Bariatric surgery

12 important questions on Bariatric surgery

Energy intake can be reduced by:

- Reduce the gastric volume
- Reduce the intestinal digestion/absorption

What is gastric banding?

An adjustable gastric band, used to divide the stomach into a small proximal compartment (pouch) and a larger distal compartment (residual stomach)

What is the function of gastric banding?

Decrease energy intake, but still having a functional stomach (only reduced in size)
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What is an alternative for gastric banding?

A gastric balloon (inflatable and adjustable in size)

What is a Roux-en-Y gastric bypass (RYGB)?

- Stomach is taken down a few cm's distal to the gastric inlet.
- Jejunum is divided 50 cm beyond ligament of Treitz, and its aboral end is connected to the small gastric pouch
- 150 cm distal to this point, the other end of the small bowel is sewn to a loop that has been pulled up to meet it (--> the Roux-en-Y reconstruction)

What is the function of Roux-en-Y gastric bypass?

restriction, with an additional malabsorptive component
- Decrease of ghrelin levels
- Pancreatic juices + gal

What is sleeve gastrectomy?

More than 80% of the stomach is resected and gastric remnant is tubularized, with an initial filling volume of less than 100 ml

What is the function of sleeve gastrectomy?

restriction and hormonal mechanisms

What is biliopancreatic diversion (BPD) with duodenal switch (DS)?

- Stomach is reduced in size (like sleeve gastrectomy)
- Duodenum is divided distal to pylorus and jejunum is divided 250 cm proximal to ileocecal valve and anastomosed to duodenum
- The other end is connected to ileum 100 cm proximal to ileocecal valve

What is the function of BPD with DS?

a combination of restriction with a considerable degree of malabsorption
- More gas production
- A small part is present where some digestion can take place

What is endobarrier therapy?

- It is NOT surgery
- A tube inside the duodenum.
- No contact between food and enzymes

What are the benefits of endobarrier therapy?

- Effective, without surgery or reliance on medication
- Reduces body weight and blood sugar at the same time
- No incisions, scarring or associated risk (therapy is completely reversible)
- Only a brief recovery

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