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Stomach Intestinal Pylorus Sparing Surgery

Basic Description

  • • Slightly larger sleeve
  • • Attached to mid small intestine not distal ileum
  • • Preserves more bowel to prevent short bowel syndrome
  • • Ghrelin suppression
  • • Like VSG with intestinal shortening

Stomach intestinal pylorus sparing surgery (SIPS) is a modified duodenal switch surgery that reduces bowel issues like diarrhea while producing effective weight loss through reported management of ghrelin hormone reduction. It preserves the pyloric valve like the VSG and does not bypass as much of the intestine as the RYGB. Because it does not have a distal anastomosis and roux limb, it is believed to reduce long-term risk of intestinal obstruction and reduce gastrointestinal symptoms.

No increased risk of bile reflux gastritis is seen because the attachment is after the stomach valve. This procedure is considered as a solution for VSG patients who regain weight or have inadequate weight loss postoperatively.

Adjustable Gastric Banding

Basic Description

  • • Restricts food intake
  • • Adjustable band is reversible
  • • Less invasive procedure, faster recovery
  • • Modest weight loss 20%-25% initial weight (may be up to 40%)
  • • Foreign object in body (can be removed)
  • • Higher reoperation rate due to complications—band slippage or erosion

Adjustable gastric banding (AGB), also called LAP-BAND, is a fluid-filled belt wrapped around the stomach to create an upper pouch that receives food from the esophagus while the lower pouch drains into the small intestine. A tube leads from the belt to a port just under the surface of the abdomen. Through the port, the physician can either add or remove fluid from the belt to adjust its tightness. The tightness of the belt regulates how easily food moves between the stomach’s upper and lower pouches.

In 2011, a Food and Drug Administration advisory panel voted to allow those with BMIs >30 or more, rather than the minimum BMI >35 to apply for gastric banding weight loss surgery. They must have tried and failed more traditional weight loss therapies—diet, exercise, and appetite suppression medications. The study was initiated and supported by Allergan, a maker of the laparoscopic adjustable gastric band (LAP-BAND) system procedure [16].

LAP-BAND is a purely restrictive procedure to control food intake. It has a low mortality rate and allows gradual weight loss. The AGB procedure is a good choice for those with regular exercise programs and disciplined food choices. Adjustments can be done every 4-8 weeks in the physician’s office, which is important in case of pregnancy.

Although patients lose weight, many regain some or all of the lost weight by overeating soft foods (i.e., ice cream) or smoothies made from high-carbohydrate and fatty foods. Since there is no modification in absorption, food discipline is critical for success. Lifelong vitamin and nutritional supplementation is still recommended to insure adequate intake of proteins, B vitamins, calcium, and trace minerals.

Gastric band slippage is a challenge that can affect weight loss and cause dysphagia and pain [17]. Slippage frequently requires revision surgery. Poor postoperative compliance with diet restrictions have been linked to band slippage [18] and disparity in dietary instructions [19] can result in deleterious results.

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