The four-hour operation made Lin Bai lose nearly 80% of his stomach. A 1.2 cm gastric tube was inserted into his stomach by the surgeon, and the cutting stapler cut off most of the rest along this scale. After gastrectomy, the patient's stomach will turn into a banana shape, with a volume of 80 ml, which is one-fifth less than a bottle of Yakult.

The Chinese-Japanese friendship doctor is in the inpatient department of weight-loss surgery, and the sports rehabilitation teacher takes the patient to do postoperative recovery exercise. Intern Li Yuning photo

Text | Intern Li Yuning Beijing News reporter Wei Furong

Editor Chen Xiaoshu proofreads Cece.

This article is about 55 10 words, and the reading time is about 1 1 minute.

In the second month after gastrectomy, Lin Bai, 2 1 year-old, felt that his life was "out of control": he could not get up every day to do his homework, and even the basic needs of eating and going to the toilet were reduced to the lowest frequency-the only options left for him were soup and water, and the toilet reminded him of the sour taste rising deep in his throat.

The four-hour operation made Lin Bai lose nearly 80% of his stomach. A 1.2 cm gastric tube was inserted into his stomach by the surgeon, and the cutting stapler cut off most of the rest along this scale. After gastrectomy, the patient's stomach will turn into a banana shape, with a volume of 80 ml, which is one-fifth less than a bottle of Yakult.

According to statistics, in 20 19 years, more than 1 10,000 people in China chose to set foot on stomach-cutting operating tables all over the country. According to the 20 19 annual report of the clinical data database of bariatric and metabolic surgery in Greater North China, women account for more than 70% of these people who have undergone bariatric surgery, with a median age of 3 1 year.

This is a relatively young group, and they have been troubled by the word "fat" for many years before surgery. But "fat" is not an absolute concept. There are two main indications for gastrectomy. One is patients with third-degree obesity and above, whose body mass index exceeds 35kg/m? . The second type is the large-weight people who have not reached morbid obesity. If they want to have surgery, they need to be accompanied by obvious metabolic syndrome or complications, such as type 2 diabetes, obstructive sleep apnea syndrome or polycystic ovary syndrome.

Lindbergh belongs to the latter category. According to the doctor's judgment, the systolic blood pressure reached 150mmHg (mild hypertension), which met the symptoms of hypertension complications and could be operated.

In fact, Bai Lin, whose height is 1 m 87 and weight is 200 kg, is not obviously fat; His face is very small and sharp in some old selfie photos with an elevation of 45 degrees. Lin Bai's motivation for the operation is to be admitted to an art school smoothly.

Wang Cunchuan, one of the main authors of "Guidelines for Surgical Treatment of Obesity and Type 2 Diabetes in China (20 19 Edition)" and a doctor in the First Affiliated Hospital of Jinan University, has seen all kinds of "obese" people push the door of the weight-loss center, including some girls who pursue the beauty of bones and weigh only 100 kilograms. "The first target group of gastrectomy is super obese patients, who are often three or four hundred pounds of' big fat people', so gastrectomy is undoubtedly a life-saving operation. But at present, there are still not many people who really meet the requirements, which also shows that our publicity is still not in place. " He said.

"the second group of people"

Before gastrectomy, four hamburgers and two cokes were the normal food intake of Lindbergh. But now, after drinking soup all day, he began to have hypoglycemia and dizziness. When he wants to eat more to maintain his physical strength, the stomach of the remnant bird can't hold too much food, and he always goes back the same way, forcing Bai Lin to vomit. Up to five times a day.

At first, doctors and nutritionists listened to his description and thought that he had not recovered, so they told him not to rush back to normal diet and continue to drink broth. Lin Bai also chose the protein powder suggested by the doctor, but the tasteless powder made him feel "suffering". Slowly, Lindbergh gave up the doctor's advice and ate hot chocolate and coffee, plus four packets of sugar. The reason is simple: being too hungry will make him feel "depressed", chocolate can make him feel less uncomfortable, sugar helps to replenish energy, and coffee ensures that he is not sleepy.

