Combined Restrictive & Malabsorptive Procedure is a type of weight loss surgery that does not only focus on limiting food intake but also in limiting the amount of nutritional intake happening in the small intestine. This procedure was only recently introduced to the public yet has proven to increase the choices of weight loss surgery options for patients needing help in weight management department.
Combined Restrictive & Malabsorptive Procedure delays the process of combining food with the gastric juices resulting to the early feeling of satiety. This effect will then reduce the desire to eat thus will lead to less consumption of food. The Combined Restrictive & Malabsorptive Procedure typically is a gastric bypass procedure yet has some modifications to add the malabsorptive effect.
The surgery is done by stapling the stomach using gastric staples to form a small pouch which can approximately hold 15 to 20 cc. Unlike other procedures, the rest of the stomach is not removed. It is only stapled shut which serves as its division from the newly created stomach pouch. An outlet is then made from the pouch which is directly emptied to the lower portion of the jejunum. This is achieved by dividing the small intestine beyond the duodenum to bring it up forming a connection with the newly created pouch. By doing this, the process of calorie absorption is bypassed, thus lessening the nutritional elements that are absorbed by the body. Length adjustments of the connection channel can be made by the bariatric surgeon to increase or decrease the level of malabsorption as the patient requires.
Risks of this particular procedure include poor absorption of iron and calcium, which can lead to anemia and osteoporosis. Metabolic bone diseases resulting in height loss, fractures, bone pain and humped back has also been reported as a side effect of the procedure. The dumping syndrome, or the rapid emptying of the stomach contents into the intestine, can happen post-operation which can lead to nausea, sweating, and diarrhea. Also, ulcers and bleedings in the bypassed portion of the stomach cannot be diagnosed with an X-ray or an endoscopy.
Recovery plan to avoid excessive malnutrition related to the malabsorptive effect of the surgery is to follow strictly the nutritional plan set forth by a dietician, which usually consists of having liquid diet first and slowly progressing to soft foods, then later to normal food. Nutritional supplements should also be taken to answer the body’s need of several essential nutrients.
Several advantages can be benefited from having a Combined Restrictive & Malabsorptive Procedure done. The most basic one is the higher amount of weight loss when compared to a strictly restrictive procedure. Approximately 77% of excess body weight is also lost after a year post-surgery. Long-term benefits and weight loss have also been reported, with patients maintaining a consistent weight loss of 50% – 60%. Also, health conditions associated with weight problems have significantly been resolved or improved as the case may be after having a Combined Restrictive & Malabsorptive Procedure done.
