Laparoscopic malabsorption procedures: Outcomes

Abstract

The concept of malabsorption in bariatric surgery is based on the fact that those with short bowel syndrome do not absorb what is ingested, resulting in weight loss. However, in bariatric surgery, these effects have to be titrated against micronutrient deficiency, protein deficiency, and the negative sequelae of malnutrition. The original jejunal-ileal bypass did not meet this objective. With preservation of 2-3 m of total intestinal length coupled with a gastric pouch that limits the speed of gastric emptying by preserving either the pyloric valve or fundus, the majority of patients can achieve adequate nutrition and lasting weight loss. Going forward, surgeons should be more aware of total bowel length exposed to food and common channel length if they are counting on any malabsorptive effect of their procedure.