Biliopancreatic
diversion
This is one of
the most efficient procedures for weight loss. It is generally offered as a
2-stage operation in patients with a BMI of more than 60 kg/m2.
The first step is to create a pouch. The surgeon uses metal staples which are similar to stitches, and then cuts through the stomach. The new stomach pouch is about a quarter of
the size of the original stomach. The remainder of the stomach is removed.
As with the gastric bypass, the surgeon will then divide the small intestine, and attach one end to
the pouch. Food will now pass from the pouch into this section of small
intestine. The remainder
of the small intestine, that previously was attached to the bottom of the patient's stomach,
now joins the other part of the small intestine close to the large intestine.
This means
that the patient's digestive juices join the intestine to mix with food right at the end
of the small intestine. This way, absorption of food is greatly reduced.
The Duodenal
Switch procedure is a variant of the Biliopancreatic Diversion. As with the
original Biliopancreatic Diversion, this operation includes dividing the
stomach, but only the outer margin is removed, leaving a sleeve of stomach with
the pylorus (the valve between the stomach and the small intestine) and duodenum at its end.
The duodenum
is then divided, so that the pancreatic and bile drainage is bypassed. The near end of
the alimentary limb is then attached to the beginning of the duodenum, while the
common limb is created in the same way as described previously.
Patients can
consume larger quantities than with other surgeries, because the pouch is bigger, and fat and sugars are not absorbed by the intestine. As a result,
patients may experience frequent loose bowel motions, especially in the first 6
months after surgery. Over time, the intestine will adapt to better absorb food, and bowel
movements will decrease to about 3–5 times per day.
Expectations
of weight loss
Following this
operation, people tend to lose weight quickly and lose 75–80% of their excess
body weight within 5 years. However, the side effects which occur following this
procedure mean that it is generally not acceptable for most patients.
Advantages
The amount of
food a patient can eat is not restricted. Weight loss
starts from the time of surgery. Patients can lose
on average 75–80% of their excess weight. Patients may be
able to maintain their weight loss better than with other types of bariatric surgeries. Resolution of
diabetes occurs in 95% of cases after 2 years following surgery.
Disadvantages
The surgery
itself has more risks than the gastric band, because it is a longer procedure
and the stomach and intestines are cut. Bowel obstruction may occur where the new joins are created at the pouch and further down the
intestine. This may require a procedure (endoscopic or surgical) in order to widen the
area and allow food to travel through at the correct rate.
Patients will
need to take many multivitamin and mineral supplements on a daily basis for
life. They will also be at greater risk of suffering from nutritional deficiencies than the gastric bypass patients, especially iron, calcium, vitamin A and D and protein. Therefore, close monitoring for
protein malnutrition, anaemia, and bone disease is required after these
operations.
The patient's hair may become thinner, although this is temporary while losing weight at a rapid rate. Patients may
develop gallstones (this happens in about 60% of cases) due to the rapid weight loss, and it
may be necessary to undergo a further operation to remove the gallbladder (laparoscopic cholecystectomy), or
it may be removed at the time of surgery.
Foul
smelling flatulence and loose stools may be experienced, especially if dietary
changes have not been made to low fat and low sugar choices. Patients may
experience dumping syndrome which occurs if a patient eats too much sugar, fat or
alcohol, or large amounts of food. This is not considered to be a major health risk, but it can
be very unpleasant, with symptoms including nausea, vomiting, diarrhoea,
sweating, faintness, weakness and increased heart rate.
Nausea and
vomiting (feeling and being sick) may occur, especially in the first few days after surgery. Vomiting
is also common if a patient eats too quickly or eats too much.
Source: NHS Choices.
http://healthitis.blogspot.com
Source: NHS Choices.