Combined Restrictive And Malabsorptive Surgery

This the second type of obesity surgery.  It also can be performed in different ways called operative procedures.  Those procedures are discussed below.  This type of surgery has it's own inherent risks, as well as benefits that you should discuss in depth with your doctor.

What Is Combined Restrictive and Malabsorptive Surgery?

Combined Restrictive and Malabsorptive Surgery - is a combination of restrictive surgery (stomach pouch) with bypass (malabsorptive surgery), in which the stomach is connected to the jejunum or ileum of the small intestine, bypassing the duodenum.⁸

Operative Procedures

• Roux-en-Y Gastric Bypass (RGB) - is the most commonly performed gastric bypass procedure,⁸ and the second most frequently performed surgery for obesity after VBG.³  RGB involves a stomach pouch for food intake restriction.  A direct connection, which is Y-shaped, is made from the ileum or jejunum to the stomach pouch for malabsorption.  The longer the segment of small intestine bypassed, the greater the malabsorption component and the greater the weight loss.  Gastric bypass with an extensive segment of small bowel bypassed is termed “Long Limb Gastric Bypass.”
  
  
• Biliopancreatic Diversion (BPD) - is one of the most complicated of the current operative procedures in obesity surgery,⁷ sometimes involving the removal of a portion of the stomach.  The remaining section of the stomach is connected to the ileum.⁸  BPD successfully promotes weight loss,⁸ but this procedure is typically used for persons with severe obesity who have a BMI of 50 or more.⁷

Benefits and Risks

• Success Rate: Researchers have found greater weight loss in gastric bypass (93.3 pounds) compared to gastroplasty (67 pounds) after one year.²  Over two years, gastric bypass surgery patients have been shown to lose two-thirds of excess weight.⁸  The success rate for weight loss for RGB is 68 to 72% of excess body weight over a three year period, and 75% for BPD.¹  After five years, the average excess weight loss from gastric bypass surgery ranges from 48 to 74%.³
  
  
• Side Effects: The “dumping syndrome” in which food moves too quickly through the small intestine can cause nausea, weakness, sweating, faintness, and sometimes diarrhea after eating.  There can also be an inability to eat sweets without severe weakness and sweating causing patients to lie down to let the symptoms pass.  Dairy intolerance, constipation, headache, hair loss and depression are other possible side effects.^{7, 8}
  
  
• Complications: There is a risk for nutritional deficiencies due to the bypass of the duodenum and part of the jejunum where many nutrients are absorbed.  Nutritional deficiencies include malabsorption of vitamin B12, leading to anemia and iron deficiency.  The reduction in vitamin D and calcium absorption can cause osteoporosis and other bone disease.^3,8  Other complications are similar to those of restrictive surgery and are due to creating a stomach pouch.

After Surgery

• Lifestyle Adjustments: Lifelong use of nutritional supplements such as multivitamins, vitamin B12, vitamin D and calcium is necessary.^3,4
  
  
• Surgical Follow-up: Physical, nutritional and metabolic counseling are needed to prevent nutritional deficiencies. ³

Learn More About Other Obesity Surgeries - Including Intestinal Bypass, Jaw Wiring, and Liposuction.