Question:
Would you like to help with the WLS definitions page?

Please take a look at this definitions page: <a href=http://www.obesityhelp.com/morbidobesity/terms.phtml>http://www.obesityhelp.com/morbidobesity/terms.phtml</a><br>http://www.obesityhelp.com/morbidobesity/terms.phtml<br>. Do you see any important terms which are missing? If so please post them as answers to this question. I can then add them to that page. Thanks!    — ericklein (posted on March 2, 2000)

March 2, 2000
Eric, I took a look at the definitions page and I can see a glaring omission. You have the Bilio Pancreatic Diversion listed when in actuality this type is not really done anymore. It is the BPD-DS DUODENAL SWITCH which is really the current operation. When the BPD alone is listed it misleads people into thinking that this is still a choice for surgery when in fact it is the DS which is what is now done. The DS is also which makes the DS a viable, attractive, and safe alternative. Unfortunately, unless we all correct this information about the BPD rather than The BPD-DS, the outdated, useless information is still going to be propagated and confuse more and more people. Even my own DS surgeon had outdated pictures and write-ups in his office!!
   — Fran B.

March 2, 2000
Eric...here is my list pic and choose what you want... Open Roux en Y (Rny) The Stomach is separated into two parts. The small Stomach pouch(A)receives food. The lower part of the stomach(B) received most of the gastric juices coming from the liver and other organs. The small intestine is carefully measured and cut.One end(C) is connected to the small stomach pouch. The other end(D) is reconnected to the small intestine, forming a "Y". ================================================= Laparoscopic Roux-en-Y same as open Roux-en-Y except instead of opening you with a long incision on your stomach, Surgeons use a pencil thin optical telescope, to project a picture to a TV monitor. Having surgery this way, smaller scars , usually 3 to 4 small incisions. Quicker recovery time and less pain. ================================================= Distal Gastric Bypass The Gastric Bypass operation can be modified, to alter absorption of food, be moving the Y-connection downstream ("distally"), effectively shortening the bowel available for absorption of food. The weight loss effect is then a combination of the very small stomach, which limits intake of food, with malabsorption of the nutrients which are eaten, reducing caloric intake even further. Patients have increased frequency of bowel movements and increased fat in their stools (bowel movements). The odor of bowel gas is very strong, which can cause social problems or embarrassment. Calcium absorption may be impaired, as well as absorption of vitamins, particularly those which are soluble in fat (Vitamins A, D, and E). Vitamin supplements must be used daily, and failure to follow the prescribed diet and supplement regimen can lead to serious nutritional problems in a small percentage of patients. We. and others, have noted an increased incidence of ulcers post-operatively, in patients having this procedure. ================================================= Biliopancreatic Diversion (BPG) This very powerful operation involves removal of approximately 2/3 of the stomach, and re-arrangement of the intestinal tract so that the digestive enzymes are diverted away from the food stream, until very late in its passage through the intestine. The effect is to selectively reduce absorption of fats and starches, while allowing near-normal absorption of protein, and of sugars. Calorie intake is much reduced, even while normal-sized food portions are eaten. Although this operation is very powerful, patients are subject to increased risk of nutritional deficiencies of protein, vitamins and minerals. Vitamin supplementation recommendations must be carefully followed, and dietary intake of protein must be maintained, while intake of fat must be limited. Patients are annoyed by frequent large bowel movements, which have a strong odor. Excess fat intake leads to irritable bowel symptoms, and may lead to rectal problems. ================================================= Adjustable Gastric Band (AGB) Gastric Banding is a variation on the gastroplasty, in which the stomach is neither opened nor stapled -- a band is placed around the outside of the upper stomach, to create an hourglass-shaped stomach, and to produce a small pouch with a narrow outlet. The special device used to accomplish this is made of implantable silicone rubber, and contains an adjustable balloon, which allows us to adjust the function of the band, without re-operation. This device enjoys considerable advantage over the standard gastroplasty: It can be inserted laparoscopically, without the usual large incision. It does not require any opening in the gastrointestinal tract, so infection risk is reduced. There is no staple line to come apart. It is adjustable. ================================================= Loop Gastric Bypass This form of Gastric Bypass was developed years ago, and has generally been abandoned by most bariatric surgeons as unsafe. Although easier to perform than the Roux en-Y, it creates a severe hazard in the event of any leakage after surgery, and seriously increases the risk of ulcer formation, and irritation of the stomach pouch by bile. Most bariatric surgeons agree that this operation is obsolete, and should remain defunct. This operation has been resurrected, in order to make the laparoscopic procedure easier to perform. A fundamental principle of laparoscopic surgery is that the operation should not be compromised or degraded, in