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Surgery in the Treatment of Obesity (cont.)

Operative Procedures

Gastric bypass

Roux-en-Y gastric bypass is the most commonly performed weight loss procedure in the United States. This operation both restricts food intake and limits absorption of food. A part of the stomach is closed off, creating a small pouch. This restricts the amount of food that you can eat at one time. The small pouch of the stomach is connected directly to the small bowel. As the name implies, food bypasses the stomach and the first portion of the small intestine. Because a part of the small bowel is bypassed, less food is absorbed.

Most people find they can eat less than 1 cup of food at a time after the operation. Food must be chewed very well. Overeating or not chewing food finely will result in cramping, nausea, and vomiting.

Laparoscopic adjustable gastric binding

This is a purely restrictive procedure. It involves placing an inflatable silastic band around the uppermost part of the stomach. This results in a smaller upper stomach pouch and a narrow opening between the upper and lower parts of the stomach. This induces and early feeling of fullness and thereby decreases food intake. It is adjustable by changing the volume of saline in a surgically placed subcutaneous reservoir, thereby tightening or loosening the band.

Biliopancreatic diversion

Biliopancreatic diversion (BPD) is a malabsorptive procedure with some restrictive component. A part of the stomach is removed and the remaining part is attached directly to the small intestine near its end. BPD is used much less often than Roux-en-Y because it has a greater risk of complications.

Vertical banded gastroplasty

Vertical banded gastroplasty (VBG, stomach stapling) is a restrictive procedure that traditionally was done by applying bands or staples to the stomach. This procedure is rarely performed today due to the high failure rate.

More information about these procedures can be obtained by visiting the American Society for Bariatric Surgery or the Bariatric Multidisciplinary Institute.

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