Combined restrictive malabsorptive surgery for Obesity
Known as the Roux-en-Y gastric bypass, the restrictive-malabsorptive option has been performed in the United States for nearly 50 years. It has been performed laparoscopically for the past 15 years and historically is the gold standard and most common operation for weight loss in this country.
The procedure is the performed in the following way:
- A. A 15- to 30-mL gastric pouch is created by completely dividing the proximal stomach (the restrictive part).
- B. The proximal jejunum is divided 15 to 50 cm from the ligament of Treitz (length depends on surgeon preference).
- C. The distal end of this divided proximal jejunum is measured out between 75 and 150 cm and this Roux limb is anastomosed to the gastric pouch. The varying length of the Roux limb is thought to affect absorption of calories; however, this likely has a small role in weight loss unless the Roux limb is made very long (a distal gastric bypass).
- D. The proximal end of divided jejunum (biliopancreatic limb) is anastomosed to the Roux limb at the previously measured length, creating the Y configuration
What is the option for malabsorptive surgery?
Biliopancreatic diversion with and without a duodenal switch. A subtotal gastrectomy is performed, leaving a gastric remnant of 250 to 500 mL. The small bowel is divided 200 to 300 cm proximal to the ileocecal valve and the ileum is anastomosed to the stomach. The jejunum is connected to the side of the ileum approximately 50 to 100 cm from the ileocecal valve. This procedure results in malabsorption by creating a short common channel for digestion and absorption of food.