Chirurgie-Digestive.com Docteur Paul Lachowsky
 
Surgery of the Digestif Tract
Surgery of Obesity
Laparoscopy

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Obesity Surgery > The Bilio-Pancreatic Bypass

The bilio pancreatic bypass:

                                      -  1°) The duodenal switch

                               -  2°) Scopinaro procedure

                     

In both techniques is the malabsoprtion crucial. The nutrients are (coming from the stomach) mixed with the secretion of the liver and pancrease (2) on a shorter length of 75 to 100 cm (3) where the most part of the digestion and absorbtion will occur. (3). due to this an important part of the nutrients will pass to the large intestine (Colon) causing the fatty faeces (rich of non-reabsorbed fat) often with uncomfortable smell. 

The weight loss due to malabsorption is maily due to the bypass of the large portion of the small intestine

A normal nutrition is possible, however a more profuse production of stinking faeces will occur

  1°) The duodenal switch           

 

                                             

. 2/3 of the stomach, with a less restrictive function, is removed. The base of the stomach (with its pump function of propagating the nutrients to the intestine) as the lower sfincter (=pylorus) that prevents a reflux from the intestine to the stomach, are conserved and are preventing the dumping syndrome, a frequent complication in the gastric bypass. By preserving this "antro-pyloric pump" a more physiologic stomach emptying is respected, this in contrast with the Scopinaro procedure (see below). The restrictive effect is however, less important. 

 2°) The Scopinaro Procedure               

The bilio pancreatic diversion by Scopinaro is based on the same principals as the duodenal switch. However, in this case by removing the stomach (1) and the pylorus, a higherprevalence of dumping syndrome and other secundary effects is possible.

The procedure can be performed by laparoscopy but is still a challanging procedure.
- The procedure take around 4 hours
- The immediate post-operative complications are the same as in the gastric bypass
- The malabsorption is responsible for the late complications such as:

- Malnutrition: the shorter the bypass is, the more fat is lost with the faeces (and thus calories) and more risk on nutrtional deficiency (as with vitamins A,D, E and Calclium). Symptoms such as fatigue, hairloss and swollen ankles can occur.

- Deshydratation: can be of consequence of the diarrhea as inadequate drinking

- Dumping syndrome only in the Scopinaro procedure. 

The efficiency of the bilio pancreatic procedure is equal to the gastric bypass (a 60 to 80 % of excess weight loss after 5 years). This procedure should be the first choice for hyper-obese patients (BMI>55).         



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