Combined Restrictive and Malabsorptive Bariatric Surgery

There are two main types of weight loss or bariatric surgery techniques. They are restrictive bariatric surgery and malabsorptive bariatric surgery. Restrictive bariatric surgery aims at restricting the food intake of the individual by manipulating the stomach to hold very little food, thus giving the person a feeling of fullness after eating very little. Malabsorptive bariatric surgery aims at interrupting the digestion process to hinder the absorption of calories, thereby reducing the desire to eat between meals. Combined restrictive and malabsorptive bariatric surgery achieves both the above purposes; that is, it restricts food intake as well as hinders the absorption of calories. 

Combined Restrictive and Malabsorptive bariatric surgery falls in two major categories: 

The Roux-en-Y gastric bypass surgery (RYGB): In this type of obesity surgery the stomach is divided into two parts by using staples. The upper part forms a pocket or sleeve where food collects. The lower larger part is still intact. The newly created pouch is directly joined to the middle part of the small intestine, thus bypassing the stomach and the connecting duodenum. This is a deliberate attempt to retard the breakdown of fats which takes place in the duodenum with the help of bile and pancreatic enzymes. The duodenum is connected in the last part of the small intestines, making it too late to digest fats. Therefore, fats and undigested bulk of food pass out in the stools. The whole arrangement gives a Y shape, and therefore the name.

The Biliopancreatic diversion: This procedure involves the complete removal of a large portion of the stomach, retaining only 25 percent to form a pouch. This pouch is directly connected to the last segment of the small intestine. The bile and pancreatic juices mix with the food in the last part of the small intestine delaying digestion and absorption of calories, thus leading to malabsorption. The advantage of biliopancreatic diversion over the Roux-en-Y is that since the larger portion of the stomach is removed, the person does not feel the sensation of hunger.

Apart from the above two types, there are other variations designed to suit the patient’s medical condition. The best type of weight loss surgery can be suggested only by a doctor.