Analysis of three types of bariatric surgery: pancreaticobiliary bypass and laparoscopic application

Other surgeries:

Biliopancreatic bypass:

This surgery is primarily used to treat extremely obese patients. Besides restricting food intake through partial gastrectomy, biliary bypass allows food to bypass pancreatic and biliary juices and most small intestinal digestive juices, thus preventing digestion and absorption and achieving weight loss.

1. Surgical method: 80% of the stomach, including the antrum, is removed, creating a small gastric pouch with a capacity of 200-400 ml. A 250 cm segment of the lower jejunum and ileum is harvested and anastomosed proximally to the remaining stomach, with an anastomosis length of 2-3 cm. The distal segment of the upper jejunum is anastomosed end-to-side to the ileum 5 cm from the ileocecal valve, allowing pancreatic and biliary juices, duodenal and small intestinal digestive juices to flow into the distal ileum.

Biliopancreatic bypass is the most effective surgical method for weight loss, resulting in rapid and sustained weight loss; most patients lose at least 50% of their excess weight. Compared to other common surgeries, this procedure is irreversible, cannot restore the original anatomical continuity of the gastrointestinal tract, and has many potential complications.

Surgical complications include anemia, protein malnutrition, deficiency of fat-soluble vitamins (A, D, E, and K), and malabsorption of iron, calcium, and vitamin B₁₂. Therefore, these vitamins and minerals must be administered orally or via parenteral nutrition postoperatively. Pancreaticobiliary bypass surgery is rarely performed clinically, and its safety and practicality require further research and observation.

Laparoscopic surgery: Laparoscopic surgery provides a minimally invasive new approach for the surgical treatment of morbid obesity.

Under general anesthesia, a small incision similar to that used in cholecystectomy is made to insert a trocar. The hepatogastric ligament is opened close to the lesser curvature of the stomach. The trocar is separated 2-3 cm below the cardia and medial to the gastric vessels, proceeding gradually along the posterior wall of the stomach towards the greater curvature. The trocar exits through the avascular area of ​​the gastric fundus and diaphragmatic ligament. During the dissection process, careful dissection is performed under illumination at a 30° angle to avoid damage to the spleen or short blood vessels in the stomach. An expandable silicone band (Bioenterics, USA) is introduced into the abdominal cavity through a 20mm cannula. Then, guided by endoscopic forceps, it tunnels around the fundus of the stomach through the posterior wall. At this point, a 30-40ml balloon tube is placed through the esophagus and inflated. The silicone band is then tightened to reduce the balloon's diameter to 12mm. An injection valve is placed within the rectus abdominis sheath; the valve's thin tube is connected to the expandable silicone band. The diameter of the gastric narrowing can be controlled by injecting or aspirating saline through the injection valve. The nasogastric tube is removed 1-2 days post-surgery, and a barium meal examination of the narrowed gastric opening is performed 3 days post-surgery. Patients are discharged 5-7 days post-surgery.

Early postoperative results are similar to those of vertical gastrectomy. The advantages of this surgery include reduced postoperative respiratory pain and avoidance of abdominal surgical complications common in obese patients, such as intestinal obstruction, incisional hernia, and pain. Long-term postoperative outcomes require further observation.

Gastric ballboon placement: In 1984, Garren performed gastric ballboon placement based on the fact that artificial gastric stones could create a feeling of fullness and reduce food intake. However, due to a lack of long-term observation of its weight loss effects and numerous complications (obstruction, ulceration, perforation, etc.), it was later banned by the US FDA.