Bypass to DRYGB Conversion
This procedure involves extending the limb, often by 100cm. This means moving the position where the stomach connects to the bowel further along the bowel than where it originally was. The theory is that this will give a longer length of bowel through which food (and the calories to contains) will pass before the calories and nutrients within are absorbed.
In that sense the procedure is effective but there are serious side effects, primarily a high incidence of malnutrition. For this reason, we do not consider this procedure a workable option, especially in the private sector. The authoritative study on Revisional DRYGB was undertaken in the US in 2010 by Logan Rawlins et all and was published in Surgery for Obesity and Related diseases in Jan/Feb 2011.
The same problem problems of vita min and mineral absorption apply with revision to Duodenal Switch/BPD. In fact, these patients are even more challenging to manage nutritionally. For this reason, we do not offer this procedure and it is rarely offered in the private sector or the NHS.
Whilst the study showed good weight loss outcomes the major concern related to post-operative management of patients who develop malnutrition. This is a serious illness that cannot effectively be managed in the private sector. In the study, almost a quarter of patients developed this.
We do not consider extension of the limb an effective treatment and do not offer it to patients.
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Revision to Duodenal Switch (DS)/Biliopancreatic Diversion (BPD)
The Duodenal Switch and Biliopancreatic Diversion is the most extreme weight loss surgery procedure. here are still a small number done in the UK but that number has fallen considerably in recent years.
Although it almost guarantees good weight loss outcomes, studies show about 70% excess weight loss, and reasonable complication rates it is rarely used as it is technically challenging and, more importantly, patients need very attentive long term nutritional management. Without this patients are at high risk of malnutrition and other side effects such as diarrhoea.
We do not believe it is possible to provide the intensive nutritional supported required by patients having this procedure in the private sector so do not offer it.
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