CMCO - PROCEDURES

CMCO Care Pathway CMCO-Parcours

Surgical Procedures

By-pass

SURGERY: 1 HOUR

HOSPITALIZATION: 4 TO 5 DAYS

SICK LEAVE: 1 MONTH

Bypass is the oldest bariatric surgery procedure.

Although it is a difficult and risky procedure in conventional surgery, it has become a benchmark in bariatric surgery since the development of laparscopy in the 1990s.
This procedure involves food restriction and intestinal malabsorption. Their combination ensures that weight loss will be sustainable over time.

The two most common bypasses are:

The Roux-en-Y gastric bypass (mini by-pass), which requires to perform two anastomoses as well as closing gaps between intestinal loops to minimize risks of occlusion. In theory, the Roux-en-Y bypass is reversible. We have been promoting this method since 2005 and have performed more than 3 000 procedures to this day.

The Omega Loop Bypass (image) only requires one anastomosis and presents no risk of bowel obstruction. The Omega Loop bypass is easily reversible.

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Gastric Band

SURGERY : 1 HOUR

NO HOSPITALIZATION (OUTPATIENT)

SICK LEAVE : 1 MONTH

This is a simple procedure that can be performed as an outpatient surgery.
It is purely restrictive ("I am eating less therefore I am losing weight") and it is easily reversible.
Gastric banding can still be advised in some cases, but due to a high weight-regain rate (in our experience, more than 80%), it is less and less recommended.
The procedure leaves no visible scars and is performed in our surgery center. (see one trocart)

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Sleeve Gastrectomy

SURGERY: 1 HOUR

HOSPITALIZATION: 4 TO 5 DAYS

SICK LEAVE: 1 MONTH

Since it is the most recent bariatric procedure there is still little data available.
It is an irreversible procedure (gastrectomy) which was initially performed as the first step of the "duodenal switch" surgery.
It is purely restrictive.

As opposed to bypass surgery, the risk of weight regain after a sleeve gastrectomy is higher.
This may be due to:
- Snacking
- The pouch stretching
- The intestine synthesizing ghrelin (the hunger hormone)

In case of failure or significant reflux, the sleeve gastrectomy can be converted to a bypass (see rescue surgery)

Rescue / Redo

In case of complications following a bypass surgery, sleeve surgery or gastric banding, surgical solutions may be considered:

« I have a gastric band but I have started putting on weight again » In 9 out of 10 cases, it is possible to remove the band and perform a bypass during the same surgery.
« I have a sleeve, I'm putting on weight again and I have reflux » It is possible to convert the sleeve to a bypass.
« I have a Roux-en-Y bypass and I'm gaining weight » In order to increase malabsorption, the bypass can be extended.
« I have a bypass and I no longer want it »The bypass can be reversed and the original anatomy restored.
« I have an Omega Loop bypass and suffer from reflux » the Omega Loop can be converted to a Roux-en-Y bypass.

Techniques

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Laparoscopic surgery

Laparoscopy is a technique that allows to perform surgery without opening the stomach. A fiber optic is inserted through the belly button. The abdomen is then insufflated with gas, which allows for a panoramic view. Finally, instruments are inserted into the abdomen through small incisions.

Advantages :
- Very little pain caused by the procedure
- Short hospital stay (less than 5 days)
- Reduced risk of infection and bleeding
- Reduced risk of incisional hernia

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One-port umbilical surgery

The one-port (also known as single-port laparoscopy or one-port access) is a recent technique in laparoscopic surgery thanks to which the surgeon operates through a single umbilical port.
Aesthetically, this technique is undeniably beneficial since it leaves no visible scars.

We usually use this procedure for Sleeve gastrectomy, Gastric banding, Gallbladder removal and Bypasses (less frequently)

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HD

Laparoscopy involves using surgical cameras. The quality of the screens is therefore essential.
For this reason, we only use HD screens when performing laparoscopic surgery in order to ensure precision and accuracy.