Proposal for a multidisciplinary approach to the patient with morbid obesity: The St. Franciscus Hospital Morbid Obesity Program

Morbid obesity program at the Saint Franciscus Hospital in Rotterdam, describing the different phases of the program and the specialists involved in each phase.

Current surgical techniques. A. Vertical-banded gastroplasty (VBG). The stomach is partitioned by a circular stapler at a calibrated point 3 cm from the lesser curve and 4–6 cm below the gastroesophageal junction and a linear stapler between the angle of His and the gastric window created by the circular stapler. B. Gastric banding. A lap-band device is positioned around the proximal stomach near the gastroesophageal junction, closed, and secured anteriorly proximal and distal to the band to prevent herniation. The subcutaneous reservoir attached to the device's tail is brought out through the abdominal wall and anchored securely to the anterior abdominal fascia of the rectus sheath. C. Roux-en-Y Gastric bypass. A Roux limb, created by dividing the proximal jejunum (20–60 cm) distal to the Treitz ligament, is anastomosed to a small gastric pouch. The proximal jejunal limb is anastomosed to the Roux limb (60–150 cm) distal to the gastrojejunostomy. D. Biliopancreatic diversion (with distal gastrectomy). This involves transection of the stomach and end-to-side anastomosis of the proximal part with a common channel of the ileum at a point between 50 and 100 cm proximal to the ileocecal junction, thus excluding the entire jejunum from digestive continuity. E. Biliopancreatic diversion (with sleeve gastrectomy and duodenal switch). Longitudinal vertical partial gastrectomy and postpyloric duodeno-ileal switch and common alimentary channel of 100 cm.