Pyloric Valve Preservation
An emerging principle, and something that may become a cornerstone of all bariatric procedures, is the concept of preserving the pylorus valve, or pyloric valve preservation. The pylorus is the valve located at the end of the stomach. It controls the release of the liquid mixture of food from the stomach into the small intestine.
The body naturally regulates the passage of food, so food will stay in the stomach for a certain period of time. We believe it is very important to continue that feeling of fullness in between meals. As a result, one of the principle functions of the pyloric valve is to regulate the amount of food products released into the small intestine where they are absorbed.
For years, we have performed gastric bypass surgery and hoped the attachment we made between the new stomach pouch and the intestine would scar and narrow to create a fixed outlet. Unfortunately, we found that in many patients the outlet enlarges and there is a rapid passage of food from the pouch into the intestine. When that occurs, patients become hungry shortly after eating.
To combat this, doctors have used a number of different strategies. Dr. Fobi in California advocates using a silastic band and created an operation called the Fobi Pouch. Recently, versions of the Fobi pouch have been used, demonstrating there is less weight regain than compared to standard gastric bypass.
At NWH, we favor another solution — Pyloric Valve Preservation
The body has a natural valve called the pylorus and we would rather preserve this valve than use something like the silastic band. We believe this causes another set of variables and can create issues in the future.
There’s a significant difference between a natural or biologic valve and a synthetic or silastic/silicon valve. The biologic valve has the ability to relax and close when appropriate or biologically necessary. A mechanical valve does not have the ability to relax, and therefore remains in the same position.
The pyloric valve is the stomach’s version of a sphincter, controlling the release of food. We believe the best results will be obtained by preserving this valve in the future. That’s why we advocate two bariatric operations that do this. One is the sleeve gastrectomy and the other is the duodenal switch operation. We’ve created a version of this procedure where we create a pouch which is similar in size to the sleeve gastrectomy, preserve the pyloric valve and then do a bypass underneath the pyloric valve, similar in length to the gastric bypass. With this operation, we have seen excellent weight loss without frequent bowel movements, and at present, no greater nutritional deficiencies than we see with gastric bypass surgery.
If you would like to learn more about pyloric valve preservation sign up for a bariatric seminar or call us at 877.677.1077.