It has been two years since gastrectomy, and Lindbergh has not been reborn. "If I used to need to eat four pounds a day to maintain my life, I can eat up to two hundred grams now. Eating less and eating more is easier said than done. Do I eat 20 meals a day? "

He joined the group after gastrectomy, and now there are 185 people, all of whom are patients undergoing surgery in the same hospital. Lin Bai recalled that in this postoperative group, 60% people complained of vomiting from time to time. In addition to vomiting, eating is also one of the topics that patients can't avoid: one year after surgery, people can eat eight jiaozi at a time, which has aroused the cheers and admiration of the group of friends; Most people still can't eat, and some people who have just finished surgery have been eating liquid food for two months, and drinking water is sour and heartburn.

The appetite of a meal before Lin Bai's operation. Photo courtesy of respondents

Emily, 28, underwent gastrectomy at the end of June this year, and she is also experiencing Lin Bai's mental journey.

Now, Emily has breakfast for more than two hours every day. At 8 o'clock in the morning, she will chew an egg first, which is the amount that her stomach can hold at one time in the morning. In the next few hours, she ate a piece of toast while working. If she eats too fast, her esophagus will reflux and cause a cough.

One day after the operation, Emily walked in the shopping mall and saw people eating rice noodles in the restaurant. It was a whole bowl of rice noodles, and the man ate it with a big mouth. Emily thinks she can never go back to that life.

Emily, like Lindbergh, doesn't need weight-loss surgery to save her life. She is also the second batch of people who adapt to surgery, suffering from polycystic ovary syndrome, and has the potential risk of developing type 2 diabetes in the future.

Emily learned about bariatric surgery on a short video website. After watching a popular science video provided by a local surgeon, she tried to come for consultation. There seems to be an endless stream of people undergoing surgery in this hospital. During this year's epidemic, the hospital has completed hundreds of operations in the previous five months. In a promotional video, the mechanical female voice announced, "This is the sixth operation today ..."

Looking at the patients randomly inlaid on the screen, Emily hesitated. "Short videos that are frequently updated seem to be products that are quickly made on the assembly line." Subsequently, she transferred to a tertiary hospital for surgery.

Emily remembers that most of the patients who had surgery with her at that time were little girls aged 20 to 25. Now, the golden weight-loss period of three months after the operation has passed, and emmerich, who was originally 190 kg, lost 35.5 kg.

Four days after Emily's operation, the photos of the wound were taken during dressing change. Photo courtesy of respondents

"Surgery is far from a permanent means."

Before the operation, Lin Bai once felt that stomach cutting, like the college entrance examination, was something she "had to do".

Lin Bai, a major in music performance and creation, used to measure the feasibility of everything with results. The words he often talks about are "purpose", "income" and "input-output ratio". In order to prepare himself to step into this circle, a few years ago, he walked into a beauty salon that was almost all girls and had an operation to open his eyes.

It's not that he hasn't considered losing weight in the ordinary way. Bai Lin has maintained high-intensity fitness for two consecutive years, at least four times a week, and each exercise time should reach three hours: the first two hours of strenuous exercise, and then an hour of brisk walking. The food is also carefully selected and matched, and boxes of fast food chicken breast and konjac silk are put into Taobao's shopping cart by him. Lin Bai's thinnest weight record as an adult was also produced in these two years. Once, he didn't eat for three days in a row, only drank a lot of water to ensure that he didn't get dehydrated. One afternoon, he was finally hungry 156 kg.

But this weight only lasted that afternoon-parents loved him dearly and took him to eat a good meal in the evening. So, after a long separation, Lin Bai's weight broke through the standard weight of 160 kg.

For the "routine weight loss experience" in the past two years, Lin Bai can't recall any moment of accomplishment, only the muscle memory of panting in the gym and the feeling of sudden hypotension without eating.

But continuous strenuous exercise is not a long-term solution. After entering the senior year, Lindbergh gradually began to receive work projects outside. He realized that he could not always have enough energy to keep his weight.

A fat girl who also knocked on the door to lose weight also complained about the dilemma of limited energy on Weibo: "As for why you don't exercise, it's already two or three in the morning after work. Do you want to exercise until dawn? "

What really promotes Lin Bai to lose weight quickly is the postgraduate entrance examination. There are only a few good art colleges, and time is tight and tasks are heavy. Lin Bai was afraid that the appearance and weight of graduate students would be affected by the interview, so she moved the idea of taking shortcuts.

