Research Chair on Obesity Centre de recherche Institut Universitaire de Cardiologie et de Pneumologie du QuébecUniversité Laval
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Massive Obesity , also called morbid obesity

Surgical procedures to help control obesity generally are divided into two categories:
malabsorptive and restrictive.

Malabsorptive Surgical Procedures

These procedures decrease intestinal absorption by the patient. Although there are some more radical procedures, the most widely used method is the Roux-en-Y Gastric Bypass. In this procedure, the surgeon utilizes staples to construct a proximal gastric pouch with an outlet that is a limb of the small bowel, thus bypassing most of the stomach and some of the small intestine.

Weight loss results from the Roux-en-Y Gastric Bypass vary widely but it is generally reported that weight loss is greater in the first year after surgery with successive years resulting in a slowing in weight loss and even weight regain. It was reported a median percentage excess weight loss (%EWL) of 68.5% in the first year post Roux-en-Y Gastric Bypass, a 71.18 %EWL after two years, 69.28 %EWL after 3 years and 57.49 %EWL after four years. These results indicated a slight weight regain by some patients after the first year post surgery. In a longer term follow-up study, 6 to 9 years, of Roux-en-Y Gastric Bypass patients a greater significance of weight regain with longer follow-up was indicated; weight loss results showed that 24% of patients had become morbidly obese again, 74% had more than 50 %EWL and only 7% had 100 %EWL.

Restrictive Surgical Procedures:

These procedures decrease the amount of solid food a patient is able to ingest. Common restrictive surgical techniques are:

· Vertical Banded Gastroplasty (VBG)

· Silicone Ring Gastroplasty (SRG)

· Gastric Banding

In the Vertical Banded Gastroplasty and Silicone Ring Gastroplasty, reduction in stomach size is achieved by using rows of staples to create a small stomach pouch along the lesser curvature of the stomach. The pouch outlet (stoma) is reinforced with a marlex band or silicone ring, sometimes placed through a hole in the stomach created by a circular stapler.

In Gastric Banding, a small upper pouch and reinforced stoma are created in one step by placing a band or ring around the upper stomach. This procedure avoids the complications associated with staple line leakage and disruption, but is believed to have been associated with a higher rate of pouch enlargement and obstruction

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