Surgical Procedures

Weight Loss Surgery Procedures

Laparoscopic Gastric Bypass

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the world. In this combined malabsorptive and restrictive procedure, a stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages
1-Very strong appetite control tool
2-Combined malabsorptive and restrictive procedure.
3-Reversible in an emergency, though this procedure should be thought of as permanent
4-The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
5-One year after surgery, weight loss can average 77% of excess body weight.
6-Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
7-A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

Disadvantages
1-Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia.
2-Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the eficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
3-A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills, nasal spray, or injections.
4-In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.

Lap Adjustable Gastric Band

In this procedure, a silicone band is placed around the upper part of the stomach to create a small stomach pouch which can hold only a small amount of food. The lower, larger part of the stomach is below the band. These two parts are connected by a small outlet created by the band. Food will pass through the outlet (“stoma” in medical terms) from the upper stomach pouch to the lower part more slowly, and one will feel full longer. The diameter of the band outlet is adjustable to meet individual needs, which can change as one loses weight.

On the inner lining of the band there is a longitudinal balloon (like a bicycle tire). The band is gradually filled with fluid by injection through the subcutaneous (just under the skin) port. It is thus possible to vary the opening in the stomach after surgery. This can be done in the surgeon’s office or under X-ray guidance.