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Published byClementine Phillips Modified over 8 years ago
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Bariatric surgery: an effective ‘psychotherapy’ for food addiction David Schroeder Surgical Obesity Service Hamilton/Wellington
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Disadvantages: Cutting and stapling of stomach & bowel and portion of digestive track is bypassed Reduced absorption of essential nutrients Side effects due to malabsorption Nonadjustable More operative complications Higher mortality rate than LAP-BAND® procedure Advantages: Rapid initial weight loss Can be done via keyhole approach Almost immediate improvement in Type II Diabetes REY Gastric bypass
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Sleeve Gastrectomy
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Adjustable gastric banding A silicone band is placed around the upper part of the stomach A small pouch is created Induces variable feeling of satiety: ‘not hungry’ Evaluated every 2-6 weeks initially for gradual tightening if necessary Disadvantages Slower initial weight loss than gastric bypass Regular follow-up critical for optimal results
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43 Possible Complications-Death 0% General operative risks bleeding, liver or spleen damage, infection, etc- <1% blood clots- 0% Band specific: Complications of the band: Slippage - 2% Erosion- 0.5% Complications of the port: Infection-0.5% Tilting, Damage-1%
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43 Possible Complications REYGB and sleeve gastrectomy specific: Leak - 0.16% Bleeding higher than banding- 1% Stricture - 3% Longterm REYGB: Vitamin deficiency- everyone who doesn’t take supplements Ulcers- 1% Bowel obstruction 2%->0% Gallstones- 12% 1212%
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Mechanisms of surgery Bypass- probably hormonally mediated decrease in insulin resistance and increase in satiety Band- probably vagus nerve mediated increase in satiety Sleeve- probably mixture but decreased ghrelin
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Effects of surgery on hormonal release Gut peptidesCentral effects on appetiteAlterations due to RGB Ghrelin PPY GLP-1 CCK Insulin Leptin
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Psychology of addiction Nucleus accumbens Prefrontal cortex- inhibited by depression tiredness alcohol smoking BMI Neocortex
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CNS Upregulation of D2 receptors Activation of hippocampus related satiety centres via vagus nerve Changes in reward centre responses to energy dense foods
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Are these changes universal & permanent? Sometimes Major business in US to help people who have regained weight after REYGB Some can lose only 4-20 kg in a year Blame placed on operation or patient: pouch dilatation, stoma enlargement
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Non-hungry eating Revert to old ways of eating: high carb, low protein Ignoring satiety Not changing habits Reactivation of cravings by memory Losing motivation to keep going Expectations not met Not telling people they have had surgery Why?
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% excess weight loss after LREYGB With wrap around Without wrap around
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Surgery does offer an effective way to switch off food addiction We are not sure of the mechanisms The results are very variable Maximum effect is in the first year- variable thereafter We can improve outcomes by understanding the mechanisms of addiction & encouraging self-care It is as safe as gallbladder surgery It is expensive short term, but saves money in the long term
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