The Surgical Treatment of Metabolic Disease and Morbid Obesity
Section snippets
Roux-en-Y Gastric Bypass
Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States (Fig. 1). It is considered the gold standard operation to which all other operations are compared. It can be performed in a laparoscopic or the traditional open technique. This procedure considered restrictive and malabsorptive. The restrictive component to this operation entails creating a 20- to 30-mL gastric pouch just below the gastroesophageal junction. This pouch is either partitioned from the
Laparoscopic adjustable gastric banding
The adjustable gastric band was first developed by Kuzmak9 in the early 1980s. It was a later refined to include a saline-filled bladder within a band that encircles the upper portion of the stomach in a belt-like fashion. The saline-filled bladder is attached to tubing that runs to a reservoir in the subcutaneous tissue. The bladder is adjusted through accessing the reservoir (Fig. 2). The band that encircles the stomach creates a small proximal gastric pouch, which can hold 2 to 3 ounces of
Biliopancreatic diversion and biliopancreatic diversion with duodenal switch
The biliopancreatic diversion (BPD) was first described by Scopinaro and colleagues13 in 1979 and remains one of the most effective weight loss operations. The procedure consists of a subtotal gastrectomy with creation of an approximately 200 to 500 mL gastric pouch. Intestinal continuity is restored through formation of a Roux-en-Y gastro-ileostomy of approximately 200 cm with a common channel of approximately 50 cm. A small amount of restriction is created by the decreased gastric reservoir
Sleeve gastrectomy
The sleeve gastrectomy or vertical gastrectomy involves the creation of a long tubular gastric conduit based on the lesser curve of the stomach (Fig. 4). Most of the fundus and body of the stomach are resected with preservation of the gastric antrum. The total volume of the resultant gastric sleeve is approximately 100 to 150 mL. Initial reports of the sleeve gastrectomy primarily involved patients at extremely high risk for conventional bariatric surgery.17 Experts believed that a laparoscopic
Vertical Banded Gastroplasty
Vertical banded gastroplasty (VBG) was the first accepted surgical weight loss procedure. It was the most common operation before the Roux-en-Y gastric bypass, and has largely been replaced by the laparoscopic adjustable gastric band. VBG created a 30- to 50-mL gastric pouch along the lesser curve of the stomach from the angle of Hiss to a circular opening created with a circular stapling device. A 5-cm long piece of Marlex mesh was then placed around the gastric pouch to create a permanently
Summary
There has never been a time when so many viable alternatives for metabolic and weight loss surgery were available. Currently four well-accepted procedures are performed: the Roux-en-Y gastric bypass, laparoscopic adjustable band, sleeve gastrectomy, and biliopancreatic diversion. Evidence shows that each of these procedures is associated with excellent long-term weight loss compared with every nonsurgical alternative, and each has a reasonably low complication profile. The emphasis now is on
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