Surgical Weight Loss Options
The minimally invasive surgical approach is the optimal technique for bariatric procedures. This approach benefits patients in a number of ways, including reduced risk of infection, quicker recovery time and decreased post-operative pain.
Bariatric surgical procedures cause weight loss by way of restricting the amount of food the stomach can hold, reducing the absorption of nutrients, and altering your metabolic hormones. Below is a description of surgeries that are offered at The Bariatric and Metabolic Institute, along with the advantages and disadvantages of each procedure.
The types of bariatric procedures that we perform include:
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.
There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by stapling off a section of the larger body of the stomach. Next, the small intestine is divided. The bottom end of the divided small intestine is attached to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.
Gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates small meal volumes, which translates into fewer calories consumed. Since the first portion of the small intestine is bypassed, fewer calories and nutrients are absorbed. Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and improves blood sugar control for those with Type 2 Diabetes.
- Produces significant long-term weight loss (60 to 80 percent excess weight loss)
- Restricts the amount of food that can be consumed
- May lead to conditions that increase energy expenditure
- Produces favorable changes in gut hormones that reduce appetite and enhance satiety
- Typical maintenance of >50% excess weight loss
- Is technically a more complex operation than the LAGB or LSG, potentially resulting in greater complication rates
- Can lead to long-term vitamin/mineral deficiencies particularly deficits in Vitamin B12, iron, calcium, and folate
- Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance
The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach.
The stomach is stapled from the bottom up to create a long tubular pouch that resembles a skinny banana. The remaining portion of the stomach (known as the fundus) is removed from the body. The fundus contains a hormone called ghrelin, which controls hunger.
This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than a normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control. Studies show that the sleeve is as effective as the LRYGB in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes, independent of the weight loss. The complication rates of the sleeve fall between those of the LAGB and LRYGB.
- Restricts the amount of food the stomach can hold
- Induces rapid and significant weight loss that comparative studies find similar to that of the LRYGB.
- Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
- Requires no foreign objects (like the LAGB), and no bypass or re-routing of the food stream (like the LRYGB)
- Involves a relatively short hospital stay of approximately 2 days
- Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety
- Is a non-reversible procedure
- Has the potential for long-term vitamin deficiencies.
Adjustable Gastric Band
The Adjustable Gastric Band – often called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, with the rest of the stomach below the band.
A silicone band is placed around the upper portion of the stomach and attached to it is a port with tubing. This port is pulled up to just beneath the skin in the abdomen.
This device works by creating a smaller stomach pouch, therefore eating a small amount of food will satisfy hunger and promote a feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin. Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.”
The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged by studies that show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. With this procedure, there is no malabsorption; the food is digested and absorbed as it would be normally. The clinical impact of the band is that it reduces hunger, which helps the patients to decrease the amount of calories that are consumed.
- Reduces the amount of food the stomach can hold
- Involves no cutting of the stomach or rerouting of the intestines
- Requires a shorter hospital stay, usually less than 24 hours
- Is reversible and adjustable
- Has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures
- Has the lowest risk for vitamin/mineral deficiencies
- Slower and less early weight loss than other surgical procedures
- Greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed
- Requires a foreign device to remain in the body
- Can result in possible band slippage or band erosion into the stomach in a small percentage of patients
- Can have mechanical problems with the band, tube or port in a small percentage of patients
- Can result in dilation of the esophagus if the patient overeats
- Requires strict adherence to the postoperative diet and to postoperative follow-up visits
- Highest rate of re-operation
Gastric Balloon Procedures
ORBERA Gastric Balloon - How it Works
Some patients who have undergone a previous surgical procedure for obesity may desire to have their surgery revised or ‘fixed.' Reasons may include the following:
- weight regain
- inadequate weight loss
- poor tolerance of solid food
- persistent vomiting
- gastroesophageal reflux disease (GERD), ulcers, or other problems
- chronic leaks
Revisional bariatric surgery is complicated and should only be undertaken after evaluating the risks and benefits. Not every patient with poor weight loss after bariatric surgery is a candidate for revisional surgery.
Revisional surgeries done at our Institute include band to sleeve, band to bypass, sleeve to bypass, and VBG to bypass.
Gastric Endoluminal Surgery
Endoluminal surgery is performed when an endoscope is placed into the hollow organs of gastrointestinal tract such as the esophagus, stomach and small bowel through the mouth. The types of surgical procedures that can be completed include dissection, suturing, stapling and stenting. Compared to traditional open and laparoscopic, these advanced techniques reduce the invasiveness of surgery, reduce surgical risks and have quicker recover with minimal pain. Gastric endoluminal surgery has benefited patients with severe GERD and ulcers, non-healing leaks from previous stapling procedures, and gastro-gastric fistulas from staple line breakdown. Endoluminal surgery may also benefit patients with weight regain after prior bariatric surgeries. Endoluminal procedures are not always covered by medical insurance unless medical necessity is determined.