order to accomplish it using limited access techniques. The loop bypass does not meet this standard ================================================= Gastroplasty Gastroplasty, or Stomach Stapling (Gastric Partitioning) is widely performed in the United States and elsewhere. It is a technically simple operation, accomplished by stapling the upper stomach, to create a small pouch, about the size of your thumb, into which food flows after it is swallowed. The outlet of this pouch is restricted by a band of synthetic mesh, which slows its emptying, so that the person having it feels full after only a few bites (one thumbful) of food. Characteristically, this feeling of fullness is not associated with a feeling of satisfaction- the feeling one has had enough to eat. Patients who have this procedure, because they seldom experience any satisfaction from eating, tend to seek ways to get around the operation. Trying to eat more causes vomiting, which can tear out the staple line and destroy the operation. Some people discover that eating junk food, or eating all day long by "grazing" helps them to feel more sense of satisfaction and fulfillment -- but weight loss is defeated. In a sense, the operation tends to encourage behavior which defeats its objective. Overall, about 40% of persons who have this operation never achieve loss of more than half of their excess body weight. In the long run, five or more years after surgery, only about 30% of patients have maintained a successful weight loss. Many patients must undergo another, revision operation, to obtain the results they seek. There are many procedures available for weight loss. Most can be categorized as: RESTRICTIVE: vertical-banded gastroplasty, roux-en-y gastric bypass, laparoscopic roux-en-y-gastric bypass) or MALABSORBTIVE: (biliopancreatic diversion, distal roux-en-y gastric bypass, jejuno-ileal bypass). The Site listed below states: That they do not perform the malabsorbtive procedures as we have not found convincing evidence that they provide a more consistent weight loss or improved quality of life. They have converted many of these procedures to the Roux-en-Y Gastric Bypass because of severe metabolic complications and malnutrition. There are many other procedures that are touted as "unique". They are only presenting common procedures with known tract records and definable statistics. They advise you to use common sense in your educational process. If it sounds too good to be true, it generally is. Malabsorbtive Procedures Common to all malabsorbtive procedures is the apparent shortening of the intestine in contact with food. Although seemingly logical at first, making the system less efficient in its absorption of nutrients requires continued overindulgence by the patient for survival. The "eat to live" configuration can be quite harmful if adequate volumes of food were not available or if you were to contract a simple case of the "flu". Because of the shortened intestinal tract, hospitalization may be required and therefore travel to certain countries that do not have the medical facilities here in the United States should be discouraged. Iron, calcium, protein, vitamin and mineral deficiencies mandate continued supplements and occasional intravenous therapy. Distal Roux-en-Y Gastric Bypass This operation is often confused with the Roux-en-Y Gastric Bypass. It is however, much closer to the biliopancreatic diversion. This operation attempts to combine a gastric restrictive and malabsorbtive procedure. A small gastric pouch is formed and over 50% of the small intestine is bypassed. This lends itself to a higher degree of protein-calorie malabsorbtion and marginal ulcer formation than the biliopancreatic diversion. Fortunately, in this case, the stomach pouch will continue to increase in size as long as the patient is encouraged to overeat. Jejuno-ileal Bypass This operation is of historic importance. This prototypical malabsorbtive procedure was performed from 1963 to 1980. The amount of small intestine in contact with food was severely shortened. Although this procedure was quite simple to perform, the metabolic complications were devastating. Protein-calorie malabsorbtion, diarrhea, vitamin and mineral deficiencies were common. In addition, kidney failure has been seen in patients ten years out from surgery. It is because of this failed procedure, that many physicians and insurance companies look down on all bariatric procedures. Biliopancreatic Diversion This operation was described in Italy in 1973 and is still being performed in a few centers. This operation consists of removing part of the stomach, leaving a 200-250 cc pouch and shortening the small intestinal food conduit to 250 cm. There is a 50 cm common channel in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs as a result of "dumping" most of the calories and nutrients into the colon where they are not absorbed. There is need for precise control of types of food ingested and an emphasis on protein load. Most patients require life-long nutritional supplements which can be quite expensive. Blood tests are required every few months. Weight loss has not been shown to be superior to the restrictive operations. The social aspects of intestinal gas, diarrhea and odor can be devastating. Most insurance companies will not authorize this type of procedure because of the high complication rates and metabolic problems following this procedure ++++++++++++++++++++++++++++++++++++++++++++++++++++++ pick and choose what you want to add.. but also we need to add things like.. Berium swallow, vena cava filter, and maybe other tests normally taken at pre-op
   — Victoria B.

