Combined Restrictive and Malabsorptive Procedure
In recent years, a better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum to bring it up and construct a connection with the newly formed stomach pouch. The other end is connected to the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
Advantages
- Rapid initial weight loss
- Resolution of co-morbidities (obesity-related health issues)
- Decreased hunger
- Laparoscopic approach
- Longer experience in the USA
Disadvantages
- Stomach cutting, stapling and intestinal re-routing required
- Portion of the digestive tract is bypassed, resulting in lifetime nutritional monitoring
- Non-adjustable
“Dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much refined sugar or foods that are high in fat are consumed. The results can be extremely unpleasant and can include heart palpitations, nausea, weakness, sweating and fatigue.