That four-hour surgery left Bailin without nearly 80 percent of his stomach. A 1.2-centimeter gastric correction tube was inserted into his stomach through the mouth by the surgeon, and a cutting anastomosis cut off most of the remaining portion along this scale. After the gastrectomy, the patient’s stomach becomes banana-shaped, measuring 80 milliliters, a fifth less than a bottle of Nutrient.
In the second month after the operation, 21-year-old Bai Lin felt his life was “out of control”: every day he couldn’t get up to do his homework, and even the basic needs of life such as eating and going to the toilet were reduced to a minimum – the only options left to him were soup and water, and the toilet reminded him of the sour taste that came up from the depths of his throat.
The four-hour operation left Bailin without nearly 80% of his stomach. A 1.2-centimeter gastric correction tube was inserted into his stomach through the mouth by the surgeon, and a cutting anastomosis cut off most of the remainder along this scale. After the gastrectomy, the patient’s stomach becomes banana-shaped and has a volume of 80 milliliters, which is one-fifth less than a bottle of Wellbutrin.
According to statistics, more than 10,000 people in China will choose to step onto the gastrectomy table in 2019. According to the Great North China Bariatric and Metabolic Surgery Clinical Data Database 2019 Annual Report, women make up more than 70 percent of those undergoing bariatric surgery, with a median age of 31.
This is a relatively young group of people who have been bothered by the word “fat” for years before surgery. But “fat” is not an absolute concept. There are two main categories of patients who are candidates for gastrectomy: those who are third-degree obese or above, with a BMI of more than 35 kg/m2 and those who are large enough to not be morbidly obese. They need to have another significant metabolic syndrome or comorbidities such as type 2 diabetes, obstructive sleep apnea syndrome or polycystic ovary syndrome to undergo surgery.
Bailin fell into the latter category. His doctor determined that his systolic blood pressure was 150 mmHg (mild hypertension), which met the symptoms of hypertensive syndrome and allowed him to undergo surgery.
In fact, with a height of 1.87 meters, 200 pounds of Bai Lin’s fat is not obvious; some old selfies taken at a 45-degree angle of elevation show his face small and pointed. The motivation for Bai Lin’s surgery was that he wanted to succeed in getting into art school.
China Surgical Guidelines for the Treatment of Obesity and Type 2 Diabetes (2019 Edition)”, one of the main authors, Dr. Wang Cunchuan, a doctor at the First Affiliated Hospital of Jinan University in Guangzhou, has seen all kinds of “obese” people. “The people pushing through the doors of the weight-loss center include even some girls seeking bonny beauty weighing only a hundred pounds or so. “The initial target population for gastrectomy surgery is super obese patients, who tend to be 300 to 400 pounds of ‘big fat,’ so gastrectomy It’s also undoubtedly a life-saving surgery. But as of now, there are still not many people who are really qualified to do it, which means that we still don’t have the right publicity. ” he said.
“The second group of people”
Before the gastrectomy, four hamburgers and two cups of coke were Bai Lin’s normal food intake for a meal. But now, after drinking soup all day, he began to suffer from low blood sugar and dizziness. When he tried to eat more to keep up his strength, his remaining stomach couldn’t take much food in, and always returned to the same place, forcing Bailin to vomit. At the most, he would vomit 5 times a day.
At first, after hearing his description, the doctor and nutritionist thought that he had not recovered well, so they told him not to return to his normal diet in a hurry and to continue to drink broth for the rest of his life. Bailin also chose the protein powder suggested by the doctor, but the tasteless powder made him feel like he was “suffering”. Slowly, Bailin gave up on the doctor’s advice and turned to hot chocolate and four extra packets of coffee with sugar. The reason was simple: the hunger made him feel “depressed”, the chocolate made him feel less bad, the sugar helped with energy, and the coffee made sure he didn’t get sleepy.
