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Other Major Malabsorptive Methods of Bariatric Surgery

Female Doctor

In terms of popularity the most common form of malabsorptive bariatric surgery is Roux-en-Y gastric bypass (RYGB). Yet, there are other possibilities from which to choose if you wish to undergo this type of weight loss surgery. The two major types currently available are.

What is BPD?

The first BPD surgery was performed by Nicola Scopinaro in 1969 at the University of Genoa in Italy. This malabsorptive technique was intended to replace a once common form of intestinal surgery the jejuno-ileal bypass (JIB). Unlike the most common form of malabsorptive surgery – RYGB, BPD does involve removal of the stomach. In fact, if you undergo BPD you may lose approximately 70% of your stomach through a horizontal cut. This incision slashes off the bottom half. The intent of such an operation is to decrease the amount of stomach acid available to aid in the absorption of nutrients.

The operation actually consists of two specific components. The first is the removal of a large portion of the stomach. The second is the creation of a long limb (RNY) anastomosis with a short digestive channel. The RNY joins the distal end of the small intestine to the new stomach. The method is to help produce short and long term weight loss.

The process works by decreasing the amount of nutrients absorbed in the gastrointestinal tract. The shortness of the passage in terms of length and the swiftness of the passage of the food through the system reduce the ability of the food to be absorbed. The individual feels fuller more quickly and less food is absorbed to add to the weight problem.

What are the Advantages of BPD?

There are several recorded advantages for this method. They focus on the success rate of this method when others such as banding and sleeve gastrectomy are not suitable or have failed. In particular, BPD is considered to be best suited for those who are super-obese or morbidly so.

What are the Disadvantages of BPD?

There are several disadvantages to this type of operation. Some relate directly to its nature – it is malabsorptive. The following are considered the most common possible negative results from BPD:

  • Not reversible
  • Lifetime monitoring
  • Need to take supplements. Research indicates patients must take calcium and vitamins for the duration
  • Foul smelling and loose stools
  • Chronic ulcers
  • Gas
  • Poor vitamin absorbtion

In patients who have undergone a BPD malnutrition can be a problem. It, therefore, requires constant monitoring of the situation.

How Successful is BPD for Weight Loss?

The success rate for those who have undergone BDP surgery is reported to be significant. This is true for both the short and long-term. The amount of excess weight lost can be as high as 70%1.  Moreover, the amount can be kept off for extended periods of time. This is not always the case with other forms of weight loss surgery. The same figures are possible with less disadvantages or risks with a modified form of BPD – BPDDS.

What is BPDDS?

BPDDS is actually a variation of the BPD. It was first noted in 1986 by Dr. Doug Hess. The procedure is often referred to as duodenal switch surgery. The essential process is identical to BPD except for the specific part of the stomach removed. In BPDDS the surgery cuts away vertically. It leaves the valve that manages food drainage – the pylorus, whole. The duodenum is cut across into a short segment then the tube reconnects lower down on the duodenum at the point where the digestive juices are entering the intestine.

This is both a restrictive and malabsorptive method. The result is that patients feel full sooner when eating. This encourages patients to eat less.

What are the Advantages of BPDDS?

The BPDSS offers several advantages over other methods of bariatric surgery.

  • It permits the ingestion of larger amounts of food when compared to either bypass or band surgeries
  • The ability to tolerate food is higher than either the BPD or other types of bariatric surgery
  • Faster weight loss than gastric banding

What are the Disadvantages of BPDDS?

The disadvantages of BPDDS are similar to those found in BPD – though less extreme. Some include:

  • Anemia
  • Osteoporosis
  • Diarrhea
  • Foul smelling gas
  • Failure to absorb sufficient fat soluble vitamins – specifically vitamins A, D, E, and K
  • Protein-calorie malnutrition – this might result in the need for a second operation
  • Iron deficiency
  • Ulcers  – although less frequent than in the case of BPDDS

BPDDS does exhibit definite signs of the so-called “dumping syndrome.” They are, however, less severe than those found in BPD

How Successful is BPDDS for Weight Loss?

Both BPD and BPDS report the highest weight loss success stories in patients. This is particularly true for those who are super obese2. Follow-ups of 5 years indicate the weight does remain off the patients3. The only problem is the restrictive diet.

Conclusion

Both BPD and BPDDS are successful means of addressing the serious issue of obesity. The success rate of these surgeries among the super-obese are well documented. However, there are severe drawbacks that raise concerns for these major operations. Talk to your medical professional before you decide to implement either of these forms of bariatric surgery.



References

Pérez, N; Baltasar, A; Serra, C; Ferri, L; and Bou, R et al. (2005). Comparative Analysis of Vertical Banded Gastroplasty and Duodenal Switch at Five Years Follow-Up. Obesity Surgery 15 (7): 1061-1065.

2 Prachand, VN; Davee, RT; and Alverdy, JC. (2006). Duodenal Switch Provides Superior Weight Loss in the Super-Obese (BMI > Or =50 Kg/M2) Compared with Gastric Bypass. Annals Of Surgery 244(4):611-9.

3 Paradis, S; Cabanac, M; Marceau, P; and Frankham, P (2007). Body Weight and Satiation after Duodenal Switch: 2 Years Later. Obesity Surgery 17 (5): 631-636.

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