Biliopancreatic Limb

Surgical treatment of obesity is called bariatric surgery, after the Greek words, Baros, which means "weight" and iatrikos, which means "the art of healing." This is the fastest growing area of surgical practice in the Western world today. This reflects the ability of bariatric surgery for a solution to an otherwise intractable problem and the evolution of forms safer, less invasive and more conservative procedures.

Surgical treatment of obesity has evolved over a period of more than 50 years. Today, there are three bariatric procedures in use: the gastric bypass, biliopancreatic diversion and laparoscopic adjustable gastric banding. Small bowel bypass is no longer performed.

1. Bypass Small Bowell

This procedure was introduced in the 1950s and there were various ways in which this operation was performed. Each of these methods, however, shared the common principle to circumvent the normal absorptive capacity of the intestine. In other words, you can eat a lot, but the food is not absorbed by the body. Instead, you have diarrhea. These procedures are generally effective in achieving weight loss, but they had a number of serious side effects, which ultimately unacceptable.

2. Gastric Bypass

This operation has been performed more than 35 years and is always a good procedure. However, it requires considerable manipulation of the intestine. Gastric bypass is the most commonly used in the United States and about half of the operations are performed by traditional open surgical approach with a long incision in the abdomen and half are performed by laparoscopy (microsurgery).

The operation can be performed in a number of different ways but they all have their effect through two common characteristics. First, they create a small upper stomach so you can eat a small amount of food at a time until you feel comfortably or uncomfortably full. Secondly, they each delay the emptying of food from the small upper stomach in the rest of the intestine in some way so that the feeling of fullness stays with you after dinner and you are not inclined to eat between meals.

In the gastric bypass procedure, a stapling device is used to cut and separate completely a small piece of the upper part of the stomach from the rest of the stomach. The upper part of the stomach becomes new and the rest is closed and no longer accessible. The upper part of the small intestine is then divided completely with the new stapling device. One end is attached to divide the new stomach to allow food to enter the rest of the intestine. The other end is connected to the small intestine further downstream, so that digestive juices from the liver, gallbladder, duodenum and pancreas can not return to the digestive tract.

stomach stapling is a big operation with a real risk of major complications and about 1% of the population died of complications. It causes major changes in the intestine and is essentially irreversible. The most common form of stomach stapling is used Roux-en-Y gastric bypass. This can be done as open surgery or laparoscopy. It is a relatively complex procedure, which provides no possibility of adjustment after surgery.

Another form of gastroplasty that is more commonly used in some centers is the gastrectomy, in which most of stomach is removed and discarded and a thin tube is left with the hope that it will not grow in the years to come. Our experience strongly suggests that hope will not be realized. So far, there has been very little published data on this procedure. Currently, we do not know about its risks and benefits and we do not know whether the effect of weight loss for a period of even 5 years.

3. Biliopancreatic diversion.