Bariatric Surgery (Updates from 27th Bailey)

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Types of Bariatric surgeries:

Restrictive procedures

Sleeve gastrectomy:

  • Most commonly done bariatric surgery
  • Sleeve created along the greater curvature
  • MC complication: Anastomotic leak.

Laparoscopic adjustable gastric banding (LAGB):

  • Silicon inflatable band placed in proximal stomach
  • MC complication: Band slippage
  • Other complication: Gastric prolapse.

Malabsorptive procedure

Biliopancreatic diversion (BPD):

  • Lower 2/3rd of stomach is removed
  • Remaining portion of stomach is attached directly to ileum
  • The biliopancreatic limb is anastomosed 75-100 cm proximal to ileocecal junction
  • The food empties directly into the ileum.

Duodenal switch:

  • DS is a variant of BPD
  • Sleeve gastrectomy → Division of duodenum → Division of ileum → Duodenoileostomy → ileoileostomy
  • The food empties directly into the ileum.

(Restrictive + Malabsorptive) procedure

Laparoscopic Roux-en-Y gastric bypass (LRYGB):

  • Most acceptable bariatric surgery
  • Small proximal gastric pouch: Restrictive
  • Roux limb of 100 cm length: Malabsorptive
  • Expected weight loss: 65%.

Comparison:

BPD and DS, which are purely malabsorptive procedures cause maximum weight loss as well as protein calorie malabsorption (so, MC complication of these procedures is malnutrition).
Gastric bypass and sleeve gastrectomy have similar effects on DM, HTN, hyperlipidemia.

Newer procedures

Mini gastric bypass surgery:

  • Stomach is divided → Creation of vertical gastric pouch (12-15 cm) along lesser curvature → Antrectomy → Loop anterior gastrojejunostomy
  • It is a combination of (Colles gastroplasty + Antrectomy + Billroth I).

Advantages:

  • Only single anastomosis
  • Shorter operating time
  • Easily reversible
  • Superior weight loss (>75%)
  • Weight loss maintained for >10 years.

EndoCinch:

  • Endoscopic suction device that uses an endoscopic suction chamber
  • Technique: Placing several stitches in the region of the esophagogastric junction
  • Aim: To reduce gastric volume.

Laparoscopic gastric greater curvature plication:

  • It is a novel bariatric surgery procedure which is gaining popularity
  • In this technique, the greater curvature is just folded (plicated) and not cut
  • This is usually combined with a lap gastric banding.

Toga (Transoral gastroplasty system):

  • New incisionless weight loss surgery
  • Creation of stapled pouch along the lesser curvature.

Intragastric balloon:

  • Commercially known as “ORBERA”
  • The deflated gastric balloon is inserted through the esophagus into the stomach
  • A syringe is then used to fill the balloon with 600-800 ml sterile saline solution. The entire procedure takes about 20 minutes.
  • After the first 6 months of the weight loss program the stomach balloon is removed.

 

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