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Fast track surgery at GB Obesitas

By | Operating methods, Our research | No Comments

If you can carry out a bariatric procedure in anaesthesia faster without the quality going down, then you have won a number of things: the patient is immobilized for a shorter period of time which reduces the risk of blood clots; the anaesthesia itself becomes shorter and produces less side effects.

Our surgical team led by Dr. Gislason has been working on creating as smooth processes around surgery as possible for more than ten years. We have two surgeons working on the patient at each surgery procedure, which reduces the surgical time for a gastric bypass or sleeve gastrectomy to an average of 35 minutes. The turnaround time between two patients in the operating room is, thanks to good teamwork, 10-15 minutes (in the normal hospital environment the switching time between surgeries is often 30-60 minutes). This means that we can operate more patients per day, without any individual patient in any way getting worse care or attention. It also makes it possible for us to keep prices down on our private operating packages.

This fast track concept attracts other teams from Europe and the rest of the world to make study trips and learn how to get the flow to work better at their home clinics. These study visits are organized in cooperation with Medtronic -maybe you will meet a visiting colleague when you are staying with us!

The concept has also been described in research articles by our team (Link No. 1), and we have authored chapters on the subject in textbooks for bariatric surgeons – see below!

Gislason H, Jacobsen HJ, Bergland A, Aghajani E, Nergard BJ, Leifsson BG and Hedenbro J. Fast Track in Bariatric Surgery: Safety, quality, teaching aspects, logistics and cost-efficacy in 8000 consecutive cases. Book chapter in: Minimal Invasive Bariatric and Metabolic Surgery. Principles and Technical Aspects. Eds. Lucchese M & Scopinario N. Springer 2015.

Link No 1: https://w ww.ncbi.nlm.nih.gov/pubmed/22116595

Optimized anaesthesia, optimized pre and postoperative care

By | Our research | No Comments

One of the things our patients tend to be most concerned about when we discuss bariatric surgery at info meetings and first visits is the anaesthesia. Becoming anesthetized (gastric bypass and sleeve gastrectomy are performed in full anesthesia) is always a feeling of loss of control, you do not know for sure what is going on. Our staff know how you feel and we will take good care of you. We are constantly trying to improve everything we do, and that also applies to the anaesthesia. More than ten years ago, our team published (link no 1) a study on how to make the anaesthesia smoother. Already during this study, we shortened the time from start of anaesthesia to start of operation from 23 minutes<to 8 minutes; And the time from the end of surgery to wake-up from<6 minutes to 2 minutes (!).

ERAS -enhanced recovery after urgery

We have also worked to make patient care after surgery as good as possible. This is done according to evidence-based guidelines, called ERAS (read more here, link No. 2) . The goal is that you as a patient should have as little side effects of the anaesthesia (nausea, etc.) and the actual surgery (pain) as possible.

All of these are examples of our philosophy within the team and the clinic: that everything that can be improved all the time should be worked actively with -and this we hope and believe that you as a patient will also benefit from.

More studies from our team can be seen below!

Bergland O, Bergland A, Gislason H, Rader J. The implementation of the ERAS protocol in high-volume bariatric surgery: complications and anaesthetic considerations in 5068 consecutive morbidly obese patients. Accepted for publication in Acta Anesth.

Karlsson A, Wendel K, Polits S, Gislason H, Hedenbro J. Preoperative nutrition and postoperative discomfort in ERAS settings: A randomized study in gastric bypass surgery. Obes Surg 2016;26:743-748

Link No 1: https://www.ncbi.nlm.nih.gov/pubmed/19025533

Link No 2: www.erassociety.org

Distal gastric bypass and SASI -alternatives to standard operations

By | Operating methods, Our research | No Comments

The basic operations with us, as in the rest of Sweden, are the surgical procedures gastric bypass and sleeve gastrectomy. These complement each other in a good way, both in terms of advantages, disadvantages and efficiency. For the vast majority it is enough to choose between these two.

But sometimes we see special cases; one example is those with an extra high BMI (BMI above 50). Here, a “regular” gastric bypass can often be quite sufficient even in the long run -but not always. What to do then?

 

Alternative options to standard gastric bypass

Our surgeon team has researched the alternatives to standard gastric bypass -you will find a list of publications below. In order not to make it all too technical and complicated, one can say that the effectiveness of the surgery can be adjusted based on how long a portion of the intestine is disconnected (if the extra-long section of the bowel is disconnected, it is called a distal gastric bypass) or how long a part that remains from the mini-stomach to the large intestine-thus how many centimeters of small bowel that are exposed to the food after the procedure. The shorter this distance is, the more effective weight loss -but also the higher the risk of side effects.

A new option, at high BMI or when a gastric sleeve does not prove to work fully, is the operation SASI (single anastomosis sleeve ileal bypass). Watch our information video here on our site here for more information on SASI!

We will look at your specific situation in connection with our first visit with checklisting. If you might be eligible for any of our more “special” procedures, we’ll discuss it with you. Then we also discuss what special things you will need to consider afterwards (for example, more ambitious follow-up with blood tests, etc.).

 

Scientific work on surgical methods

Leifsson BG, Gislason H. Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: Technique and experience with the 150 first patients. Obesity Surgery 2005;15:35-42.

 

Nergaard BJ, Leifsson BG, Hedenbro J, Gislason. HG. Gastric bypass with long alimentary limb or long pancreato-biliary limb-Long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg 2014;24:1595-1602.

 

Shah K, Nergard BJ, Fagerland M. Gislason H. Limb length in gastric bypass in super-obese patients – importance of total alimentary small bowel tract. Accepted for publication in Obesity Surgery.

 

Shah K, Nergard BJ, Fagerland M. Gislason H. Distal gastric bypass – 2 m bilipancreatic limb construction with varying lengths of common channel. Accepted for publication in SOARD.