• BATRIATRIC PROCEDURES

Bariatric procedures always include a restriction component (i.e a reduced gastric volume) and lead to reduced meal sizes (will vary according to the type of procedure performed)

‏

• PROCEDURES

Bariatric procedures however are referred to as « restrictive » or « malabsorptive » procedures.

Restrictive procedures are : adjustable gastric banding (gastric banding), vertical banded gastroplasty (VBG) (Mason and the modified Mason-McLean operation) and sleeve gastrectomy (Sleeve).

Malabsorptive procedures include: Roux en Y gastric bypass (gastric bypass or RYGB), Biliopancreatic diversion (BPD) (known as Scopinaro procedure) and the modified Biliopancreatic diversion with duodenal switch (BPD-DS)

‏

• MALABSORPTION

Malabsorptive procedures bypass a variable length of the small bowel (more in BPD/BPD-DS than in RYGB) and significantly modify the digestion process with very little fat and reduced protein absorption. This means a reduced absorption of select vitamins and micro-nutrients. Long term vitamin supplementation is necessary after any malabsorptive procedure. Blood samples (see) every 3 months during the 1st year, 4 to 6 months during the 2nd year and every 6 months to 1 year thereafter ensure there is no deficiency and help to adapt vitamin supplementation.

• WEIGHT LOSS

Weight loss will usually occur during the 2 years following surgery (faster the 1st year). Weight loss is commonly expressed as percentage of excess weight loss (%EWL).

Excess weight is defined as the difference in Kilograms between the preoperative weight and the « ideal » weight defined as the weight for BMI 25

Beyond 5 years all bariatric procedures are subject to weight regain for a number of reasons but this will not be systematically observed (see paper by KOLANOWSKI)‏