ABSTRACT
Protein-energy malnutrition (PEM) is one of the most serious complications of bariatric surgery. With contemporary restrictive bariatric procedures such as laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG), or a combined restrictive-malabsorptive procedure such as standard Rouxen-Y gastric bypass (RYGB), PEM is rarely encountered unless in the presence of significant surgical complications or in patients who are noncompliant with postoperative dietary modifications.1,2 For malabsorptive bariatric procedures, however, PEM remains a concern. The history and development of malabsorptive surgical procedures are closely related to PEM, as it is often the reason leading to modification of existing procedures or development of new approaches in hopes of avoiding this dreadful complication.3 This chapter will briefly describe clinical characteristics of PEM in bariatric patients, and will discuss PEM in the context of historical and contemporary malabsorptive surgical procedures, including jejunoileal bypass (JIB), biliopancreatic diversion (BPD), and its variation,
9.1 Introduction .................................................................................................. 177 9.2 Clinical Characteristics of Protein-Energy Malnutrition in Bariatric
Patients .......................................................................................................... 178 9.3 Jejunoileal Bypass and Protein-Energy Malnutrition .................................. 180 9.4 Biliopancreatic Diversion and Protein-Energy Malnutrition ....................... 180 9.5 Biliopancreatic Diversion with Duodenal Switch and Protein-Energy
Malnutrition .................................................................................................. 184 9.6 Roux-en-Y Gastric Bypass and Protein-Energy Malnutrition ..................... 185 9.7 Long-Limb Roux-en-Y Gastric Bypass and Protein-Energy Malnutrition ... 186 9.8 Distal Roux-en-Y Gastric Bypass and Protein-Energy Malnutrition .......... 187 9.9 Conclusion .................................................................................................... 188 References .............................................................................................................. 191
gastric bypass (LL-RYGB), and distal Roux-en-Y gastric bypass (D-RYGB).
