BARIATRIC SURGERY
Gastric Diversion Technique (Primarily Restrictive And Partially Malabsortive)
Within these possibilities are the Fobi technique, the Capella technique, and the proximal gastric diversion Roux-en-Y, considered the preferred choice (figure below). The different types of gastric diversion are associated in a marked gastric reduction (reservoir of 30 ml), a gastro-jejunustomy (the joining of the remaining stomach to the jejunum) that avoids the passage of food to the majority of the stomach, the duodenum and a portion of the jejunum with a variable food canal (between 50-150 cm) to the anastomosis of the jejunum-jejunal, to the bile and pancreatic secretions, and finally to a common canal of various meters in length to the large intestine.
The incidence of surgical complications today have reduced to 10% and include possibilities of damage to the spleen, oesophagus, vagos nerves, pancreas, liver and colon; there have also been reports of gastritis, ulcers, and sharp gastric dilatation. The belated complications are understood to be peptic ulcers, dumping syndrome in 20% (facial redness, palpitations, sweating and diarrhoea) because of the rapid emptying of the stomach and/or the hypoglycaemic reaction in the 90-120 minutes after the ingestion of simple sugars. Nutritional changes include: anaemia for the deficit of iron up to 50% in some cases, deficit of vitamin B12 in 35% of cases, and a less frequent alteration in calcium levels and other micronutrients that are easy to control with protein supplements. It is not usually associated with an alteration in the absorption of proteins. Chance of death is 0.5%-1%.
The medium of weight-loss in those patients subjected to this technique is 35% (the major part in the first year), with a light recuperation of weight post-operation in the 3-5 years following the intervention. These techniques of gastric diversion reduce the risk of cardiovascular problems in 66% of patients thanks to a normalization of glucose of 95%, reduction of 50% in triglycerides and 20% in cholesterol.
Compared with restrictive techniques, diversion techniques have demonstrated a greater loss in weight on the short and mid-term, especially in those individuals that eat sweets. Reinterventions because of complications or insufficient weight-loss are less frequent, although the side-effects and post-operative mortality are slightly higher.
