The USC Approach to Obesity Surgery
Distal Gastric Bypass with Duodenal Switch
The distal gastric bypass with the duodenal switch is among a "new generation" of obesity surgeries. Dr. Anthone, Associate Professor of Surgery at the University of Southern California School of Medicine, says this operation differs dramatically from the "stomach stapling" procedures that were popular for years, and holds promise for appropriate candidates who have battled obesity all of their lives. Since 1992, he has performed hundreds of obesity operations at USC, which have utilized this particular gastric bypass technique.
History of Obesity Surgery
Jejunoileal Bypass
Dr. Anthone notes that "obesity surgery" dates back to 1954, when the first jejunoileal bypass was done specifically for the purpose of weight loss. The procedure involved bypassing most of the small intestine, anastomosing 14 inches of jejunum to the last 4 inches of ileum. The jejunoileal bypass had severe metabolic side effects, due in large part to the nonfunctional portion of the intestine remaining. Toxic products from bacteria that overgrew in the defunctionalized intestine were absorbed directly into the portal venous system, causing liver failure. Other side effects included severe diarrhea, protein malnutrition and kidney stones. The jejunoileal bypass is no longer performed.
Proximal Gastric Bypass
A second obesity operation, developed in 1969, is the proximal gastric bypass. The surgery's main goal is to restrict eating by stapling off most of the stomach. What is eaten goes directly into the intestine, bypassing the duodenum and the first part of the jejunum. "Undigested food drops right into the intestine, resulting in a dumping syndrome," Dr. Anthone says. "The side effects of this operation include transient abdominal cramps, bloating, systemic flushing (hot flashes), pain and diarrhea, causing some patients to develop an aversion to eating, particularly simple sugars, which eventually leads to weight loss."
Vertical Banded Gastroplasty
A third alternative, the vertical banded gastroplasty, entails stapling the lesser curvature side of the stomach, creating a small pouch and placing a banded outlet where the staples end. "The food drops directly into the pouch and is released slowly to the rest of the stomach because the outlet diameter is the size of a pen," Dr. Anthone points out. "With this procedure, food must be chewed thoroughly. Otherwise, food particles may become, stuck, sometimes requiring an endoscopic procedure to remove them. While the vertical banded gastroplasty eliminates the dumping syndrome, if patients eat more than a few bites at a time, they may vomit. Consequently, the success of this procedure basically depends on forced behavior modification."
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