Malabsorptive Procedures

Gastric Bypass and Beyond

The medical term for changing the ability of the digestive system to absorb food is Biliopancreatic Diversion or BPD. There are actually several types of this procedure but basically they all are geared to decreasing the size of the stomach plus altering how the intestinal system functions to absorb nutrients below the stomach. Each process attempts to move the digestion of the food lower down to the middle or lower end of the intestines so there is less option for absorption of carbs, fats and calories by the system. Since
digestion only occurs in the presence of bile and pancreatic enzymes, changing where these components are introduced to the food in the system can limit the body’s ability to absorb the fat causing substances. In simple biliopancreatic diversion about three quarters of the stomach is removed, leaving only a small pouch. From this pouch all the food goes through a part of the small intestine that has been created by the surgeon. This part of the intestine does not have any connection to the pancreatic and
bile system so no absorption of any food occurs. The surgeon then attaches the biliopancreatic tubes to the lower part of the intestine called the “common intestine” which limits the area that digestion and absorption can
occur. In an Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E) the stomach is not removed, just stapled to about ¾ of its normal size. A part of the small intestine is then used to divert all the digestive juices to the mid to lower part of the intestine where digestion occurs. The surgeon can limit or expand the area of absorption by where he or she ties in the digestive tube to the main intestine. The final option is a biliopancreatic diversion with a duodenal switch, which basically removes the outer areas of the stomach, leaving a long, narrow
pouch. The upper intestine, the duodenum, is then divided to divert the digestive juices and prevent digestion until further down the intestines as described in the above procedures.

PROS

• Very high success rate with most patients achieving approximately 60-90% of their weight loss goals within five years
• High levels of malabsorption of food mean weight loss does occur
• Patients report feeling full and satisfied even on small portion diets since the stomach size is greatly reduced

CONS

• Changes in the digestive systems and the pancreatic processes can result in the formation of gallstones and subsequent gallbladder
surgery
• Patients will be required to continue a life-long supplement of vitamins and minerals. Bone density, deficiencies, anemia and nutritional
deficiencies can occur if the proper supplements are not routinely taken
• Any surgical procedures poses the risk for infections or surgical complications
• Some patients may develop chronic diarrhea, ulcers and gastric irritations

Now lets take a look at Combination Procedures …..