March 2, 2000
Eric, the description posted by Fran of the BPD is no longer accurate. It describes the procedure as it was performed years ago. Please use the following for the DS and BPD: <br><br> Distal Gastric Bypass with Duodenal Switch (also known as the Bileopancreatic Diversion with Duodenal Switch): The distal gastric bypass with the duodenal switch helps morbidly obese patients lose weight because it combines moderate food restriction with the malabsorption of fats. Fats cannot be absorbed into the body unless they become water soluble, which is accomplished by bile. This operation is based on the ability to keep bile from mixing with the food. <br><br> The operation first involves removing the greater curvature of the stomach , reducing stomach volume to 150 to 250 ccs in size (compared to 20-30ccs in the other operations). This moderate restriction is done to limit food intake as well as to reduce excess stomach acid, and thus prevent ulcer formation. The remaining stomach, however, still allows patients to eat a normal sized meal and gradually enlarges over the period of 1-2 years. Next, the small intestine is divided. One end of the "distal" small bowel is attached to the duodenum just past the stomach and the other end is attached to the intestine, a distance of 2 to 3 feet from its junction with the large bowel. This creates one tract for food and another for transporting bile and pancreatic juices down to the food. Full digestion begins where the tracts meet. <br><br> One key aspect of the operation is that the pyloric valve of the stomach is left intact, which facilitates a controlled release of stomach contents into the intestine - thus further avoiding the "dumping syndrome." <br><br> The original biliopancreatic diversion is still performed by some surgeons, with modifications to minimize the risks and side effects. This original procedure is similar to the duodenal switch procedure as described above, in that food and bile are seperated to minimize the absorbtion of fat, but the restrictive portion of the surgery is similar to the pouch procedures used in the Roux-en-Y. <br><br> For more information about the BPD and BPD/DS, please visit the Duodenal Switch Information Zone at www.duodenalswitch.com
   — Kim H.

March 3, 2000
Hey Eric, I looked again at the definition page and I thought of something else that might be helpful. Where you have the BMI defined would you consider adding the formula to calculate the BMI? I know that there are sites which will calculate BMI for you (this one included) but I know a very simple formula which people can use. It is very simple and I know I posted this as an answer to someone's question several months back. The formula is : take the person's weight, multiply that by 703. Then multiply the person's height in inches times their height in inches. Divide the weight answer by the height answer and you've got the BMI. This allow for a very accurate BMI because a person can use their actual height if it is 1/4, 1/2. or 3/4 rather than just using a whole number. This formula is especially easy because there is only 2 operations, mutiplication and division of real number, not kilograms, or numbers squared, etc. Especially good for the math challenged !!! :-) Fran wt. x703 ______ ht.in xht.in =BMI
   — Fran B.

March 3, 2000
Other terms that might be defined are nasogastric tube, endotracheal tube, ventilator, Jackson Pratt drain (JP drain). Oh, and also, you might want to consider adding the words in parentheses (no longer performed) next to Bilio Pancreatic Diversion since I think that the only place the true BPD may still be offered is in Italy with Dr. Scopinara who was the originator of the classic BPD. I think he was recently in New York City to observe Dr. Gagner perform the BPD-DS laparoscopally.
   — Fran B.

May 17, 2002
Eric, you might change your wording on laproscopic- you typed that the incisions were stab wounds- it might look better as 4 to 5 small incisions. Sorry but you did ask :)
   — Debby M.