Two years after the gastrectomy, Bailin has not had a “new lease on life”. If I needed to eat four pounds a day to survive, I can now eat up to 200 grams a meal,” he says. Eating less and eating more is putting it mildly, but do I eat 20 meals a day? “
The post-operative gastrectomy group he joined now has 185 people, all of whom are patients who had surgery at the same hospital. Bai Lin recalls that 60% of the people in the group have complained about vomiting from time to time. In addition to vomiting, food is also one of the topics that patients can’t avoid: one year after surgery, people can eat 8 dumplings a meal, which can already cause cheers and admiration from the group; most people still can’t eat rice, and more people who have just finished the surgery even eat liquid food for two months, and drink water with acid reflux and heartburn.
The 28-year-old Ai Meili, who underwent a gastrectomy at the end of June this year, is also going through the same journey as Bailin.
Now, Ai Mei Mei takes more than two hours for breakfast every day. At 8 a.m., she will start with a small bite of an egg, which is the amount her stomach can currently hold in the morning to eat all at once. In the next few hours, she eats a slice of toast as she works, “taking two bites to rest for a while”, eating too fast will cause her esophagus to regurgitate, leading to choking.
One day after the surgery, Emily was walking in the mall and saw people eating rice noodles in a restaurant; it was a whole bowl of rice noodles, and the man was gulping it down. Ai Mei Li thought that she could never go back to this kind of life.
Like Bailin, Emily didn’t need bariatric surgery to save her life. She is also in the second group of people who are suitable for surgery, suffering from polycystic ovary syndrome, with the potential risk of developing type 2 diabetes in the future.
Emily learned about bariatric surgery on a short video website. She tried to come in for a consultation after watching a scientific video run by a local surgeon. The hospital has a seemingly endless stream of people undergoing surgery, and also during this year’s epidemic, it had performed hundreds of surgeries in the first five months. In a promotional video, a mechanical female voice announces, “This is the sixth surgery today ……”
Looking at the patient with a random mosaic inside the screen, Emily hesitated, “the frequently updated short video seems to be a product made quickly on the assembly line. “Subsequently, she was transferred to a tertiary hospital to undergo surgery.
Ai Meili remembered that most of the patients who had surgery with her were 20 to 25 years old. And now, three months after the operation of the golden weight loss period has passed, the original 190 pounds of AiMei lost a total of 35.5 pounds.
“Surgery is far from a permanent solution,”
Before the surgery, Lin Bai once thought that cutting her stomach was like taking the entrance exam, something that she “had to do”.
The musical theatre performance and composition major Bai Lin is accustomed to measuring the feasibility of everything by the results. The words he often uses are “purpose”, ” Income” and “input-output ratio”. In order to prepare himself for this world, he went into a beauty salon, which was almost exclusively female, and had open-eye surgery a few years ago.
It’s not that he hadn’t considered losing weight the normal way. Bailin had maintained a high-intensity workout for two years, at least four times a week, and each time for three hours: the first two hours of vigorous exercise, then an hour of brisk walking. The food was also carefully selected, with boxes of instant chicken breasts and shredded konjac in his Taobao shopping cart. On one occasion, he didn’t eat for three consecutive days, relying only on drinking a lot of water to keep from becoming dehydrated, and finally reached 156 pounds in one afternoon.
But that weight only lasted for that one afternoon – his parents were so distressed that they took him out for a nice dinner in the evening. The long-awaited reunion meal helped Bailin break through the 160-pound weight barrier again.
During this two-year “regular weight loss experience”, Bailin can’t recall any moments of accomplishment, only the muscle memory of gasping for air in the gym and the darkness when he had low blood pressure without eating.
But sustained and intense exercise was not a long-term solution. As he moved into his senior year of high school, Bailin gradually started getting outside work projects and realized that he wasn’t guaranteed to have enough energy to maintain his weight all the time.
A chubby girl who was also knocking on the door of weight loss complained about the limited energy dilemma on Weibo: “As for those who ask why they don’t work out, it’s already two or three in the morning after work, do they have to work out until dawn? “
What really pushed Lin Bai to the path of rapid weight loss was the graduate school. There were only a few good art schools and time was of the essence, so Lin was afraid that he would get stuck in the postgraduate interview and lose his weight, so he decided to take a shortcut.
