Bariatric Surgery Procedures

Gastric Bypass  |  Gastric Banding  |  Sleeve Gastrectomy  |  Benefits  |  Risks

Gastric Bypass Surgery

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Gastric Bypass surgery was one of the first Bariatric procedures performed to promote weight loss. It involves segmentation of the stomach into a small pouch and allows food to bypass part of the small intestine. Once this is done, you will become full faster with a smaller amount of food, thus reducing the amount of calories consumed; bypassing part of the intestine also results in fewer calories being absorbed, leading to weight loss.

GBS is usually performed laparoscopically, with the surgeon making three small incisions. The laparoscopic approach offers less discomfort and a quicker recovery time for the patient. Patients are usually required to spend the night in the hospital.

Risks

Negative aspects of the surgery include the potential for nutrient deficiencies due to the malabsorptive component, the need for stringent dietary and lifestyle changes, and the potential to experience dumping syndrome (negative body response to refined sugars, high-fat foods, and simple carbohydrates). Because of the extensive research done on the negative aspects of gastric bypass surgery, most programs are able to offer detailed diet modification plans to help the patient overcome any issues that could occur post-operatively.

Benefits

Benefits of the surgery include two stages of weight loss mechanisms, restriction (dramatic reduction in the amount of food you can eat at a given time) and malabsorption (reduction in your body's capability to fully absorb all of what you do eat). Patients can expect statistically to lose 70-80% of their excess body weight with full aftercare compliance, and have shown an ability to maintain that loss 15 years with continued diligence to post-surgical dietary changes.

Medical Results of Weight Loss Surgery and Subsequent Weight Loss

• Elimination or improvement of diabetes
• Decrease in or elimination of hypertension
• Elimination of GERD
• Elimination of most forms of sleep apnea
• Decreased risk of many forms of cancer, such as breast, pancreatic, esophageal
• Decrease in fat concentration in liver, reduced risk of steatohepatosis
• Decreased risk of cardiovascular event
• Increased life expectancy averaging 20 years
• Improvement in orthopedic conditions
• Improved quality of life

Adjustable Gastric Band

Adjustable Gastric Banding is a technique for pure restrictive weight loss surgery. There is no malabsorptive component to the procedure, and weight loss is achieved by careful planning with the reduction in calories consumed. What makes this procedure more effective than the other traditional restrictive procedures, such as the Vertical Banded Gastroplasty (VBG), is the adjustability of the band. LAP-BAND® Adjustable Gastric Banding gives flexibility in the amount of restriction you have, thus the ability to vary the amount of calories consumed, in a manner that can provide optimum weight loss with a minimum of potential for nutrition problems.

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We believe that LAP-BAND® Adjustable Gastric Band surgery can be equally effective as gastric bypass if the patient is committed to a life-long process of education and maintenance geared towards maximizing their outcomes. For someone who believes that their weight loss hinges strictly on the ability to reduce their consumption, this procedure can be tremendously effective. For someone who feels as though poor dietary choices are their biggest problem, the LAP-BAND® Adjustable Gastric Banding may not be as effective. Proper mechanical adaptation in eating habits, a sound approach to developing a balanced diet, and regular exercise are the keys to long-term success with LAP-BAND® Adjustable Gastric Band surgery.
 
Adjustable Gastric Banding procedure involves making several small incisions, introduction of a camera into the abdomen to visualize the upper stomach, and then placing the band around the fundus of the stomach. The band is fastened into place and then sutured to the stomach to prevent slippage. The adjustment tube coming off of the band is then passed through the abdominal wall and attached to the adjustment port, which is secured in a hollow between your involves a minimum of skin, subcutaneous layers, and the abdominal muscles. This procedure involves less tissue dissection and tissue disruption, thus a reduction in discomfort for the patient.  A radiological evaluation is done, where the patient swallows some contrast, and the passage through the band is visualized to verify correct placement. The patient is then discharged to home on a liquid diet. We are excited about offering this option to motivated patients, as it offers the best of new, minimally invasive techniques while still providing an excellent tool for weight reduction.

