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Home | Sample Articles | Weight Loss Surgery: Restrictive, Ma . . .

Weight Loss Surgery: Restrictive, Malabsorptive, and Combination

In this artticle we'll look at the three types of Weight Loss Surgery: Restrictive, Malabsorptive, and Combination Surgeries


Restrictive Surgeries

Restrictive weight loss surgeries are the least preferred option by the medical community. There are two types of restrictive surgeries.

Adjustable Gastric Banding (AGB) or LapBand®

An elastic band made from a special silicone material is placed around the upper part of the stomach to create a small pouch. The pouch can hold only a small amount of food at one time   generally just 1 ounce to begin with   which later expands to 2-3 ounces. The opening of the small pouch to the larger pouch or the majority of the stomach is very small -- only about a quarter of an inch. The food thus passes from the small pouch to the large pouch very slowly and one feels full longer with a lesser amount of food.

Pros of LapBand® surgery:
The biggest advantage is that there is no removal of any body part including stomach and intestines. 
The body is not altered in any unnatural ways.
Recovery period is short. 
A simple procedure that is fairly safe.
Less possibility of complications.

Cons of LapBand® surgery:
A 5% possibility of complications that include an internal infection, erosion/damage to the band or leakage from the small pouch.
Some patients simply cannot eat after the operation, which can cause problems.
Less successful than malabsorptive techniques in maintaining long-term weight loss.

Vertical Banded Gastroplasty (VBG)

This is the most commonly used type of restrictive surgery. It is similar to LapBand® surgery except that VBG uses both bands and staples to create the small stomach pouch.

Pros of VBG surgery:
The biggest advantage, and the reason why it is so preferred, is that the procedure is completely reversible.
The body is not altered in any unnatural ways.
The food passes through the body slowly and steadily so no dumping syndrome.
Recovery period is short. 
A simple procedure that is fairly safe.
Less possibility of complications.

Cons of VBG surgery:
Less successful than malabsorptive techniques in maintaining long-term weight loss.
Requires the patient to follow a strict diet plan to avoid any complications.
If the patient eats too quickly or does not chew the food properly it can lead to vomiting.

Malabsorptive & Combination Surgical Procedures

Malabsorptive procedures are generally more successful in long-term weight loss than restrictive procedures. Malabsorptive procedures bypass a portion of the intestine by creating a direct connection from the stomach to the lower portion of the intestine. The food then comes in contact with a smaller portion of the intestine. Thus, fewer calories are absorbed into the body, resulting in weight loss. There are three different types of malabsorptive and combination procedures.

Roux-en-Y Gastric Bypass (RNY)

This is the most common of all bariatric surgeries. A small pouch is created by stapling the upper portion of the stomach to reduce food intake. A Y shaped section of the intestine is then attached to the pouch.

This allows the food to bypass the first two portions of the intestine and severely restricts absorption of calories and nutrients thus effecting weight loss.

In one study it was found that almost 2% of patients who had undergone RNY died within thirty days of having the surgery.

However, 27% fewer patients that had the surgery died
than those who did not in a 15-year follow up.

This suggests that the surgery is definitely helpful but risky as well. (Source: Journal of American College of Surgeons, Oct 2004) Some studies have shown that patients who undergo RGB lose an average of a 100 pounds after surgery.

Pros of RNY surgery:
An average 77% of excessive body weight is lost after one year. Patients have been found to keep off almost 50-60% of the weight loss, even after 10-14 years. This is definitely the most effective long-term weight loss surgery available today.
A reversible procedure, though not easily.
Severely controls the ability to eat food.
Found to provide a cure for other obesity-related problems like sleep apnea, back pain, diabetes, high blood pressure, and even depression.

Cons of RNY surgery:
Possible complications can arise if the staples used to create the small pouch fail to do their job effectively.
Possibility of the patient developing ulcers and hernias.
The narrowing of the stoma (stomach outlet) can cause it to get blocked.
If the patient eats too quickly or does not chew the food properly it can lead to vomiting.
The dumping syndrome can occur due to high intake of sugar, fats, or overeating. The contents of the stomach are literally dumped too quickly into the intestine and can cause nausea, weakness, fainting, diarrhea and sweating.
Can cause nutritional deficiencies over a period of time. Vitamin and mineral supplementation is essential. If the patient fails to take supplements as prescribed by the doctor for life it can cause major deficiencies.
This procedure requires close monitoring of the patient and lifelong restrictive eating habits. Also, regular check ups and follow ups are a must for life.

Biliopancreatic Diversion (BPD) or Scopinaro Procedure

In this type of surgery portions of the stomach are actually removed and just a small pouch is left behind. This pouch is then directly connected to the last portion of the intestine completely bypassing the duodenum and jejunum.

Pros of BPD surgery:
The stomach capacity is 4-5 ounces with BPD so one can lose weight and still enjoy a healthy meal.
There is significant weight loss that is maintained over a long period of time.

Cons of BPD surgery:
Portions of the stomach are removed from the body and altering the natural body can always create problems.
High risk of developing ulcers, chronic diarrhea, and pungent stools and flatulence. 
Since the duodenum and jejunum are completely bypassed, the patient invariably suffers from nutritional deficiencies. These must be supplemented carefully.
Calcium and vitamin deficiencies are also possible.
High chance of dumping syndrome.

Duodenal Switch (BPD/DS)

The duodenal switch is similar to BPD but less invasive. It leaves larger portions of the stomach intact and also retains the pyloric valve that controls the release of the stomach fluids and juices into the intestine. This surgery also retains part of the duodenum in the digestive track.

Pros of BPD-DS surgery:
Less invasive than BPD. 
Better absorption of nutrients like calcium, iron, and vitamin B12.
The patient can eat better as compared to other weight loss surgeries.
Practically resolved issues of ulcers and dumping syndrome.

Cons of BPD-DS surgery:
Pungent stools and flatulence but less so than with BPD alone.
High risk of contracting chronic diarrhea.
Very high malabsorptive component.

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