biliopancreatic diversion vs roux

biliopancreatic diversion vs roux

biliopancreatic diversion vs roux-en-y


Philippe Topart, MD, Guillaume Becouarn, MD, Carine Phocas, RN. Societe de Chirurgie Viscerale, Clinique de l’Anjou, Angers, FRANCE

Objectives- Roux-en-Y gastric bypass (RYGB) is now one of the most used bariatric procedures. Although an efficient one, weight regain appears to be frequent  and in approximately 20% of the cases will eventually lead to poor weight loss results.  Besides applying further restriction to a basically mostly restrictive procedure in case of weight loss failure, conversion to a more malabsorptive procedure has been proposed. In addition to the modification of the proximal RYGB to a distal gastric bypass (D-RYGB), conversion to a biliopancreatic diversion with or without duodenal switch (BPD-DS)) has been described. Conversion to BPD-DS is by far the most complex as it implies the take down of the gastrojejunal anastomosis and restoration of the gastric continuity before performing the BPD-DS itself. As a result, only half of the procedures could be completed in 1 stage in the few published reports.

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Methods and procedures- A 1 stage procedure was designed, keeping the gastric pouch of the RYGB as well as the gastrojejunal (GJ) anastomosis. The alimentary limb was divided 10 cm below the GJ and the fundus of the remnant stomach resected, leaving only the antrum. An anastomosis between the short segment of alimentary limb and the antrum was performed, thus constructing a "hybrid" sleeve gastrectomy.  The remaining alimentary limb was reconnected to the biliopancreatic limb of the RYGB. A new 150 cm alimentary limb with a 100 cm common channel using the ileum was measured and the ileo-ileal anastomosis performed 100 cm distal to the ileo- caecal valve. An end to side duodeo-ileal anstomosis was performed with a 21 mm circular stapler after dividing and stapling the duodenum 3-4 cm distal from the pylorus.

Results-  4 patients with weight loss failure had their RYGB converted to BPD-DS using this technique. Their initial BMI was 45, 56, 61 and 70. Their respective BMI at the time of the conversion was 45, 52, 44 and 50. One procedure was done open because of an incisional hernia and the 3 others were done laparoscopically. One patient with a retro-colic, retro-gastric RYGB had to be converted to an open procedure to locate the alimentary limb. The surgery duration was 4 hours. No death occured and 1 patient with an open procedure had to be reoperated on for an abdominal abscess. 6 to 18 months postoperatively, the weight loss experienced ranged from 10 to 38 Kgs.

Conclusion- Although remaining complex, this procedure of conversion from RYGB to BPD-DS can always be done as 1 stage. Laparoscopy is feasible providing the RYGB has been done ante-colic, ante-gastric. The long term benefit on weight loss needs to be further assessed.

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According to :

10 common questions about biliopancreatic diversion vs roux

1What is the best surgery for weight loss?
The three types of surgery included gastric bypass, sleeve gastrectomy and adjustable gastric banding (also known as lap band). The study found that gastric bypass surgery boasted the greatest weight loss -- both short- and long-term
2What is the difference between gastric bypass and duodenal switch?
During a gastric bypass, a surgeon shrinks the size of the stomach by making its upper portion into a smaller pouch and connecting that directly to the small intestine. In comparison, a duodenal switch involves "bypassing" much of the small intestine, where nutrients are absorbed
3Is Roux en Y reversible?
Roux-en-Y (roo-en-y). This is a type of gastric bypass surgery, and is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat at one sitting and reducing absorption of nutrients.
4What is the best surgery for belly fat?
The best way to make a choice between liposuction, CoolSculpting, Zerona, truSculpt, and other noninvasive forms of fat reduction is to seek the advice of a board certified cosmetic surgeon.
5What is the least invasive surgery for weight loss?
'All Is Better' After Minimally Invasive Weight Loss Procedure. A new endoscopic procedure designed to shrink the stomach without surgery helped a mother of five lose weight and regain an active lifestyle. As the first patient in Michigan to receive an endoscopic sleeve gastroplasty, Christine Holmgren made history
6How much weight can you lose with a duodenal switch?
50 pounds Two years after surgery, duodenal switch patients had lost more weight: about 50 pounds more, on average. People shed a substantial amount of weight with either type of surgery. Gastric bypass patients cut an average of 111 pounds, while duodenal switch patients dropped about 162
7What is the safest form of weight loss surgery?
Gastric banding is considered the least invasive weight loss surgery and also the safest
8Which is better gastric bypass or sleeve?
A new stomach pouch is created by making a small or large incision in the abdomen. Like vertical sleeve gastrectomy, it causes you to feel full for a long period after eating only a small portion of food. The main difference is that gastric bypass bypasses part of the digestive track whereas sleeve gastrectomy doesn't.
9How much weight do you lose the first month after gastric bypass?
Gastric Bypass patients lose weight rapidly in the first 12-24 months after surgery. The rapid weight loss is due to a variety of factors, including: Your stomach size (pouch) is small, it holds about 1 ounce of food
10What percentage of bariatric surgery patients regain weight?
Truth: As many as 50 percent of patients may regain a small amount of weight (approximately 5 percent) two years or more following their surgery. However, longitudinal studies find that most bariatric surgery patients maintain successful weight-loss long-term


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