Bariatric Surgery: Adjustable Gastric Band & Biliopancreatic Diversion

Written By: Tony Amodeo

Bariatric surgery methods are designed as processes for weight loss surgery. Two of the various procedures that exist are the Adjustable Gastric Band and the Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass methods. Here we will review both and contrast differences as well as advantages and disadvantages of them.

Adjustable Gastric Band

This process involves an inflatable band being positioned near the top of the stomach, forming two sections. A small food section resides above where the band is placed, while the remainder of the stomach is below the band. When food is ingested it settles in the now smaller stomach pouch which is formed. The individual experiences a feeling of “fullness” now by eating considerably less food. This procedure allows for flexibility in adjusting the size of the stomach pouch to optimize the benefits. To adjust the size of the pouch, the surgeon is able to fill the inflatable band with a sterile saline product, which is accessed through a point of access (or port) within the adjacent skin region. The space or size of the opening is minimized incrementally over a period by making adjustments. In this process there is no malabsorption; therefore, the food is ingested, digested and absorption occurs as normal.

Advantages:

• It limits the volume of food the stomach can hold.
• Expectations are that excess weight loss of nearly 50% is achieved.
• No incisions to the stomach or adjustments to the positioning of the intestines are needed.
• Hospital stays are typically under 24 hours--outpatient in many cases.
• The procedure can be reversed if necessary.
• There are considerably fewer complications resultant of the method.
• There is low risk for nutritional deficiencies from a lack of minerals or vitamins.

Disadvantages:

• Typically, the period of time before significant weight loss occurs is longer than with other options.
• A higher likelihood exists for inability to lose at least 50% of excessive body weight versus other options.
• Band slippage or deterioration is possible.
• This method has the highest rate of needing re-operation(s).

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass

A portion of the stomach is removed creating a smaller stomach pouch, and the small intestine is bypassed. The duodenum part of the small intestine is split, while the other portion is lifted to connect to the outlet of the new stomach. Approximately 75% of the small intestine is bypassed during the food-streaming process. The portion of the intestine containing bile and enzymes needed to breakdown food is reconnected further along the food stream. This method is effective for the treatment of diabetes.

Advantages:

• Usually 60-70% excess weight loss is typical.
• Patient is able to eat closer to normal volumes.
• Fat absorption is dramatically reduced.

Disadvantages:

• The method has relatively high rates of complications.
• It may require longer than average hospital stays.
• It has higher potential for nutritional deficiencies.
• It requires a more restrictive set of dietary and supplemental requirements.