At first, he pushed open the door of "Badachu" (Plastic Surgery Hospital of China Academy of Medical Sciences) and wanted to consult liposuction. A word from the doctor who saw him inspired him: "Since you want to do it once and for all, why not try gastrectomy?"

"But bariatric surgery is not everything, it can only lose 70% of excess weight." Sun Bei, an assistant doctor, said, "The remaining part, that 30%, needs the patient's continuous efforts after the operation to be reduced."

Six years ago, Sun Bei was also a patient undergoing weight loss surgery. Because of his excellent recovery, he was invited back by Hua Meng, director of the Center for Weight Loss and Diabetes Health Management of Beijing China-Japan Friendship Hospital, and joined the team.

Overweight refers to the difference between a person's own weight and the standard weight. Before the operation, Sun Bei's weight was as high as 300 kg, but Sun Bei, as a doctor, now weighs 130 kg.

"It's really not easy for Sun Bei to lose 100% of the excess weight." Hua Meng said, "In most cases, surgical patients don't have this perseverance. The previous obesity experience changed their hormone secretion and the pressure on their body organs. Accurately speaking, hormones make people unable to control their mouths, and weight makes people unable to walk. There may be some improvement after the operation, but you still have to rely on yourself. "

Hua Meng also said, "The overweight part is also calculated according to the upper limit of the standard weight of the card line. In other words, after this operation, you still have to accept the fact that you may still be a little fat. Surgery is far from a once-and-for-all means. "

Cut it with one knife-achieve the effect of demanding consistency

After returning to China at the Eighth National Congress, Lin Bai began to study gastrotomy. The document retrieval ability cultivated when writing papers before college is now in use. Lin Bai consulted the websites of top foreign academic journals and found gratifying results of gastrectomy. His expectations for surgery have increased a little.

From September, 2065438 to September, 2009, one week after learning about the gastrectomy, Lin Bai registered the bariatric surgery clinic in the 3A hospital. His weight base is not large, but his blood pressure reaches 150mmHg, which is consistent with the portrait of people with complications suitable for surgery, so the doctor agreed to his operation application. Then, he completed two pre-operative examination task lists sent by doctors, among which, besides routine examination, three were related to the stomach.

The doctor showed Lin Bai a schematic diagram of gastrostomy. The ratio of excised part to retained part is about 2: 1, which seems simple and safe. He felt great, not only stopped the gym, but also said goodbye to the chicken breast.

In Lin Bai's view, people who come for surgery have a "very simple and beautiful purpose." The schematic diagram coincides with his psychological prediction. It turns out that this operation can really make his stomach "slightly" smaller. "For example, like four pounds of rice, just cut it into two pounds for me."

But at present, the operation process of sleeve gastrectomy in China does not vary from person to person. Whether it is 1.5 meters high or 1.9 meters high, a bird's stomach of the same size will be harvested after the operation. Lin Bai said that this is the one-size-fits-all approach, "the most deadly."

Wang Cunchuan admits that there is indeed a problem with the current "one size fits all", regardless of height or size, but it is the only way to streamline and standardize operations in the short term.

"Now gastric resection all over the world is drawing lessons from gastric correction tubes. These tubes will be put into the stomach from the patient's mouth before operation and play the role of molds. It can be said that gastric correction tube greatly improves the success rate of gastrectomy. Because the stomach cut along the tube is unified, it will not be too narrow or partially expanded, and the normal function of the remnant stomach is also guaranteed. " Wang Cunchuan said.

He explained that there are several types of gastric correction tubes suitable for gastrectomy, but there is little difference in size, and the diameter is about 1.2cm. Which model to choose depends more on the doctor's surgical habits than the patient's body shape difference.

"The stomach is an elastic body tissue. After conditioning, the cut stomach will gradually adapt to the needs of the human body and can accommodate more food. Cutting it small at an early stage also means that patients can lose weight by consuming fat themselves. In this sense, it is still necessary to standardize the remnant stomach cutting. " Wang Cunchuan said.

