Bariatric Surgery

Q)  False regarding Bariatric surgery

a) VBG produces less weight loss when compared to RYGB

b) Jejuno-ileal by-pass not done nowadays.

c) Dumping is due to non- compliance of dietary advice

d) LAGB requires once a 4-6wk follow up

Answer (free)

c
Calorie restriction is responsible for long term weight loss and its beneficial effects such as control of diabetes, dyslipidemia, hypertension and other metabolic abnormalities.
Restrictive procedures are LSG and  LAGB  which decrease the appetite and induce early satiety.           
The RYGB (ROUX en Y  gastric bypass ) is  a malabsorptive procedure  with long term sustained weight loss.
Mechanism of weight loss after bariatric surgery
Ghrelin is orexigenic gut hormone, which increases appetite. After food intake ghrelin levels fall and appetite decreases.
After restrictive surgery such as LYGB and LSG, ghrelin levels fall and appetite decreases.
Vertical Banded Gastroplasty (VBG) This procedure has been abandoned in favor of other operations because of poor long-term weight loss, a high rate of late stenosis of the gastric outlet, and a tendency for patients to adopt a highcalorie liquid diet, thereby leading to regain of weight. Choice a is correct

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Roux en Y gastric bypass

Q) Which  of the following statement about Roux en Y gastric bypass is not true?

a) After weight loss it resolves symptoms of venous ulcers due to stasis

b) Symptoms of pseudo tumor cerebri are resolved

c) Heartburn is alleviated immediately

d) Protein malnutrition is a very common problem


 

Answer 

d Protein malnutrition is common in Biliopancreatic division and duodenal switch.

Essential components of successful Roux en Y gastric bypass are 

  1. Small Gastric pouch (15-20ml) made from cardia of stomach
  2. Keep the length of roux limb at around 75 cm
  3. Division of gastric pouch from distal end of stomach

After RYGB 90% of patients immediately start to have relief from heartburn and other symptoms mentioned in the question

REF sabiston 20th edition page 1171