There are three major types of wieght loss surgeries being done for Morbid obesity
Restrictive bariatric Procedure which includes
- Adjustable gastric bands
- Vertical band gastroplasty
Malabsorbtive weight loss Procedure
- Biliopancreatic diversion (BPD)
- Duodenal Switch (DS)
Mainly Restrictive Mildly Malabsorbtive bariatric Procedures
- Roux en y gastric bypass (RYGB)
Adjustable lap Bands
These weight loss procedures are more popular in Europe and Australia. All the surgery may be done laproscopically and through the conventional open technique. An adjustable band with inflatable band portion is placed on stomach between the Angle of HIs and top of the spleen.
Anterior wall of stomach is imbricated over the band
Advantage of this bariatric surgery is that the infatable ballon can be inflated or deflated with saline as desired.
Malabsorbtive weight loss Surgery
Biliopancreatic Switch (BPD)
Distal hemi gastrectomy is performed. Stomach volume is kept around 150-250 ml
Proximal end of ileum 200 cm is anastomosed to the stomach
The end of ileum which is continuous with jejunum is anastomosed to ileum 50-100 cm from the Ileocaecal junction
BPD was associated with high rates of marginal ulcer thats why the Duodenal Switch (DS) was invented
A vertical sleeve of stomach is resected and anatomy is reconstructed as in BPD. The common distal ileum limb is kept at 100 cm and the functional ileum length is 150 cm
Roux en Y Gastric Bypass Procedure
This procedure has two parts, one is creation of a sleeve gastrectomy and reduce the volume of stomach inlet to about 100-150 ml
Then a roux loop of small intestine is taken and anastomosed to that small stomach.
So it works both as a restrictive as well as malabsorbtive bariatric procedure.
Pre Operative preparation of the patient before undergoing surgery
There are certain pre requisites for patients before undergoing this prodecure
-The patient should be mentally stable and should have exhausted other means of loosing weight
- They should understand that this is not a miracle procedure and their compliance is of utmost importance
- Certain weight loss programmes are available in the market
- Also there are certina diet programes like Atkins diet or medifast diet. The efficacy and safety of these programmes however is in doubt
- Once patient has been listed for bariatric surgery, they should undergo extensive spiorometric exercises.
The most dreaded complication is leaks from the gastric stapled line
Patient with leak will present with signs of
An obese patient will not often have the classical signs of guarding and rigidity and a high degree of suspicion and low toelrance should be there in further investigating the patient