Question:
Help for all our new members and ones still deciding...
I happened on these sites for some great description of the different procedures (with pictures).. I'm not pitching any particular procedure (that is your choice) all of these sites you need to read for yourself, gather all the information you can then once you decide on a surgeon discuss these with him/her..What is right for one may not be right for you. Read all the information and date collected and research the issues on each surgery procedure.. Good luck in your quest for knowledge on the best procedure for you.. The below paragraphs are from the first website listed below please visit all these informational sites.. I though I would pass these on to all the ones really confused by now.. 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). We 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. We 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". We are only presenting common procedures with known tract records and definable statistics. We 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. Overview http://www.valleysurgical.com/MorbidObesity/Procedures/index.htm Other Procedures http://www.valleysurgical.com/MorbidObesity/Procedures/other.htm#Jejuno Gastric Bypass Types http://www.angelfire.com/ok3/vbowen8/index.html The Mini-Gastric Bypass http://clos.net/ Academy of Bariatric Surgeons - Suggested Links <~~Great links here..... http://www.obesityhelp.com/abs/links.htm — Victoria B. (posted on February 28, 2000)
February 27, 2000
Vicki... thanks for posting all this info, as I am sure your list will
help. One thing was omitted though.... the Bilio-Pancreatic Diversion with
a Duodenal Switch (BPD/DS). Info about this procedure can be found at
www.duodenalswitch.com
— Kris S.
February 27, 2000
Kris, you're right I forget about this procedure so often. Mainly
because there is just not enough clinical information about this
procedure out there..The website you mentioned is comprised solely by a
few patients that have had this type of surgery, well that is what I
gathered by the disclaimer written at bottom of page anyhow... Like I
said RESEARCH, RESEARCH, RESEARCH
— Victoria B.
February 28, 2000
Melanie and Kris: Just an observation on my part and not meant to sway or
detour anyone form doing the own homework and research on a particular
surgery.. But I was wondering why there are not more sites out there on
this procedure.. There is an abundance of sites out there on RNY
actually hundreds of thousands... however, I have only found this
"patient originated" one on DS. Are there more sites out there
to research other than this one? Maybe a list all the DS sites would help
on people doing their own research... Can you comprise a list for the site?
That might be helpful..
— Victoria B.
February 28, 2000
OOps meant to type...
Can you comprise a list of the DS sites? That might be helpful.. Surely
there are more than just ONE!!!
— Victoria B.
February 28, 2000
I keyed in BPD-DS on the search engines and the only thing I located was
this.. at (www.obesityhelp.com) This is what they had to say.. Keep in
mind they promote RNY on this site, however, I would hope their postings
are from actual clinical finding...
Mini-Gastric Bypass Outperforms More Extensive
Biliopancreatic Diversion-Duodenal Switch: (BPD-DS)
The BPD-DS is a much more extensive operation that the Mini-Gastric
Bypass.
The BPD-DS is much more dangerous, it involves much more operating, most of
the stomach is cut out, and long term complications are much higher than
with any other procedure.
This might be acceptable if the results were better, but they are not...
Comparison of Mini-Gastric Bypass weight loss to reported weight loss after
BPD-DS shows MGB patients on average do as well or better...
— Victoria B.
February 28, 2000
Hurray! I am tired of seeing of her posts too!
— Jane D.
February 28, 2000
<< if you'd like, I'll be happy to copy that list here >>
Yes please do... I think all the sites we put out there.. helps every
one in limbo make a decision. Thank for your input.
— Victoria B.
February 28, 2000
Vicki, thanks for the great informative post! I won't beleaguer the point
that the DS was left out (others have already mentioned it), but I do want
to address your post and correct some information that is outdated and/or
false.<br><br>
"Iron, calcium, protein, vitamin and mineral deficiencies mandate
continued supplements and occasional intravenous therapy." The
duodenal switch variation of the BPD basically eliminates iron, calcium and
protein deficiencies by moving the duodenum (where processing and
absorbtion of these nutrients takes place) to the top of the digestive
tract. As for vitamin deficiencies, a good multivitamin taken daily
eliminates this risk in all but a very few patients.<br><br>
"Biliopancreatic Diversion: 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." This is
misleading - the food travels through the lower half of the intestine, and
absorbtion is limited but does not eliminate "most" of anything
other than fat calories. Additionally, the common tract has been
lengthened to 75-100 cm, and this has eliminated most if not all of the
problems related to malabsorbtion. "There is need for precise control
of types of food ingested and an emphasis on protein load." This one
deserves an emphatic BULLSH*T. I eat what I want, when I want, and don't
precisely control anything that goes into my mouth (which is probably why I
end up with so much of it in my lap). I do eat a lot of protein, which all
malabsorbtive procedures require, but that's my only food guideline.
"Most patients require life-long nutritional supplements which can be
quite expensive." A daily multivitamin is expensive? "Blood
tests are required every few months." Again, not true. For the first
year post-op, I'll have blood tests every three months, and then annually
thereafter (which I can do during my annual physical). "The social
aspects of intestinal gas, diarrhea and odor can be devastating."
I've never heard of a single person with the BPD/DS having devastating gas,
diarrhea or odor. In fact, the only person I've ever heard of with this
kind of problem had an RNY, and it ended up being a result of some kind of
bacteria. "Most insurance companies will not authorize this type of
procedure because of the high complication rates and metabolic problems
following this procedure." Again, misleading. The "big
three", Blue Cross, Aetna and PacifiCare, all authorize the BPD/DS,
among others, and more carriers are adding it as time
passes.<br><br>
Thanks again so much for taking time to post information that can help
newcomers make educated choices about which procedure to pursue. I wish
there were more posts like yours and people like you!
