Chirurgie Générale

Horaires

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Chirurgie Générale
et digestive - Stomathérapie

le secrétariat est ouvert
de 8h30 à 17h30
Chirurgie vasculaire
et thoracique

le secrétariat est ouvert de
8h30 à 17h
Urologie
le secrétariat est ouvert de
8h30 à 17h










Localisation

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Consultations
Hôpital J. Monod
zone consultations
rez-de-chaussée Nord
Hospitalisations
Hôpital J. Monod Nord 2ème étage

Contact

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Tel Chirurgie Générale
et digestive - Stomathérapie

02 32 73 32 45
Fax : 02 32 73 32 51
Mail : sec.chir.gen@ch-havre.fr
Tel Chirurgie vasculaire
et thoracique

02 32 73 44 14
Fax : 02 32 73 32 51
Tel Urologie
02 32 73 32 87
Fax : 02 32 73 32 88
Mail : sec.chir.semaine@ch-havre.fr/
Tel Chirurgie plastique, esthétique et reconstructrice
02 32 73 44 14
Fax : 02 32 73 32 51

Les professionnels

Les médecins Afficher +
professionnels associés Afficher +

Les pathologies prises en charge

  •  Chirurgie digestive et viscérale
  • Chirurgie de l’obésité
  • Chirurgie endocrinienne
  • Chirurgie vasculaire
  • Chirurgie thoracique
  • Chirurgie urologique
  • Chirurgie cancérologique
  • Chirurgie plastique, esthétique et reconstructrice

En savoir plus

  • Hospitalisations traditionnelles au 2ème étage Hôpital J. Monod Ailes 1 et 3

ABOUT THE SURGICAL TREATMENT OF MORBID OBESITY

Morbid obesity is a disease that increases the risk of emerging diseases (hypertension, non-insulin dependent diabetes, osteoarthritis hips and knees, dyspnea and sleep apnea, …) and reduces the expected life.  It is characterized by an overweight in Kg reported to the square in size M, which produced a body mass index above 40 or 35 in case of an associated pathology (hypertension, diabetes, jointdisease, …).

This overweight is responsible for a physical impact (associated diseases, inability to perform certain gestures of everyday life), psychological (sense of shame, rejection by others) and social (tendency to isolation, difficulties in finding work).
Patients often have tried many diets, sometimes followed by a successful transition but they will no longer have sufficient willingness to follow an effective diet and the courage to practice regularly a physical activity. So they seek help, and put all their hopes in surgery.

Several points are common to all diets and interventions :

You must lose weight slowly for a lasting result, because a harsh diet can not be maintained over a lengthy period and results in abandoning it all together.

It takes an appropriate number of calories for its physical needs, with a regular and balanced diet which bans nibbling between meals.

A regular sportive activity is essential, different from the simple daily physical activity, by scheduling one to two sessions per week.

If obesity is a reaction to a sexual assault, stress, depression then we must attend these problems first otherwise failure will most certainly follow.

Several techniques are available :

The gastric ring, which causes a distention of the small pouch at the top of the stomach, head of the feeling of satiety. This is a relatively simple procedure, reversible, done by laparoscopy, occasioning 24 to 48 hours hospitalization. The nibbling or absorption of liquids does not allow the system to function, the main cause of failure. Moreover, it is a transitional aid, because after a few months, the ring no longer works and must be inflated through a subcutaneous device connected to the ring by a catheter (tube). It can be inflated 2 to 3 times, which means that after a 2 years period it is no longer viable, except in cases of massive food ingestion. This technique allows excellent results for more than 30% in the medium term, and only 15% rate of success for long term(after 5 years), is therefore recommended to those able to change their lifestyle permanently during the period of weight loss.

The gastrectomy sleeve is a way to achieve a new gastric tube, removing the entire left side of the stomach, which secretes ghrelin, an appetite stimulating hormone. Performed with laparoscopy, the hospitalization range between 48 to 72 hours and has greater surgical risks. Effective for snack lovers and sugary drinks, this technique is more recommended to patients presenting a difficult bypass surgery (previous intervention, extra large left liver), or higher risk. However, in medium or long term, because of gastric dilatation, there will be weight gain, indicating a transformation in Bypass or Duodenal Switch.

The gastric by-pass (video) associate the restriction of the small gastric pouch and a malabsorption, as some of the small intestine (150 cm) is short-circuited, digestion is then only done in the common limb. The 1 meter long alimentary limb and the bilio-pancreatic limb of 50 cm are not involved in the digestive process. On the other side, sugars are absorbed immediately, leading to insulin secretion and some uneasiness (dumping syndrome). This technique is particularly suitable for sweet-eaters. In post-surgery appears a sharp decrease in appetite, due by a decreasing in the secretion of gastric ghrelin (appetite stimulus), and an increased in secretion of ileal PYY (inhibitor of appetite). Performed by laparoscopy, it combines a more important surgical risk, but achieves a greater effectiveness, for a hospitalization period of only 48 to 72 hours. This technique is aimed at snack lovers and sugary drinks, as well as failures resulting from other techniques. Monitoring the levels of vitamins every 6 months is required to correct any deficiencies.

Intestinal bypass, performed in the USA and Italy, induces some major hydro electrolytic disorders, with the possibility of death in the long term and is not currently in our therapeutic arsenal.

During the first consultation, the surgeon verifies that there is a surgical indication (which at this stage eliminates 70% of patients), and then propose a solution, after reviews, which last several months that the patient will use to consider what he really wants and the solution most suited to his abilities and his case. Participating in group therapy, where the patient can help answer some questions and understand potential failures, which in 90% of cases are due to the patient. The reasoned opinion after extended follow-up, the endocrinologist and the opinion of the psychiatrist, are paramount in making a therapeutic decision. The patient should not hesitate to consult associations or websites dealing with obesity because an effective preparation is essential for optimal results. The surgeon and specialists (dietician, psychiatrist, endocrinologist and pulmonologist) involved in the appraisal, are available to answer questions and help during weight loss.
The success will come from the patient, but the multi-disciplinary team will do its utmost to help, provided a valid indication, an appropriate intervention, a final modification of eating habits, a regular physical activity and the disappearance of the psychological causes if any.

Pose de bypass gastrique

Dr Bernard BOKOBZA (Curriculum Vitae)


Dernière mise à jour le 12 mars 2018 par Webmestre