Weight Loss by Surgical Intervention
Nathalie Bergeron, Patty W. Siri-Tarino, George A. Bray, Ronald M. Krauss in Nutrition and Cardiometabolic Health, 2017
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.
Surgical Treatments of Obesity
Ruth Chambers, Paula Stather in 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.
Surgical Treatment of the Obese Individual
G. Michael Steelman, Eric C. Westman in Obesity, 2016
Several other newer procedures are becoming increasingly used for weight reduction. Gastric sleeve surgery is the most common of these procedures. A gastric sleeve procedure is a restrictive procedure in which the stomach is resected along the greater curvature, leaving a tubular stomach of 60 to 80 cm. The antrum and pylorus of the stomach are preserved. The procedure has been performed in patients with Crohn’s disease, ulcerative colitis, cardiomyopathy with low ejection fraction, and renal transplant patients. A review by Iannelli et al. (25) revealed a mean weight loss of 83% at 12 months, although Almogy et al. (26) revealed an excess weight loss of 45.1% at 12 months. Mortality rate in the reviewed studies by Iannelli et al. (25) is 0.9% and morbidity is 10.3%. This procedure is often used as part of a two-stage approach for the superobese patient with second-stage duodenal switch. Oberbach et al. (27) report using the gastric sleeve and gastric bypass in 10 adolescent cases.
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.