Selective Malabsorption

These procedures are designed to establish a more selective type of malabsorption and to incorporate gastric restriction as well. The first type was the gastric bypass (Figure 36-1C). This operation partitioned the stomach (by a row of staples) into a small upper pouch completely discontinous with the distal stomach. A loop of jejunum was then anastomosed to the proximal pouch. This procedure worked in two ways—first, by its gastric restriction of oral intake and second, by setting up a dumping physiol ogy for high calorie sweets. The vast majority of the stomach and all of the duodenum were bypassed. However, this procedure was complicated by bile reflux esophagitis in over 30% of patients, guiding a modification of the loop anatomy to a Roux limb as currently used today (see below).

The second selective malabsorptive procedure was the partial biliopancreatic diversion designed by Scopinaro and colleagues (1996) in Italy. This operation involves an 80% distal gastrectomy (the restrictive component) and transection of the ileum 250 cm proximal to the ileocecal junction; the distal ileum is sewn to the stomach, while the proximal ileum (the pancreatobiliary limb) is re-anastomosed to the Roux limb of ileum 50 cm proximal to the ileocecal junction (Figure 36-1D). This diversion of the biliopancreatic secretions to the distal ileum leads to bile salt loss into the colon with a subsequent selective maldigestion and thus malabsorption of fats (and fat soluble vitamins). This procedure has not become popular in the United States because of a high incidence of protein/calorie malnutrition and rather severe steatorrhea, but it has spured the current concept of biliopancreatic diversion (BPD).

Virtual Gastric Banding

Virtual Gastric Banding

Virtual Gastric Band Hypnosis Audio Programm that teaches your mind to use only the right amount of food to keep you slim. The Virtual Gastric Band is applied using mind management techniques, giving you the experience of undergoing surgery to install a virtual gastric band or virtual lap-band, creating a small pouch at the top of the stomach which limits how much food can be eaten. Once installed, the Virtual Gastric Band creates the sensation of having a smaller stomach that is easily filled and satisfied with smaller amounts of food.

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