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XII.C. Surgical therapy

Surgical therapy was introduced long ago, because the above-mentioned treatments proved successful in extremely obese patients.  The aim of surgery is to decrease the GIT and hence decrease absorption.

a) Jejunoileal shunt surgery

In such surgery, the proximal jejunum was initially bound to the medial part of the transversal colon by end-to-side anastomosis. The patients lost considerable weight, but there were serious side-effects.

Through a jejunoileal shunt, the upper 20 cm of the jejunum was later anastomosed to the terminal ileum 20 cm above the Bauchin valve by an end-to-side method. The upper part of the small intestine was closed blindly, and re-anastomosis was then performed after a normal body weight has been reached (Fig. 34).

 

Figure 34. The jejuno-ileal shunt
(Chandra Hassan: Metabolic surgery.ppt, Bariatric Surgery, St. Vincent’s Charity Medical Center, Cleveland, OH, USA)

After surgery, the body weight decreased rapidly. The decreased absorption led to diarrhea and a K+ loss, and a vitamin deficiency was often found. The greatest problem was the liver dysfunction after surgery (increased fatty liver). The precise mechanism of the liver failure is not understood. It is possible that the inhibition of the absorption of essential and non-essential amino acids promotes the development of side-effects. Jejuno-ileal shunt surgery is no longer carried out because of the side-effects and the recurrence of obesity after elimination of the shunt.  

b) Bariatric surgery

In the event of the ineffectiveness of conventional therapies (calorie restriction, lifestyle change, medicaments, etc.), a band is placed around the stomach under laparoscopic surgery (Fig. 35).

Figure 35. Bariatric surgery
(Chandra Hassan: Metabolic surgery.ppt, Bariatric Surgery, St. Vincent’s Charity Medical Center, Cleveland, OH, USA)

A smaller stomach pouch is created and hence consumption of a smaller amount of food leads to a feeling of fullness. This leads to a weight loss, but this procedure is not widespread due to the problems.

There are other, more or less drastic surgical procedures in the USA (Fig. 36).

Figure 36. Bariatric surgical procedures
(Chandra Hassan: Metabolic surgery.ppt, Bariatric Surgery, St. Vincent’s Charity Medical Center, Cleveland, OH, USA)