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Surgical treatment of obesity

Gastrointestinal bypass procedures

A current variation of the intestinal bypass and one that has become the "standard" is the Roux-en-Y Gastric Bypass. This procedure involves decreasing the size of the stomach by stapling across the top of the stomach and then bringing-up and attaching a portion of the small intestine directly to the stomach (thus bypassing part of the small intestine). This surgery is much better tolerated than the "old" intestinal bypass, but still results in significant complications, such as vitamin and mineral deficiencies, and may lead to osteoporosis (softening of the bones) in the long-term. 

There is usually only mild malabsorption of nutrients (as compared to the old intestinal bypass surgery). This surgery causes gastrointestinal hormonal changes, which result in decreased hunger. Individuals undergoing this surgery will lose significant amounts of weight (mainly fat as opposed to lean body mass or muscle tissue) with about 50-70% of excess body weight being lost initially. Weight maintenance is generally excellent with usually only small increases in weight occurring over five years. Like any obesity surgery, the patient will require lifelong medical follow-up and treatment of the medical complications that usually occur, for example, vitamin B12 deficiency and anemia.

This procedure can now be done laparoscopically, which offers a faster surgical recovery, but with the potential for more severe surgical complications since it is a technically difficult procedure. The availability of new state-of-the-art 3-D visualization equipment may make the laparoscopic Roux-en-Y Gastric Bypass the procedure of choice for individuals electing to undergo surgical intervention for their obesity.

For a QuickTime movie (208 KB /approximately 60 seconds download with 28.8 modem) illustrating a roux-en-y bypass, please click here (animation compliments of Vista Medical Technologies). If you don't have QuickTime, you may download it from Apple Computer (it works great on Macs and PCs) by clicking here).

Biliopancreatic bypass procedures (and similar extensive intestinal bypass procedures)

In these procedures, the digestive juices from the liver and pancreas are diverted to the distal small intestine near the entrance to the large intestine.  Thus, food enters the stomach, rapidly transverses the distal small intestine (where absorption of nutrients primarily occurs), and is then delivered to the large intestine (where excess water from the stool is removed). This results in marked malabsorption of nutrients with subsequent marked weight loss (up to 80% of excess body weight). Since there is marked malabsorption of essential nutrients, the probability of vitamin, mineral, and protein-calorie malnutrition is significant. These procedures are probably best avoided since the marked nutrient malabsorption may result in very severe long-term complications that may be similar to the old intestinal bypass operation.

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