TAILIEUCHUNG - Chapter 075. Evaluation and Management of Obesity (Part 7)

The three restrictive-malabsorptive bypass procedures combine the elements of gastric restriction and selective malabsorption. These procedures include Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD), and biliopancreatic diversion with duodenal switch (BPDDS) (Fig. 75-2). RYGB is the most commonly performed and accepted bypass procedure. It may be performed with an open incision or laparoscopically. Although no recent randomized controlled trials compare weight loss after surgical and nonsurgical interventions, data from meta-analyses and large databases, primarily obtained from observational studies, suggest that bariatric surgery is the most effective weight-loss therapy for those with clinically severe obesity. . | Chapter 075. Evaluation and Management of Obesity Part 7 The three restrictive-malabsorptive bypass procedures combine the elements of gastric restriction and selective malabsorption. These procedures include Roux-en-Y gastric bypass RYGB biliopancreatic diversion BPD and biliopancreatic diversion with duodenal switch BPDDS Fig. 75-2 . RYGB is the most commonly performed and accepted bypass procedure. It may be performed with an open incision or laparoscopically. Although no recent randomized controlled trials compare weight loss after surgical and nonsurgical interventions data from meta-analyses and large databases primarily obtained from observational studies suggest that bariatric surgery is the most effective weight-loss therapy for those with clinically severe obesity. These procedures generally produce a 30-35 average total body weight loss that is maintained in nearly 60 of patients at 5 years. In general mean weight loss is greater after the combined restrictive-malabsorptive procedures compared to the restrictive procedures. An abundance of data supports the positive impact of bariatric surgery on obesity-related morbid conditions including diabetes mellitus hypertension obstructive sleep apnea dyslipidemia and nonalcoholic fatty liver disease. Surgical mortality from bariatric surgery is generally 1 but varies with the procedure patient s age and comorbid conditions and experience of the surgical team. The most common surgical complications include stomal stenosis or marginal ulcers occurring in 5-15 of patients that present as prolonged nausea and vomiting after eating or inability to advance the diet to solid foods. These complications are typically treated by endoscopic balloon dilatation and acid suppression therapy respectively. For patients who undergo LASGB there are no intestinal absorptive abnormalities other than mechanical reduction in gastric size and outflow. Therefore selective deficiencies occur uncommonly unless eating habits become .

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