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Surgical Treatments of Obesity
Published in Ruth Chambers, Paula Stather, Tackling Obesity and Overweight Matters in Health and Social Care, 2022
Duodenal switch: this procedure can be offered for super-obese patients as a two-stage operation where initially a laparoscopic sleeve gastrectomy is performed six months to one year after a laparoscopic duodenal switch is done. The second part of the duodenum is divided, and the ileum is attached to the proximal first part of the duodenum, whereby more than 70% of the small bowel is bypassed. This results in the rapid transit of food through the patient’s bowel and incomplete digestion, leading to malabsorption and severe steatorrhoea. Those having this procedure can eat more than if they had had a gastric bypass and still lose weight. Those undergoing the operation can lose over half their excess weight—but complications are common and occasionally life-threatening. Complications include acute hepatic failure, cirrhosis, chronic renal failure and malabsorption. Surgical re-anastomosis may be required to limit the associated morbidity. This procedure is rarely performed now in view of the high risk of complications.
Bariatric surgery in children
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Hariharan Thangarajah, Sanjeev Dutta
Being a primarily malabsorptive procedure, biliopancreatic diversion with duodenal switch has the capacity to engender significant nutritional perturbations including deficiencies in vitamins A, B12, D, E and K, iron and protein. RYGB may produce similar effects, though not typically to the same degree as biliopancreatic diversion with duodenal switch. LAGB, vertical banded gastroplasty, and laparascopic sleeve gastrectomy are primarily restrictive procedures that harbour a lower risk of producing malabsorptive sequelae.
Weight Loss by Surgical Intervention
Published in Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss, Nutrition and Cardiometabolic Health, 2017
Karim Kheniser, Sangeeta Kashyap, Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss
Biliopancreatic diversion with duodenal switch is an invasive procedure that necessitates transection of portions of the gut and bowel and frequently requires a cholecystectomy. Initially, a sleeve gastrectomy (partitions the majority of the stomach, which leaves a “sleeve-like” stomach) is performed to reduce gastric volume to 80–100 mL, which, depending on the surgical technique, excludes the ghrelin-producing fundus (Hess and Hess 1998; Kotidis et al. 2006). Then, the duodenum is transected 4–5 cm distally from the pylorus and the distal portion of the ilium is bisected (Hess and Hess 1998). When the proximal portion of the duodenum is preserved, the incidence of ulcerations is reduced (DeMeester et al. 1987). Thereafter, the distal portion of the ileum is anastomosed to the duodenum to create a duodenoileostomy; similarly, the proximal ileum is anastomosed to the distal portion of the ileum (i.e., ileoileostomy), which is located proximally to the cecum (Hess and Hess 1998). The point from the duodenoileostomy to the ileoileostomy is denoted as representing the alimentary limb. Thus, the procedure bypasses the majority of the jejunum and duodenum and the biliopancreatic juices flow through the biliopancreatic limb into the distal portion of the ileum where the ingested food converges with and forms the common limb. The delayed mixing of biliopancreatic juices and ailments promotes malabsorption.
Technical aspects and standardization of the totally robotic Roux-en-Y gastric bypass. Results of a single surgeon experience with a 5-year follow-up
Published in Acta Chirurgica Belgica, 2022
Emmelie Reynvoet, Veerle Van Vlodrop, Kurt Hendrick, Dries Vandeweyer, Carlos Vaz
The most frequently performed procedure in this cohort was the primary RYGB, which was done in 155 patients according to the standardised technique described above. In 23 patients revisional surgery was performed: 17 patients had a conversion of a gastric banding to a RYGB bypass, 1 patient had a conversion of a Mason gastroplasty to a RYGB bypass, 1 patient had a conversion of a sleeve gastrectomy to a RYGB bypass, 1 patient had a conversion of a Nissen fundoplication to a RYGB bypass (for obesity and resistant reflux), 1 patient had a conversion of a Scopinaro to a RYGB bypass, 1 patient had an Undo of a gastric bypass with a gastro-gastric anastomosis for refractory ulcers, 1 patient had a pouch resizing, reconstruction of the gastrojejunal anastomosis, positioning of a fobi ring plus distalisation. In three patients a duodenal switch was performed and in 2 patient a sleeve gastrectomy was performed as first step of a duodenal switch.
Peroneal neuropathy and bariatric surgery: untying the knot
Published in International Journal of Neuroscience, 2020
Mohamad Y. Fares, Zakia Dimassi, Jawad Fares, Umayya Musharrafieh
Gastric bypass is a restrictive-malabsorptive bariatric procedure that is considered the most commonly used worldwide [27]. This procedure reduces stomach size and bypasses part of the bowel to achieve a markedly lower stomach volume [28]. Several modifications and variations evolved over the years, like reduction in gastric pouch size, complete gastric transection, and application of a Roux-en-Y [29]. Gastric banding is a procedure introduced in the 1980s that constricts the stomach using an inflatable silicon band placed around the top portion of the stomach. This slows and restricts the quantity of food consumed by the patient, hence causing an earlier feeling of satiety. Later modifications saw the introduction of adjustable devices and better techniques that helped increase this procedure’s popularity [30,31]. Gastroplasty is a restrictive procedure first conducted in the 1970s; this procedure later developed into vertical banded gastroplasty (VBG) and became popular in the 1990s [31]. VBG uses a band and staples to reduce stomach size and create a small stomach pouch, thereby decreasing eating consumption. Food can flow into the rest of the gastrointestinal system through a small hole at the bottom of the stomach pouch. Sleeve gastrectomy is a restrictive procedure that was derived from the concept of VBG to be used in high risk patients [32]. This procedure removes a large portion of the stomach along the greater curvature, resulting in a sleeve or tube-like structure [32]. Similar to other procedures, this limits the amount of food taken and illicits hormonal changes that assist in weight loss. A duodenal switch is a less common restrictive-malabsorptive procedure [31,32]. It involves reducing the stomach size by around 80% and bypassing the majority of the intestine by connecting its end portion to the duodenum near the stomach [31,32]. Duodenal switch is considered a very reliable and long lasting BS procedure for weight loss.