| WEIgHTMAnAgEMEnT | OpiniOn
(ghrelin is a hormone produced in the stomach that stimulates hunger) and the melanin‑concentrating hormone type 1 receptor antagonists, most of which have yet to enter the clinic. That leaves surgical intervention, and
while the performance of the pharma sector in terms of bringing new products to market has been disappointing, medtech companies have been extremely innovative in this area. Although surgical intervention to reduce food intake (bariatric surgery) has been in use for a number of years, it suffers from some shortcomings, and a range of devices have been developed in an attempt to overcome these limitations. In addition, surgery is only indicated for patients who are grossly overweight or obese, rather than individuals who wish to shed a few kilograms for cosmetic reasons.
Surgical interventions The most widely used form of gastric bypass surgery is the Roux‑en‑Y anastomosis. In this procedure, the stomach is made smaller by creating a pouch at the top using surgical staples or a plastic band. The pouch is connected directly to the jejunum, bypassing the duodenum, while the open ends of the remainder of the stomach and attached duodenum are closed, although the duodenum is anastomosed to the jejunum so that it can drain. Owing to the small size of the pouch,
only a small amount of food can be eaten at one time, and the food must be thoroughly chewed before swallowing. Without these precautions, the patient is likely to experience considerable discomfort. In addition, drinking during a meal is not possible; foods with high sugar content must be avoided; and the patient will probably need to take vitamin and mineral supplements. During the mid‑1980s, the Roux‑en‑Y
procedure began to be replaced with the so‑called gastric band, which is applied like a belt around the top of the stomach. This has
three A number of designs of gastric band are
available. At its simplest, it consists of a silicone ring, the ends of which can be held together by a locking device, and a reservoir that connects to a balloon on the inner surface of the ring. The amount of food that can pass through the banded area of the stomach can be controlled by inflating or deflating the balloon. Complications that may occur with gastric banding include slippage of the band along the length of the stomach, requiring re‑placing in the correct position; erosion of the stomach wall by the band, requiring band removal; leakage of the reservoir or tubing; and infection. An alternative to
gastric banding is sleeve gastrectomy. This procedure, which is not reversible, involves dividing the stomach vertically by stapling and then removing
the
redundant part. In contrast with the Roux‑en‑Y procedure, there is no intestinal bypass, and this is claimed to avoid potential
long‑term
c om pl ic a t ion s . Furthermore, problems associated with the presence of the gastric band, such as slippage or erosion, are eliminated. An additional advantage of
by 2015, the WhO
sleeve gastrectomy is that the portion of the stomach that is removed is the major site of ghrelin production. The procedure, therefore, results in reduced appetite. According to from
predicts, approximately 2.3billion adults will be
overweight, and more than 700 million obese.
s i g n i f i c a n t advantages compared with the Roux‑en‑Y procedure: it is reversible; it can be performed laparoscopically; and it is adjustable.
figures 20092
, almost
350 000 bariatric s u r g e r y procedures were p e r f o r m e d globally in 2008, with nearly two
thirds carried out in the US and Canada. The vast majority (more than 90%) were carried out laparoscopically. The Roux‑en‑Y technique accounted for
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