There are several different types of Bariatric weight loss surgical procedures, but they are known collectively as 'Bariatric surgery'. To understand this, the procedures can be grouped in three main categories below). The three types are :
* Malabsorptive procedures: This surgery does focus at reducing the stomach size but they mainly aim on creating malabsorption. i.e. Biliopancreatic Diversion (Scopinaro procedure - rare)
* Restrictive procedures: This kind of surgery primarily reduces the stomach size. There are three ways of doing this:
o Vertical Banded Gastroplasty (Mason procedure, stomach stapling)
o Adjustable gastric band (or "Lap Band")
o Sleeve gastrectomy
* Hybrid procedures: In this type, both the techniques of restriction and malabsorption are applied simultaneously. i.e. Gastric bypass surgery, like Roux-en-Y gastric bypass
In this section, we will discuss all the procedures but only a surgeon can decide which one is suited the best for patient. Infact he is the only person who can tell whether the case could be handled laparoscopically or should be carried out as open surgery. This section is dedicated to providing you with the information to help you get familiar with Bariatric surgery
This surgery focuses to reduce the stomach size but they mainly aim on creating malabsorption. So if the stomach pouch is smaller in size and if there is signifcant malabsorption, this will lead to impairment of nutrition absorption and assimilation. In other words Malabsorptive procedures alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.
Biliopancreatic Diversion: (BPD)
The original version of this procedure (without the duodenal switch) was developed by Dr. Scopinaro in Italy. This operation creates an impairment of nutrient absorption (called "malabsorption")
as the primary factor in weight loss. This is done by removing about 2/3 of the stomach, and arranging the small intestine so that the section where food mixes with digestive juices is fairly short. This surgery is rare now because of problems with malnourishment. These operations may be more effective in achieving excellent weight loss in the extremely obese, but bring with them a higher rate of true malnutrition (malnutrition is very rare for those who undergo standard gastric bypass).
There are several different types of Bariatric weight loss surgical procedures. Restrictive procedures are surgical procedures which primarily reduce the stomach size. They can be done in three ways. So the three surgical ways are:
This operation emphasizes the volume restriction aspect of calorie control, by creating a tiny stomach pouch that exits into the lower stomach through a small fixed outlet that is reinforced by a permanent calibrated band on the stomach outlet. The operation was devised by Dr. Mason, one of the original Gastric Bypass surgeons, as he sought to devise the safest and most straightforward operation for morbid obesity. It is now an outmoded procedure because long term studies have demonstrated that it does not maintain weight loss as well as the Roux-en-Y gastric bypass.
Adjustable Gastric Band
The Laparoscopic Adjustable Silicone Gastric Band (LapBand®, Inamed) was approved by the FDA in June 2001, for use in treatment of Severe Obesity. The Lap-Band is a device designed to produce a small upper gastric pouch, and a narrow opening from it into the lower stomach. Surgeons use a silicone band to create a small pouch using the top part of the existing stomach. This limits food consumption without disrupting the normal progression of food through the digestive tract. It causes a sense of fullness after only a few bites of food, and it helps make the decision to reduce food intake, and to lose weight. It can be inserted laparoscopically. The biggest advantage is that it is a reversible process. This operation is especially attractive to persons who can spare only a small amount of time, and who need to return quickly to full activity. With one to two days hospitalization, a busy executive can return to his desk, and gain control over troublesome weight problems.
"Removable" in the list of key features refers to the fact that the Lap-Band can be removed from the patient with little residual impact on the stomach. This seems to be true even when the band has eroded into the stomach, or become infected, or slipped out of position. This is possible because the substance from which the band is made creates essentially no tissue reaction, so that the Band is not stuck in place over time. This feature also means that the Lap-Band procedure is "reversible" in a certain sense. We hasten to clarify that the Band would only be removed in our practice because of medical necessity, and that if it were not replaced by some other weight loss procedure that the patient would be guaranteed to experience significant weight regain.
This surgery as explained before, involves placement of a band around the outside of the upper stomach, to create an hourglass- shaped stomach, and to produce a small pouch with a narrow outlet. The special device used to accomplish this is made of implantable silicone rubber, and contains an adjustable balloon, which allows us to adjust the function of the band, without re-operation. Using thin surgical instruments and a small internal camera to monitor the operation, the surgeon places a silicone band without cutting or stapling. This pouch later limits the patient's food consumption without disrupting the normal progression of food through the digestive tract.
In some cases, the gastric band is connected via a small tube to a small reservoir that contains saline. This reservoir is placed under the skin of the upper abdomen. After surgery, the surgeon will examine the patient to ensure that the band contains enough saline. It needs to be tight enough to allow for gradual weight loss while ensuring that the patient eats enough food for proper nutrition. Adjustments are typically made to the band one month after the procedure. Using a fine needle, the surgeon can add or remove saline to enlarge or shrink the band. The number of adjustments varies from person to person, but most patients need three to five before the band is at the ideal tightness. The length of this laparoscopic procedure is one to two hours. Because the stomach is not cut, stapled or opened there is less trauma to the body. The most common problem is a slippage of the stomach through the band, causing the upper stomach pouch to enlarge and obstruct, often requiring a revisional surgery, which can usually be done laparoscopically. For best success, frequent adjustments of the band are needed, and one must learn to change eating behaviour.
A variation of the biliopancreatic diversion includes a duodenal switch. The part of the stomach along its greater curve is resected. The stomach is "tubulized" with a residual volume of about 150 ml. This volume reduction provides the food intake restriction component of this operation. This type of gastric resection is anatomically and functionally irreversible. The stomach is then disconnected from the duodenum and connected to the distal part of the small intestine. The duodenum and the upper part of the small intestine are reattached to the rest at about 75-100 cm from the colon.
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