However, at present, bariatric surgery has not been listed as a standard surgery in China. "The guidelines for surgical treatment of obesity and type 2 diabetes in China (version 20 19) only determine the recommended surgical population and the size of gastrectomy," said Wang Cunchuan. "But it depends on the experience of the surgeon and his team, that is, whether to actually open three or five holes in the stomach, whether to use a catheter, and how to recover after surgery."

As the chairman of the Obesity and Diabetes Surgeons Committee of the Surgeon Branch of the Chinese Medical Association, Wang Cunchuan revealed that the Committee is currently applying for bariatric surgery to become a standard surgery, which is expected to be passed early next year.

"slimming surgery" is not called "slimming surgery"

For Lin Bai, this operation is a turning point in his life. In his original idea, cutting the stomach should be another possibility in life. Now, his right to choose is put into a specimen bag with more than half of his stomach and thrown into a bright yellow medical trash can.

After gastrectomy, because of "depression", Lin Bai also received the first all-weather nursing psychotherapy in her life. Hypnosis made him selectively forget some negative emotions brought by the operation.

He opened the paper website again and entered keywords such as "stomach sleeve", "stomach" and "vomiting", trying to find some remedies. Lin Bai has seen some cases abroad. Botox is injected into pylorus to relax muscles and make food enter the small intestine more smoothly, instead of flowing back upwards.

In April this year, Lin Bai found a doctor in endocrinology with this research and told him about the implementation of the therapy. The doctor thought it was feasible and arranged an injection for him.

After Botox, Lin Bai experienced a long-lost normal life. His vomiting frequency is reduced to once a day. But after two weeks, the botulinum toxin lost its effect. Lin Bai said that he "can feel subtle differences". With the end of the drug effect, he immediately returned to the normal state of vomiting three times a day.

The second time, Lin Bai brought physical therapy. He suggested that the doctor dilate the pylorus with a balloon and put a gastroscope in the stent to dilate. Half an hour at a time, the effect can last for two days. In the end, Lin Bai gave himself a prescription: he kept playing Botox until more advanced treatments appeared.

Now, Lin Bai began to try to accept his new stomach, and he also saw the good side of the operation: after all, now he can maintain the weight he had tried to lose without deliberately exercising and dieting. Bai Lin currently weighs 172 Jin, and her greatest wish is to "live like a normal person".

Hua Meng is striving to add two treatment rooms for psychological intervention before and after operation. A study published in Current Perspectives of Psychiatry (20 14) pointed out that half of the candidates for bariatric surgery are depressed patients. Hua Meng hopes that through proper psychological counseling, new patients can understand that stomach cutting is not the last straw to cure all diseases, and doctors can't expect a single operation to solve all patients' problems.

Hua Meng believes that the first purpose of bariatric surgery is to treat patients with extreme obesity and type 2 diabetes, and bariatric surgeons have the same mission of saving lives as other surgeons. This is why "slimming surgery" is not called "slimming surgery".

Hua Meng in gastrectomy. Photo courtesy of respondents

According to the Blue Book on Prevention and Treatment of Obesity in China published on 20 19, the proportion of overweight and obesity in China exceeds 40% of the monitored population. "There are so many potential patients in China, what is certain is that everything in this industry is developing too fast, or the good and the bad are mixed." Wang Cunchuan said, "But it must be a good thing that more people pay attention to bariatric surgery, because we are really saving lives. Slowly, weight loss surgery will definitely become formal. "

"If someone just wants to look good, then I will definitely persuade him not to go." Emily wrote in her diary entitled "Regret every day after weight loss surgery". "At present, my regret for the operation is 50%, and I still feel that it is not worth it.

However, after her stomach was cut open, Lin Bai did successfully get the postgraduate admission qualification of her favorite school.

In September this year, Lin Bai first stepped into the cradle of this famous singer and actor. Walking on campus, his illusion that the school is full of handsome men and beautiful women was quietly broken. Among the people passing by, there are many students with ordinary looks and bodies. As for whether cutting the stomach has brought extra points to Lin Bai's interview, there is no way to know.

(Emily, Lin Bai and Sun Bei are pseudonyms)