c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Bariatric Surgery Options: 1

A D V E R T I S E M E N T

   
 

The Roux-en-Y gastric bypass is the gold standard for weight loss surgery in America.

A biliopancreatic (BP) limb is formed by dividing the bowel 50cm distal to the Ligament of Treitz. The distal portion is labeled the roux limb and is run 75-150cm distally. The BP limb and distal portion of the roux limb are anastomosed.

The stomach is divided to create a 30ml pouch. The roux limb is brought up to the pouch, either in front of the transverse colon or behind. The gastrojejunal anastomosis is performed in many ways with the goal to create a 1.5-2.0cm opening.

This surgery has the benefit of an immediate effect on glucose metabolism, it has excellent long term results. The risks of this surgery include internal hernia, marginal ulcer, anastomotic leak and malnutrition.    

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Bariatric Surgery Options: 2

A D V E R T I S E M E N T

   
 

The biliopancreatic diversion with duodenal switch (BPD-DS) originated in its modern form in Italy and spread to America.

The first step is dividing the duodenum and creating a pylorus preserving sleeve gastrectomy. The distal ileum is anastomosed to the gastric sleeve. Then the small bowel is measured from the terminal ileum proximally to create a common channel (typically 50-100cm) and the biliopancreatic limb is anastomosed to the ileal limb that was brought up to the gastric sleeve at this point in a side to side fashion.

This surgery has excellent weight loss >90%, but in addition to the complications associated with the roux-en-y gastric bypass, it has much higher rates of malabsorption and protein malnutrition.    

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Bariatric Surgery Options: 3

A D V E R T I S E M E N T

   
 

The sleeve gastrectomy originated from the BPD-DS surgery where it was used as the initial procedure in a two-step operation for patients very high morbidity and extreme obesity. This operation is typically chosen for patients with many comorbidities, inflammatory bowel disease or history that would necessitate surveillance of the stomach (which would be excluded in RYGB and BPD-DS).

The greater curvature of the stomach is freed of all adhesions posteriorly. A 32-60Fr bougie is used to stent open the stomach and to size the sleeve. Starting 2-10cm from the pylorus the stomach is divided and there is a 75% reduction in stomach volume along the greater curve.

The major risk of this procedure is an Angle of His leak, which can be much more difficult to manage than a leak in the RYGB. The expected percent excess weight loss is less than a RYGB.    

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This page was last modified on 3/14/2013.