Risks

Negative aspects of LAP-BAND® Adjustable Gastric Band surgery include the adjustment routine, which requires an office visit with a physician, a needle stick to inject or withdraw saline from the port, and typically a radiological evaluation to verify flow through the gastric pouch. Current studies indicate a slower rate of weight loss than with malabsorptive or hybrid procedures, to a reported average of up to 75% excess weight loss, with most patients reporting in the 40-50% range.

Benefits

Benefits of LAP-BAND Adjustable Gastric Banding are that the procedure is much less invasive than the malabsorptive or hybrid procedures, the patient difficulties are kept to a minimum, and the band's adjustability allows the flexibility to meet the changing needs of the patients. The procedure is relatively easy on both patient and surgeon, and is typically performed as an outpatient procedure. Generally patients will return to work within one week. Without a malabsorptive component to the operation, there will be more flexibility in the patient's diet and less dependency upon long-term vitamin and mineral supplementation to avoid deficiencies. There is no 'dumping syndrome' associated with LAP-BAND® Adjustable Gastric Band surgery, and thus no issues with food preferences.

Vertical Gastric Sleeve

The sleeve gastrectomy is a surgical procedure for weight loss that is particularly suited to those patients at highest risk for surgery, either because of their medical co-morbidities or their weight. This operation can be performed with traditional open techniques or with minimally invasive laparoscopy.

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Whether or not you are a candidate for the laparoscopic technique is decided between the patient and surgeon during the consultation, and will be dependent upon prior surgery to the area. We offer this procedure for patients who have had prior esophageal surgery for GERD (gastroesophageal reflux), previous stomach surgery, or as a first-stage, lower-risk surgical alternative that can be the starting ground towards other bariatric surgery procedures such as Roux-en-Y gastric bypass. The procedure is also an excellent alternative for clients who wish to have a restrictive procedure (no malabsorption) without the risk of long-term issues and maintenance of a device, as used in gastric banding.
 
The surgery involves stapling off and separating about 70-80% of the stomach's natural carrying capacity without involving the intestinal tract. An advantage of the sleeve gastrectomy is that you gain a significant amount of restriction immediately after surgery without having to make manual adjustments as in gastric banding. You also gain some of the metabolic advantages that you would in a gastric bypass without involving the small intestine. As there is no malabsorptive component, digestive function remains essentially the same.

The procedure produces a sense of early satiety, thus limiting the patient's ability to eat large meals. Appetite is generally reduced significantly, unlike gastric banding procedures. Used properly with a good, balanced diet and eating schedule, the sleeve gastrectomy can be an effective tool to producing significant weight loss and improved overall health.

Benefits of Bariatric Surgery

The benefits of this surgery are more than skin deep. Bariatric surgery will, with proper post-surgical care, help you live a longer, healthier and more active life.

• Patients lose at least 50% to 80% of excess body weight depending on the procedure
• Improvement or resolution of many health problems such as Type II Diabetes,
  hypertension, high cholesterol and sleep apnea
• A return of normal periods for young women with abnormal
  or absent menses and improvement of fertility
• Improved sexual function for many males.
• Reduction of periods of sleep apnea.
• Eliminates or slows the disabling effects of arthritis.
• Improved self-esteem and more energy.
• A well established method for long-term weight control
• Improvements in surgical techniques have resulted in considerable
  progress in safety, effectiveness, and maintenance.
• Lessened joint pain
• Enhanced quality of life, improved mobility and stamina, better mood,
  and higher self-esteem and lessened self consciousness.
• Enjoyment of social and physical activities that were previously inaccessible

Benefits of Gastric Bypass

Gastric bypass is the favored bariatric surgery in the United States. Surgeons prefer this surgery because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes. In addition to dramatic weight loss, gastric bypass surgery may improve or resolve the following conditions associated with obesity:

• Type 2 (adult-onset) diabetes
• High blood pressure
• High blood cholesterol
• Obstructive sleep apnea
• Gastroesophageal reflux disease (GERD)

The improvements observed in type 2 diabetes, high blood pressure and high blood triglycerides may significantly decrease the risk of cardiovascular events in people who have undergone gastric bypass surgery compared with those people who did not have surgery. Also, gastric bypass surgery may reduce the risk of dying of diabetes, heart disease and cancer. The surgery has also shown to improve mobility and quality of life for people who are severely overweight.

