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Bariatric Weight Loss Surgery Information
Malabsorptive Operations Like Roux-en-y Gastric Bypass & Duodenal Switch Surgery to Reduce Obesity
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Stomach Bypass Procedures to Reduce Severe Clinical Obesity

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Malabsorptive Surgical Operations

Malabsorptive operations are the most common gastrointestinal surgeries for weight loss. They restrict both food intake and the amount of calories and nutrients the body absorbs.

Roux-en-Y Gastric Bypass (RGB)

This operation, illustrated in figure 4, is the most common and successful malabsorptive surgery.

Figure 4. Weight Loss Surgery - Roux-en-Y gastric bypass (RGB)

First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the amount of calories and nutrients the body absorbs.

Weight Loss Surgery - Roux-en-Y Gastric Bypass (RGB)
Advantages & Disadvantages


  • Greatly controls food intake
  • Reversible in an emergency - though this procedure should be thought of as permanent


  • Staple line failure
  • Ulcers
  • Narrowing/blockage of the stoma
  • Vomiting if food is not properly chewed or if food is eaten to quickly

Biliopancreatic Diversion Scopinaro procedure (BPD)

In this more complicated malabsorptive operation, portions of the stomach are removed (see figure 5).

Figure 5. Weight Loss Surgery - Biliopancreatic Diversion (BPD)

The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure successfully promotes weight loss, it is less frequently used than other types of surgery because of the high risk for nutritional deficiencies.

This procedure is less food restrictive than the RNY. The stomach capacity is 4-5 ounces compared with RNY of around an ounce. There is a significant malabsorptive component which acts to maintain weight loss long term. The patient must be closely monitored to guard against severe nutritional deficiencies.

Weight Loss Surgery - Biliopancreatic Diversion (BPD)
Advantages & Disadvantages


  • Significant malabsorptive component
  • Better chance of sustained weight loss
  • Ability to eat larger quantities of food and still lose weight


  • Greater chance of chronic diarrhea, stomal ulcers, more foul smelling stools and flatus
  • Higher risk of nutritional deficiencies
  • Higher chance of micronutrient deficiencies such as vitamins and calcium

Duodenal Switch (BPD/DS)

A variation of BPD includes a “duodenal switch” (see figure 6), which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway.

Figure 6. Weight Loss Surgery - Duodenal Switch

This weight loss surgical procedure is an improvement of the BPD. Here again, there is a significant malabsorptive component which acts to maintain weight loss long term. The patient must be closely monitored to guard against severe nutritional deficiencies. This procedure, unlike the BPD, keeps the pyloric valve intact. That is the main difference between the BPD and the DS.

Weight Loss Surgery - Duodenal Switch
Advantages & Disadvantages


  • More "normal" absorption of many nutrients than with BPD, including calcium, iron and vitamin B12
  • Better eating quality when compared to other WLS procedures
  • Eliminates or greatly minimizes most negative side effects of the original BPD
  • Essentially eliminates stomal ulcer and dumping syndrome


  • Greater chance of chronic diarrhea
  • Significant malabsorptive component
  • More foul smelling stools and flatus, but less than with the BPD alone

Gastrointestinal Surgery - "Dumping Syndrome"

RGB and BPD operations may also cause “dumping syndrome.” This means that stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and sometimes diarrhea after eating. Because the duodenal switch operation keeps the pyloric valve intact, it may reduce the likelihood of dumping syndrome.

The more extensive the bypass, the greater the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require close monitoring and life-long use of special foods, supplements, and medications.


Additional Weight Loss Surgery Resources:

American Society for Bariatric Surgery
140 NW 75th Drive, Suite C
Gainesville, FL 32607
Phone: (352) 331-4900
Fax: (352) 331-4975
Website: www.asbs.org

You can find hundreds of weight loss surgery patients at ObesityHelp.com. You can find your surgeon, research his credentials and read about what his patients have to say about him. See also: Bariatric Surgery For Severe Obesity.


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