At first, he pushed open the door of the “Bada Office” (Plastic Surgery Hospital of the Chinese Academy of Medical Sciences) and wanted to inquire about liposuction surgery. He was inspired by the words of the doctor who saw him: “If you want to get rid of it once and for all, why don’t you try gastrectomy? “
“But bariatric surgery is not a panacea; it can only lose 70 percent of the excess weight. ” said Sun Bei, a physician’s assistant, “The remaining part, the 30 percent, still needs constant efforts from the patient himself after the surgery to lose it. “
Six years ago, Sun Bei was also a patient who had undergone weight loss surgery and was invited back to join the team by Meng Hua, director of the Weight Loss Diabetes Health Management Center at the China-Japan Friendship Hospital in Beijing, because her recovery was so good.
Excess weight is the difference between a person’s own body weight and the standard body weight. Before the surgery, Sun Bei weighed as much as 300 pounds, but today, as a physician, she is 130 pounds.
“Sun Bei is losing 100 percent of her excess weight, which is really hard. “Most cases of surgical patients don’t have this perseverance, and their previous experience of being fat has created changes in their hormone production and the stress on their organs,” said Meng Hua. To be precise, the hormones make people unable to keep their mouths shut and their weight makes them unable to move their legs, which may improve a little after the surgery. “
Menghua also says, “The excess weight is also counted as the cardinal standard weight limit. In other words, after this surgery, you still have to accept the fact that you may still be a small fat person. Surgery is far from a permanent solution. “
lit. cut all at one stroke (idiom); to impose uniformity
After returning home from Bada University, Bailin began to research gastrectomy surgery. The literature search skills he had developed while writing his dissertation at university now came in handy as Bailin looked up the promising results of gastrectomy surgery from the websites of top foreign academic journals. His anticipation for the surgery had increased a little more.
In September 2019, a week after learning about the gastrectomy, Bai Lin registered for a bariatric surgery clinic at a tertiary care hospital. His weight base was not large, but his blood pressure was to 150mmHg, which fit the population portrait of a suitable candidate for surgery with comorbidities, so the doctor approved his application for surgery. Immediately afterwards, he completed two pre-operative checklists sent by the surgeon, which included three stomach-related tests in addition to the routine ones.
The doctor showed Lin Bai a diagram of a gastrotomy, in which the ratio of the removed part to the preserved part was about 2:1, which looked simple and safe. He felt so good that he not only stopped going to the gym, but also said goodbye to his chicken breast.
In Norman’s opinion, people who come for surgery are “very simple and good”. The schematics fit his mental prediction that the surgery would really make his stomach “a little” smaller. “Like like a four-pound meal, just cut me into two pounds”.
But at present, the procedure of sleeve gastrectomy in China does not vary from person to person, whether they are one and a half meters tall or one and a half meters tall, they will harvest a small bird stomach of the same size after the operation. It is such a one-size-fits-all operation that “kills the most people,” said Bai Lin.
Wang Cunchuan admitted that today’s “one size fits all” regardless of height, fat or thin does have problems, but this is the only way to make the surgery to process and standardize in the short term.
Now the world’s gastrectomy surgery are using the gastric tube as a reference, the tube will be placed into the stomach from the patient’s mouth before surgery, to play the role of a mold. It can be said that the gastric correction tube has greatly increased the success rate of gastrotomy surgery. Because the stomach cut along the tube is uniform, it will not produce local overly narrow or dilated, so the normal function of the residual stomach is also guaranteed. “Wang Cunchuan said.
He explained that there are several models of gastric correction tubes suitable for gastrectomy surgery, but the sizes do not differ greatly, with all being around 1.2cm in diameter. Which model is chosen depends more on the surgeon’s surgical habits than on the difference in the patient’s size.
“The stomach is a resilient body tissue, and after recuperating, the cut stomach will also slowly adapt to the body’s needs and be able to hold more food. A smaller cut up front is also necessary for the patient to be able to lose weight through their own fat consumption. In this sense, the standardized residual stomach cutting is still necessary. “Wang Cunchuan said.