Benefits of Gastric Banding

Most patients are expected to lose 75 to 80% of their excess body weight. Well over 70% of patients with hypertension will be off medications and well over 90% of patients with type II non-insulin dependent diabetes mellitus are expected to be off medication. Drastically improved, if not completely resolved includes sleep apnea, asthma, joint pain, arthritis, reflux, fatigue, shortness of breath and an overall increased sense of well-being.

There is expected to be a significant reduction in risks of heart disease, pulmonary disease and cancers. Morbid obesity can reduce the lifespan as much as 20% in a given patient, depending on their age and comorbid problems. There is also a significantly improved quality of life and self-esteem in patients who have undergone gastric bypass procedure for weight loss.

Benefits of Gastric Sleeve

The most important benefit of sleeve gastrectomy is that it allows patients who have been unable to control their weight through a combination of diet and exercise to achieve rapid, dramatic weight loss. Maintaining an appropriate weight is an important part of living in good health - avoiding heart disease, hypertension, diabetes, and the many other medical problems associated with obesity. Most gastric sleeve patients also enjoy dramatically improved energy and self-esteem, as they are able to fully enjoy an active, healthy lifestyle after surgery.

Sleeve gastrectomy may be safer than gastric bypass for patients who have a number of health risks.  It lowers the risk of ulcers compared to gastric bypass. The surgery cuts away the part of the stomach that produces grehlin, a stomach hormone that stimulates hunger.  Though the stomach is smaller, the openings are left intact, so digestion can go on as normal.

The body is free of foreign objects like those associated with a gastric banding procedure.

Risks of Bariatric Surgery

Risks of Gastric Bypass

If you are considering having the gastric bypass surgical procedure done, it is important that you understand the risks involved. At the time a decision is made to have the surgery, you will be asked to sign a consent form stating you understand all the risks involved. You are encouraged to ask any questions at the time of your consultation. Some of the risks are as follows:

• Bleeding
• Infections
• Follow-up surgeries to correct complications, or to remove excess skin
• Gallstones due to significant weight loss in a short amount of time
• Gastritis (inflammation of the lining of the stomach)
• Vomiting from eating more than the stomach pouch can hold
• Iron or vitamin B12 deficiencies (if they occur) can lead to anemia
• Calcium deficiency (if it occurs) can contribute to the development
  of early osteoporosis or other bone disorders

Risks of Gastric Banding:

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis. Perforation or tearing in the stomach wall may require an additional operation.

• Access port leakage or twisting may require an additional operation.
• May not provide the necessary feeling of satisfaction that one has had enough to eat.
• The band portion of the lap band slips and the small gastric pouch above the band becomes larger. This can cause a partial obstruction and vomiting and may require removal of the band. This problem is prone to occur early after the lap band has been placed and is more likely to occur if there is repeated vomiting. Generally a liquid diet is recommended for the first month after the lap band operation.
• Slower initial weight loss than Gastric Bypass or BPD.
• Regular follow-up critical for optimal results.
• Requires an implanted medical device (the lap band).
• In some cases, the lap band's access port may leak and require minor revisional surgery.

Risks of Gastric Sleeve:

• Sleeve gastrectomy is more common in Europe, but most American health insurance carriers still consider it an investigational procedure and do not cover the cost.
• Anytime you have anesthesia or surgery, there is a risk
  of blood clots, other complications or death.
• Do not smoke. Smoking would put you at high risk for infection,
  blood clots, slow healing and other life-threatening complications.
• Complications can occur with the stapling, such as leaks or bleeding.
• You may need malabsorptive surgery – intestinal bypass or duodenal
  switch – in addition to your sleeve gastrectomy in order to lose all the
• weight you need and want to lose.
• The smaller portion of the stomach may stretch.
• Foods that you eat now may cause discomfort,
• nausea or vomiting after your surgery.
• Gastric surgery puts you at higher than normal risk of developing
• gallstones and gallbladder disease.
• You will not lose weight or maintain your weight loss unless you eat a healthy diet and exercise regularly. This is the reason we stress long-term follow-up with our center and your doctor.