Gastric Bypass in Obesity

Abstract

An ideal operation for control of obesity should limit ability to overeat and yet should allow normal nutrition.Subtotal gastric resection would satisfy these objectives but is too radical and.irreversible.Gastric bypass is an operation exactly like Billroth II gastric resection except that nothing is removed.A 15 to 30 per cent fundic segment is anastomosed to the upper jejunum.The distal segment of stomach is closed and sutured to the surface of the fundic pouch. EXCLUSION OPERATIONSAntral exclusion was used early in the history of ulcer operations in order to avoid closing a badly diseased duodenal stump.The operation was abandoned because of stomal ulceration.The procedure was resurrected by McKittrick, Moore, and Warren as the first stage of a two-stage operation.At the second stage the antrum was removed.Waddell and Bartlett performed 50 hemigastric exclusion operations with vagotomy.The inclusion of vagotomy with antral exclusion eliminated the high risk of stomal ulceration.D. W. Kay theorized that if sufftcient acid-secreting mucosa were excluded with the antrum, the acid gastric juice bathing the antrum would inhibit gastrin release.He reported 23 patients with 50 per cent gastric exclusion, three of whom developed stomal ulcers.A. W. Kay reported 20 patients treated with hemigastric exclusion and eight of these developed stomal ulcers between one and 18 months after the operation.The failure of hemigastric exclusion does not seem surprising in view of the failure of hemigastrectomy in the treatment of ulcer.