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intestinal bypass

A bariatric surgery designed to achieve irreversible weight loss in patients with morbid obesity who have not succeeded with strict dietary restrictions. It anastomoses the proximal duodenum to near the end of the distal ileum, that creates a blind loop and bypasses large part of the small intestine. The absorption of nutrients is greatly reduced (malabsorption), leading to apparent weight reduction. • gastric bypass: Primarily focuses on reducing the stomach's size and rerouting food to the start of the first part of the jejunum, combining restriction of food intake with some degree of malabsorption. E.g. Roux-en-Y gastric bypass. • intestinal bypass: Predominantly emphasizes malabsorption by rerouting food to the last part of the ileum, minimizing nutrient absorption regardless of altering the stomach's size. E.g. biliopancreatic diversion. The patients will experience abdominal discomforts such as steatorrhea and abdominal pain after taking excessive food, as their digestive system capacity has been reduced drastically. The complications include severe electrolyte imbalance and metabolic disturbance and liver failure. It is necessary to take tailored food supplements to correct vitamin, mineral, and protein deficiency after intestinal bypass. If severe malnutrition persists in the patients, reversal surgery should be performed. Due to the presence of surgical alternatives and anti-obesity medications, intestinal bypass is only a last resort. (Examples of medication that treats obesity) • metreleptin: A synthetic analog of leptin used to treat various forms of dyslipidemia (e.g. lipodystrophy). • setmelanotide: A medication used to treat genetic obesity caused by a single-gene mutation. • semaglutide: An antidiabetic medication used to treat type 2 diabetes and an anti-obesity medication used to treat long-term weight management. It is a peptide similar to glucagon-like peptide-1 (GLP-1), modified with a side chain. • liraglutide: An anti-diabetic medication used to treat type 2 diabetes, and chronic obesity. It is a second-line therapy following first-line therapy with metformin. It is a GLP-1 receptor agonist (incretin mimetics). (Variations) • jejunocolic bypass: Anastomoses the proximal duodenum to the transverse colon. • end-to-side jejunoileal bypass: Anastomoses the end of the proximal duodenum to the side of the distal ileum. Owing to the possibility of reflux of ileal content to the blind loop, the effectiveness can be doubted, but both end-to-side and end-to-end jejunoileal bypass seem to have similar weight loss effect. • end-to-end jejunoileal bypass: The end of the proximal duodenum is anastomosed to the distal ileum and the blind loop is drained to the transverse colon. It prevents the reflux of ileal content to the blind loop. • biliopancreatic diversion: Involves gastrectomy and intestinal bypass. It anastomoses the proximal duodenum and the distal ileum. The blind loop carrying bile and digestive enzymes drain into the distal portion of the small intestine, tremendously reducing the absorption of nutrients (esp. fat). (Comparisons with duodenal switch) • biliopancreatic diversion: Removes a part of the stomach. The remaining part of the stomach is connected to the lower portion of the small intestine. It is without duodenal switch. • biliopancreatic diversion with duodenal switch (BPD/DS): Involves a sleeve gastrectomy preserves the pylorus. It is modified from "without". • single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): With one fewer anastomosis (connection) to the intestine than BPD/DS, reducing the risk. Cf. distal gastric bypass