The first statement that jumps out is: "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." I'm a frequent traveler in
developing nations, and were this true I'd never have had the surgery I
chose (the DS). The bottom line is, all travel in developing nations
carries some risk, since there aren't adequate medical facilities for any
type of medical problem, but a malabsorbtive procedure does not preclude
one from traveling there any more than does the threat of a potential
broken leg.<br><br>
— Kim H.
February 28, 2000
Kudos to Vicki, Kim H and Melanie for this extraordinarily informative and
courteous thread of discussion. I do want to add some second-hand info
about Dr. Rutledge and the "Mini-Gastric Bypass". When I went
for a consult with a surgeon, I asked him why other surgeons don't do this
surgery, since after reading the http://clos.net site I thought that it
sounded great. The surgeon I met with (Dr. Inabnet, same office as Dr.
Gagner in NYC) told me that this procedure was actually a shortcut, an
inadequately performed RNY, and that Dr. Rutledge's work is frowned upon by
major medical organizations (sorry, I can't remember if he named the ASBS
or not). Again, this is hearsay...but I was convinced when he showed me
via a diagram just where the shortcutting was.
— Julie C.
February 28, 2000
Kim: Please feel free voice your opinion on any information you feel
needs to be corrected anything helps the new members or undecided
members... Of course you know I didn't author what I posted, it was a
collection of quotes from several diffrent surgeons websites as indicated
on my post... I just cut and pasted the documentation from the surgeons
sites and posted their web address for the group to take a look at... If
any information is outdated and/or false, well that's up to the members to
research and discuss with their surgeon of choice. Thanks for your input
though, looks like there is a lot of info out there that we all just need
to weed out the facts from hype...Looks like some surgeons need to
get busy and get published with JAMA and NIH sure needs to update
their old and outdated 1991 consensus report that is pretty much worthless
for comparisons.
— Victoria B.
February 28, 2000
Melanie: Thank you for the sites you posted. I have visited most, this
one was most informative, however, Laparoscopic.. Was your surgery done
that way also? I guess it never dawned on me that that a very large
portion of the stomach can be removed through laparoscope. Here is the
info for the members..
Laparoscopic Biliopancreatic Diversion (BPD)
The laparoscopic biliopancreatic diversion, or Lap BPD, is a less-commonly
performed surgical weight loss procedure. The full name of the procedure
is: laparoscopic biliopancreatic diversion with duodenal switch, or lap
BPD/DS. The principal advantage of this procedure is the excellent weight
loss it provides: you may expect to lose from 80-90% of excess weight after
this procedure!
The operation is less restrictive than gastric bypass, so it does not
change your eating habits as much. It is more malabsorptive than gastric
bypass, so the risk of long-term nutritional deficits is relatively
greater.
This operation has been performed extensively in Europe, and has resulted
in an average loss of 80% or more of excess body weight. Thus, it appears
to provide greater weight loss than any other surgical weight loss
procedure. Some important side effects to be aware of are: frequent, pasty
bowel movements, foul-smelling stool, abdominal bloating, and heartburn.
Because the pylorus, the outlet of the stomach, remains intact, dumping
syndrome should not occur after lap BPD/DS.
Lap BPD: The Operation
Laparoscopic biliopancreatic diversion with duodenal switch is more
complicated than the gastric bypass. It involves the following steps:
"A large portion of the stomach is surgically removed". The part
of the stomach from which food exits (the pylorus) is left intact, however.
The size of the stomach is quite reduced, but not nearly as severely as
with the gastric bypass procedure. This type of stomach resection is
referred to as a sleeve gastrectomy.
The small intestine is divided with a surgical stapler 250 cm (8 feet) from
the junction of the small intestine and colon (ileocecal valve). This
creates 2 limbs of bowel. The alimentary limb is the segment through which
food passes. The biliopancreatic limb is the segment containing only bile
and pancreatic juice. These 2 limbs join at a point 100 cm (3 feet) from
the junction of the small intestine and colon. The segment of small
intestine through which food and digestive juices pass together is called
the common channel. The common channel is 100 cm long, and comprises the
last 100 cm of the small bowel (the ileum).
Results of Lap BPD/DS
In a 1998 article in the World Journal of Surgery, Dr. P. Marceau of Laval
University in Quebec published a study looking at outcome and patient
satisfaction with the BPD/DS operation. The 465 BPD/DS patients
participating in this study had their surgery performed through an open
incision, not laparoscopically.
Weight Loss
Patients in Dr. Marceau's study lost an average of 73% of their excess
weight. The average body mass index, or BMI, was 47 before the operation,
and 30 after the operation.
Eating Habits
More than half (58%) of patients did not significantly change their eating
habits after the operation. About one-third (32%) said they avoided some
foods postoperatively.
Side Effects
Patients reported an average of 3 bowel movements per day after the BPD/DS
operation. The stools have a fairly unpleasant odor which was considered to
be a "major problem" by 43% of patients. The most frequent side
effect of the operation was abdominal bloating, which was experienced by
one-third of patients more than once a week. Heartburn and abdominal pain
occurred more than once a week in about 15% of patients after BPD/DS.
This information came from:
http://www.surgicallyslim.com/lap_bpd_results.htm
— Victoria B.
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