However, the bariatric surgery is still not classified as a standard procedure for surgery in China. “The Chinese Surgical Guidelines for the Treatment of Obesity and Type 2 Diabetes (2019 edition) only identifies the population recommended for surgery with the size of the gastrectomy,” said Wang Cunchuan. “But it’s the experience of the lead surgeon and his own team to actually make three or five holes in the stomach, use a urinary drainage tube or not, and how he should recover after the procedure. “
As the Chinese Medical Association Surgeons Branch of the Obesity and Diabetes Surgeons Committee Chairman, Wang Cunchuan revealed that the committee is currently applying for weight loss surgery to become a standard procedure, is expected to pass early next year.
“Weight loss surgery” is not called “slimming surgery”.
For Bailin, the surgery was a turning point in his life. In his earliest conception of a gastrectomy, he was supposed to exist as one more possibility in life. Now, his options were in a specimen bag, along with most of his stomach, and thrown into a bright yellow medical trash can.
After the gastrectomy, Bailin also underwent his first round-the-clock supervised psychotherapy for “depression,” a hypnosis that allowed him to selectively forget some of the negative emotions he had experienced as a result of the surgery.
He opened his thesis website again and typed in the words “gastric sleeve”, “gastric sleeve”, “gastric sleeve” and “gastric sleeve”. “Stomach,” “vomiting. ” and other key words in an attempt to find some remedy. Bailin saw some foreign cases where botulinum was injected into the pylorus to act as a muscle relaxer, allowing food to flow more smoothly into the small intestine, rather than back upwards.
In April of this year, Norman took this research to an endocrinologist and reviewed the procedure of the therapy with him. The doctor felt it was feasible and arranged for him to receive an injection.
After the Botox shot, Bailin experienced a long-awaited normal life. The frequency of his vomiting was reduced to once a day. But after two weeks, the botox lost its effect. Bailin said he “could feel the subtle difference. As soon as the drug was over, he went back to vomiting three times a day.
The second time, Bailyn brought in physical therapy. He suggested pyloric balloon dilatation, a procedure in which a stent is placed with a gastroscope to hold open the dilation. The stent was placed for half an hour at a time, and the effect lasted for two days. Eventually, Bailin prescribed for himself: until more advanced therapies became available, he kept getting Botox.
Now, Bailin is trying to accept his new stomach, and sees the good side of the surgery: after all, he doesn’t have to work out and diet, and he’s able to maintain the weight he struggled to lose before. Currently, Bailin weighs 172 pounds, and his biggest wish is to “act like a normal person”.
Menghua is working toward an additional two treatment rooms at the hospital for pre- and post-operative psychiatric interventions. A study published in Current Opinion in Psychiatry in 2014 noted that half of the candidates for bariatric surgery are depressed; Menghua hopes that with proper counseling, new patients will understand that a gastrectomy is not the last straw, and that doctors cannot expect one surgery to solve all of a patient’s problems.
According to Meng Hua, the first goal of bariatric surgery is to treat patients with extreme obesity and type 2 diabetes, and bariatric surgeons have the same mission as other surgeons to save lives. This is why “bariatric surgery” is not called “slimming surgery”. “The reason.
Several public and private hospitals have agreed to the request of a young woman, who is 1.62 meters tall and weighs 130 kilograms, to have her stomach cut in an unannounced visit by the Beijing News.
According to the Blue Book on Obesity Prevention and Control in China, published in 2019, the rate of overweight and obesity in China is more than 40 percent of the number of people monitored. “There are so many potential patients in China, it is certain that there is everything in the industry that develops too fast or is uneven. ” said Wang Cunchuan, “but more people are paying attention to bariatric surgery, which must be a good thing, because we are also really saving lives. Slowly, bariatric surgery will definitely go formal. “
“If someone just wanted to look good for their body shape, then I would have advised them not to go. “Emily wrote in her diary titled ‘I Regret Every Day After Weight Loss Surgery’, “I currently regret the surgery at 50% and still feel like it was not worth it .
However, after her stomach was cut, Bai Lin did manage to get a postgraduate admission to the school of her choice.
In September this year, Bai Lin stepped into the cradle of famous singers and actors for the first time. As he walked around the campus, his illusion of a school full of “handsome men and beautiful women” was quietly shattered, and among the people passing by, there were many students with ordinary looks and figures. There is no way to know whether the stomach-cutting brought Bai Lin more points for his interview or not.
(Ai Meili, Bai Lin, Sun Bei are pseudonyms)
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