The Rationale and Results of Gastroplasty/Distal Gastric Bypass

Abstract

A recent review of the results of gastroplasties done at the University of Alberta Hospital showed that there was a high incidence of late weight loss failure. Therefore a new operation, gastroplasty/distal gastric bypass, has been performed on 263 patients. This operation results In a profound (mean greatest percentage excess weight loss of 87% at approximately 2 years) and lasting weight loss (mean final percentage excess weight loss of 78%) at 4 years, range 2-7.5 years post-operatively. Only 0.9 % of patients failed to maintain at least a 40% excess weight loss. The operation achieves its effect through a moderate restriction that permits patients to eat normal table food from the time of discharge and with a mild metabsorption that is not ordinarily associated with diarrhea or notable deficiencies. Certain patients required debanding of the stoma and others developed staple-line eventration. Neither of these events after long-term follow-up resulted in weight loss failure nor in other serious side-effects. It Is concluded that moderate failure of the gastroplasty stoma and staple line does not necessarily result in weight loss failure, because the malabsorptive portion of the operation remains intact. Low hemoglobin occurred in 16% of cases and deficiency of serum iron In 34%; a much smaller number of patients had chronic or Intermittent deficiencies of these entities. Correction was easily achieved with oral replacement. Deficiencies in albumin, calcium, phosphorus and folate were rarely seen and minimal elevation of serum AST values occurred In just over 1% of patients. Chronic deficiencies or elevations were not seen in these patients. Stomal ulcer occurred in 6% of patients and bleeding associated with stomal ulcer in 1%. Half the patients with ulcer were managed with H&inf2; blockers, the other half with vagotomy. Both forms of treatment when individualized effectively prevent re-ulceration.

Surgical treatment for morbid obesity

“…To avoid calcium depletion and osteoporosis, Scopinaro advises a daily supplement of 2 g calcium (often not taken by patients), as well as a monthly intramuscular injection of 400,000 IU vitamin D 20 . Despite these preventive measures, 7% of patients undergoing this surgical treatment develop bone demineralization, usually between the second and fifth postoperative years 19 . Since vitamin B12, in its protein-bound form, is poorly absorbed in these patients, Rhode 30 has recently suggested daily administration of the crystalline form of vitamin B12 at very high dosage.…”

Obesity: An overview on its current perspectives and treatment options

“…This technique induces weight loss by combining restricted intake and a moderate degree of malabsorbtion [71]. Initial loss of weight is greater after this procedure than following gastroplasty [72]. …”

Nutrition Management After Gastric Bypass Surgery

“…As much as 60-70% of excess weight is lost in the 1-2 years following surgery 1 as a result of four postop-erative phenomena (Table 2). Fewer calories are consumed because of patients' smaller stomach capacity.…”