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              Q89. Which of the following is not a restrictive surgical procedure in Bariatric surgery

                    a) Vertical band Gastroplasty (VBG)
                    b)  Laproscopic adjustable gastric banding  (LAGB)
                   c)  Duodenal Switch
                   d)  Roux -en-Y gastric bypass

                  Q90. Vertical band gastroplasty is now abandoned. Which one of the 

                       following is not a reason for it being abandoned?             

                           a ) Poor long term weight loss
                           b) This procedure is more adjustable
                           c) High rate of late stenosis of gastric outlet

                           d) Regain of lost weight

               Q91. Most common complication of Adjustable gastric banding is (LAGB)

                a) Band slippage

                b) Erosion in stomach

               c)  Anastomotic leak

               d) Port access problems

                  Q92. Which of the following  is not an essential component of RGB

                          (Roux -en -y) Gastric Bypass

               a) Small proximal gastric pouch

                b)Roux limb atleast 40 cm in length

               c) Enteroenterostomy is must to avoid stenosis or obstruction

               d) Closure of defects in mesocolon

89) c

Duodenal switch is purely a malabsorptive procedure. VBG and LAGB are largely restrictive, (they restrict the oral intake) where as Roux en y gastric bypass is largely restrictive and mildly malabsorptive.
Sabiston text book of surgery 18th edition page 404

90) b
VBG is not adjustable, it is a permanent procedure. The LAP band  is an adjustable prcedure, it can be adjusted to restrict the oral intake. Also VBG has poor long term weight loss, more chances of stenosis of gastric outlet.

After VBG the patients have a high tendency to adopt high caloie liquid diet, leading to regain of weight.

Sabiston text book of surgery 18th edition page 405
 

91) a

Lap bands are used quite frequently these days and have an established role in management of morbidly obese. Only three types of bands are availale,

LAP-BAND (INAMED Health), Swedish adjustable band (Obtech medical) and the french

MIDBAND. The most common complication is band slippage or prolapse - 11-15%

Erosion - 2-3% and port access problems 5%. There are no leaks because no anastomoses is done.

Laparoscopic complication incidence remains the same.

Ref. sabiston 18th edition page 423

92) b

The lenght of the Roux limb is 80-120 cm atleast if the BMI is in 40s, In a patient with higher BMI the length of the Roux limb can go upto 150 cm

The capacity of the proximal gastric pouch should be 15 ml. Enteroenterostomy and closure of mesenteric and mesocolic defects is done