21 August 2008

Like all modern gastric bypass operations, BPD aims to restrict food intake by reducing the size of the stomach.
  1. First, using gastric staples, a pouch of the upper (proximal) stomach is created approximately 200 ml (6 oz) in size. (After Roux-en-Y gastric bypass the stomach is roughly 30 ml in capacity.) The distal stomach is then removed from the body. Second, the surgeon connects the stomach (by anastomosis) to the ileum (the final section of the small intestine) at a point roughly 2-4 feet above the colon. The proximal small intestine (duodenum), which receives biliary and pancreatic secretions, is then attached to the last 50 cm of small intestine, allowing these digestive substances to mix with food from the stomach in a "common channel" comprising only the last 20 inches of ileum. This reduction in digestive capacity means that BPD patients are unable to digest much of the food they eat.
  2. The bariatric surgeon is able to modify the severity of both the restrictive and malabsorptive parts of the procedure, for patients with varying weight loss needs. For example, super-obese BPD patients may be given a smaller stomach than usual, while for less obese BPD patients the surgeon may create a slightly longer length of "common channel" (the last 100-150 cm, 40-50 inches) to increase nutritional uptake and reduce the possibility of malnutrition.
  3. BPD bariatric procedures may be performed using traditional open surgery or the minimally invasive laparoscopic (keyhole) techniques.

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