Surgery remains the most effective approach in the fight against the ever-increasing disease of obesity. Different approaches are possible.
Surgical procedures that reduce the ability to ingest calories per os (what are known as restrictive techniques) have not proven to be effective in the long term. By contrast, reducing the ability to absorb ingested calories (“malabsorption”) appears to provide better and longer lasting outcomes.
Historically, the biliopancreatic diversion (BPD) according to Scopinaro, or according to Marceau and Hess, constituted for years the gold standard of malabsorptive operations. These latter techniques, however, were fraught with a substantial incidence of perioperative complications and unwanted outcomes such as malnutrition and diarrhea. Quite logically, newer, less aggressive procedures, including SADI and OAGB emerged. They are the modern versions of malabsorptive procedures.
The essential difference with classic BPD is the presence of just one anastomosis, whereas the main difference between the two resides in the incorporation versus the exclusion of the pylorus, respectively. The influence of both procedures on the uptake of carbohydrates, protein and fat as well as micronutrients is examined. The positive impact on obesity and on obesity-linked comorbidities is demonstrated. An essential and critical topic of interest in both operations is the “active” bowel length, i.e. the bowel that is in contact with the nutrient stream. Undesired side effects are described, and the “ad hoc” treatment explained.
The conclusion is that SADI and OAGB are very effective procedures in the war on obesity, provided that some essential precautions are taken. Patient compliance and adequate lifelong follow-up are essential for an optimal outcome.
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