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home - Stomach - Obesity Surgery - Gastric Surgery Malabsorption Type Written by Dr Sebastian Zeki
Knowledge


Describes the risks associated with obesity
Describes the dietary, pharmacological and surgical techniques
(including anatomical re-configuration) for managing obesity and their
associated medical and nutritional complications

Skills
Takes a relevant history and perform an appropriate examination in
order to be able to define level of obesity, identify potential
complications and arrange relevant investigations before referral to
an obesity service

Investigates and appropriately manages (in conjunction with surgical
and dietetic colleagues) patients admitted with complications from
bariatric surgery

Behaviours
Recognises obesity as an illness and will evaluate and treat the
patient in a sympathetic manner

Gastric Surgery Malabsorption Type

Biliopancreatic diversion Malabsorptive ProceduresThe primary mechanism of malabsorptive procedures is to decrease the effectiveness of nutrient absorption by shortening length of functional small intestine.Jejunoileal bypass (JIB), the biliopancreatic diversion (BPD), and duodenal switch operation (DS) are examples of malabsorptive procedures.Profound weight loss can be achieved by the malabsorptive operations depending upon the effective length of the functional small bowel segment.The benefit of superior weight loss offset by the significant metabolic complications such as protein calorie malnutrition and various micronutrient deficiencies.Some procedures have both a restrictive and malabsorptive component.The Roux-en-Y gastric bypass (RYGB), for example, is primarily a restrictive operation in which a small gastric pouch limits oral intake.The small bowel reconfiguration provides additional mechanisms favoring weight loss including dumping physiology and mild malabsorption. The operation involves division of the jejunum close to the ligament of Treitz and connecting it a short distance proximal to the ileocecal valve, thereby diverting a long segment of small bowel, resulting in malabsorption.Outcome data shows excess weight loss was excellent.The high complication rate and frequent need for revisional surgery (10% mortality so no longer done.) is partly related to bacterial overgrowth in blind loop. Liver failure occurs in up to 30 %)- same histology as alcoholic liver disease. The operation is a variant of the BPD.It involves a partial sleeve gastrectomy with preservation of the pylorus, and creation of a Roux limb with a short common channel.The BPD/DS procedure differs from the BPD in the portion of the stomach that is removed, as well as preservation of the pylorus.Indications include super-morbid obesity (BMI >50).Complications include a lower incidence of stomal ulceration and diarrhea than with BPD alone.Can be done laparoscopically. The procedure consists of a partial gastrectomy and gastroileostomy with a long segment of Roux limb and a short common channel (the part of the small bowel that receives both food and biliopancreatic secretions) resulting in malnutrition. Up to 72 % excess weight loss up to 18 years have been reported.Laparoscopic BPD has also been performed with acceptable outcomes. Malabsorption Procedures Biliopancreatic diversion with duodenal switch Jejuno-ileal bypass Death.Diarrhea.Electrolyte imbalances.Oxalate renal stones.Vitamin deficiencies.Malnutrition.Arthritis. Outcome: Side Effects of Biliopancreatic diversion:Protein malnutrition.Anaemia.Diarrhea.Stomal ulceration. Written by Dr Sebastian Zeki

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