progressively the "migration" of the ring in the digestive light and leading forcibly to coelioscopy ablation.
Complications at the level of the injection chamber:
turnaround, disconnection of the intake manifold, infection, though less severe/serious, requiring however a surgical act.
Work interruption
There is no need for interrupting the work: the recovery stay spent in Tunisia following the operation is very beneficial and enables most of our patients to resume their professional activities as soon as they return home.
Fees
The fees required for a gastric ring are : 3600 euros
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