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Bariatric Surgery: A Primary Care Perspective


In order to manage patients appropriately, it is important that the PCPs understand the anatomical changes that underlie bariatric procedures. Among the most common procedures performed today are bypass vertical confidence gastrectomy (VSG) and gastric bypass Roux-en-Y (RYGB). Laparoscopic adjustable gastric banding (LAGB) and biliopancreatic redirection with a duodenal switch are less common but have been done regularly before. Patients who have had these procedures can still present them to PCPs in the clinic, so it is also important to understand their anatomy. Currently, most of the bariatric procedures are performed on a laparoscopically basis, thus reducing the incidence of surgical site infection, abdominal wall hernia, and posturgical stress. Surgical anatomes have resulted in the three most common procedures.

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Modern bariatric surgical procedures: A) gastric bypass Roux-en-Y, B) vertical sleeve gastrectomy, C) adjustable gastric banding, and D) duodenal switch.

Although RYGB has lower popularity, gold quality is always about metabolic procedures efficiency. This procedure is done by creating a small gastric protagonist pouch and separating this pouch from the area stomach. Then the small intestine is divided from 30 to 100 cm on the Treitz ligament, creating the biliopancreatic limb. Gastrojejunostomy is created between the distal end of the small hand and the gastric pouch. This part of the intestine is the alimentary limb, known as the Roux limb after a 19th century surgeon. The biliopancreatic conductor is then connected to a Roux limb 75-50 cm from the gastrojejunostomy. The increase in the length of the Roux limb increases the malabsorption seen after the procedure, although it was not always clear how much of this calorie is compared to micronutrient absorption. Therefore Roux-en-Y’s anatomy is created by the Roux robot arm, and the biliopancreatic limb refers digestive enzymes, and the common channel remotely, where nutrient absorption occurs.

The VSG was originally developed as the first part of a two-stage approach to weight loss. The procedure involves cultivating a larger curvature of the stomach from the fat and vessels of the omentum. The abdominal anesthesia team usually goes into the stomach, and the stomach is divided by using laparoscopic stapling devices which start a few centimeters from the phylorus and continue towards its angle to the gastroesophageal junction. In this way, a larger curvature of the stomach is removed as a partial gastrectomy specimen, and as a result, the operation cannot be reversed.

The LAGB is usually a restrictive procedure a year ago, but is rarely done. It involves the upper balloon surrounding a soft silicone balloon beneath the gastroesophageal junction. The silicone ring is connected to an infusion port that is sent to a rural subcategory. This allows the size of the restriction to be adjusted by infusion or transfer of saline from the sub-skin port.

The DS usually has fewer centers due to its complexity and challenges in post-operative care. In this procedure, the proximal duodenum is divided, and armor gastrectomy is performed. Subsequently, the distal ileum is divided, and the distal part of the ileum attached to the stomach and the proximal part anastamosed to the ileum terminal 50-100 cm from the ileocecal valve. DS was originally and is now done in two phases: the first that creates the sleeve gastrectomy and the second making the intestinal renovation. The DS offers the greatest weight loss but has a significant disease profile due to the stimulated malabsorption.

There are a number of medical devices available for weight loss rather than adjustable gastric banding devices, although insurance companies usually rely on these as investigative companies, and the availability of treatment for patients is limited due to a lack of insurance coverage. These include an in-estuary balloon, vaginal barrier, and aspiration. The vagal immune device and two intracranial balloon devices are now approved and showed moderate weight loss in randomized trials. Otherwise, these procedures are largely investigative and are outside the scope of this review, although described elsewhere in this question.

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