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‘Stomach Drain’ For Obesity

Surgery for weight loss has gone through a dramatic evolution over the last 60 years.  The first weight loss (bariatric) surgery was first introduced in the 1950’s.  It was the jejunoileal bypass (JIB) which induced a state of malabsorption by bypassing most of the intestines while keeping the stomach intact. Although the weight loss with the JIB was good, too many patients developed complications such as diarrhea, night blindness (from vitamin A deficiency), osteoporosis (from vitamin D deficiency), protein-calorie malnutrition, and kidney stones. Some of the most worrisome complications were bacteria liver failure, severe arthritis, skin problems, and flu-like symptoms.

It was not until the 1960’s that the gastric bypass was introduced.   This operation, known as a “Roux-en-Y”, connects a limb of intestine to a very small stomach pouch bypassing the remaining stomach and first segment of small intestine.  However, because the bypassed portion of intestine is where the majority of calcium and iron absorption takes place, anemia and osteoporosis are the most common long-term complications of the RYGBP.

More recently, the lap-band technique was introduced where a plastic band is placed around a portion of the stomach to restrict the quantity of food eaten.     Complications of this include Band slippage (stomach prolapse), leakage of the balloon or tubing, port or band Infection, obstruction, nausea and vomiting, band erosion into the stomach, esophageal dilatation, and failure to lose weight.

The newest surgery approved this year involves a tube being placed into the stomach.  The other end contains a valve that lies flush against the skin.  After meals, the person can drain about a third of their partially digested food into the toilet.   As a safety feature, the device, called AspireAssist can only be used three times a day for up to six weeks before one part stops working and needs to be replaced.   Patients were able to lose 14% of their body weight after a year.    Only time will tell what complications this new procedure will carry with it.


Terry Pfau DO, HMD

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