"Synergy Bariatrics provides a comprehensive bariatric surgical program with education and support to help individuals live healthier, longer, and lighter."

Weight Loss Surgery Options

Synergy Bariatrics offers the most effective weight loss procedures today. These procedures can be grouped into two categories: restrictive and combination. Restrictive procedures include laparoscopic adjustable gastric banding, and laparoscopic vertical sleeve gastrectomy. We also perform Roux en Y Gastric Bypass; a combination procedure that uses both restrictive and malabsorptive components to induce weight loss. Although each of these bariatric surgery procedures enable patients to lose a significant amount of excess weight, the operative techniques and fundamental principles vary with each. Learn about each option thoroughly so that you can make an educated decision about which procedure may be right for you.

Laparoscopic Adjustable Gastric Banding
Laparoscopic adjustable gastric banding involves placement of a silicone band around the main portion of the stomach, dividing it into two sections, one much smaller than the other. A flexible tube connects this band to a port fastened just below the surface of abdominal skin. By filling the band up with saline and tightening the restriction around the stomach, less food can be eaten and fullness is felt much sooner than before. Band tightness is achieved slowly over several adjustments thus causing gradual excess body weight loss over a period of 18 months to 3 years. However, since adjustability of the band and strict adherence to our nutrition recommendations are an integral part of success, regular follow-up with us is mandatory and continued for as long as the band is present. To learn more about the laparoscopic adjustable banding procedure and the commitments required for weight loss maintenance, visit the manufacturers of gastric band devices at www.lapband.com and www.realizeband.com.
Laparoscopic Vertical Gastric Sleeve Gastrectomy
Laparoscopic vertical sleeve gastrectomy involves surgical division and removal of approximately 85% of the stomach with only a tubular shaped or sleeve-like portion remaining. All nerves to the stomach and the intestines remain intact, so the normal functions of the modified stomach are preserved. The newly-created tube shape restricts the amount of food that can be comfortably eaten but also, because the appetite hormone secreting part of the stomach has been removed, hunger is temporarily suppressed after surgery as well. Sleeve gastrectomy can be performed as a weight loss procedure itself, but it also can be the first part of two planned procedures for very high BMI patients who may be at increased risk for other bariatric procedures like gastric banding or gastric bypass. Although this procedure is not widely performed in the United States and insurance coverage of it may not be available, it has demonstrated great success in other countries with weight loss, resolution of obesity-related illnesses, and patient safety.
Roux en Y Gastric Bypass
Roux en Y gastric bypass involves the creation of a small pouch from a permanent surgical division of the stomach to restrict the volume of food that can be eaten. This pouch is then connected to a portion of the small intestine where normal absorption of nutrients, vitamins, and minerals is bypassed. Although the main part of the stomach is not removed, it will never receive food again. Weight loss occurs much more quickly after gastric bypass than after purely restrictive procedures, but it also is considered a more invasive procedure. Although our mortality rate after gastric bypass is very, very low (<0.3%) the risk serious complications should be considered. Because of the implications gastric bypass surgery has upon the absorption of nutrients and the suppression of hunger, it is critical that patients adhere to specific nutrition guidelines which focus upon protein at every meal, 4 – 6 small meals daily, avoidance of high-fat, high-sugar foods, and daily bariatric vitamin and mineral supplementation.
Open vs Laparoscopic Gastric Bypass
Gastric bypass can be performed using either an open or a laparoscopic approach. The laparoscopic approach to gastric bypass utilizes several small incisions in the abdomen. These openings allow for the insertion of small surgical instruments and a tiny video camera-like device called a laparoscope. Advantages to this method include less pain during recovery, fewer instances of infection or hernia in the wound, and faster return to work. However, laparoscopic surgery may be difficult in patients with prior abdominal surgery, liver disease, or a small rib cage opening. The open technique refers to the use of one central incision (usually 4-5 inches long). The majority of the procedures performed by the Synergy Bariatrics surgical team have utilized the open approach with great success. Despite national trends for longer hospitalization with open gastric bypass versus laparoscopic gastric bypass, our patients have been well enough to go home after an average of two days in the hospital. Complication rates are the same as with the laparoscopic technique, and most incisions heal very well.

Qualifications for Surgery

Criteria for weight loss surgery have been established by the National Institutes of Health:
• Body Mass Index (BMI) of at least 40 or
• BMI greater than 35 with the presence of obesity associated illnesses or obesity-induced physical problems that interfere with daily living.
• Ages 18 – 60 years old (Synergy Bariatrics has performed surgery on select candidates older than 60 years)
• History of repeated failures at medically supervised weight loss
• Ability to demonstrate an understanding of the surgical procedure, its associated health risks, and the lifestyle changes that must accompany it for success
• Greater potential benefits of surgery than surgical risks
• Stable psychological condition
• Tobacco-free for at least 8 weeks prior to surgery
• At the discretion of the bariatric surgeon, other qualifications may apply.

Benefits of Surgery

Sustainable Weight Loss

Bariatric surgery has been demonstrated as the most effective long-term method of weight loss. Patients can expect to lose significant amounts of excess body weight over time; as much as 65% or more. Although the degree of weight loss and the time over which it occurs varies slightly with procedure type, it can be sustained life-long with permanent changes to diet content and eating habits. Of course, just like regular exercise and healthy behaviors, bariatric surgery is simply a tool. But by applying all of these elements to daily life, patients can achieve and maintain weight loss, improve overall health and quality of life.

Improvement In Health
Patients can expect an improvement in obesity related diseases and conditions. Studies show resolution of diabetes, high blood pressure, sleep apnea, and high cholesterol. ***It is important to note that these improvements need to be monitored by patients’ primary care physicians so that medications can be reduced or withdrawn.
Improvement in Quality of Life
Patients experience higher self-esteem and renewed self-confidence after weight loss surgery. Many give up bad habits and are able to adopt healthier lifestyles with better food choices and regular participation in exercise and recreational activities. They find that they have more energy to participate in family and social activities, make advancements at work, and are able to better deal with the stresses in their lives, particularly those from bad relationships. Sometimes, these adjustments are not made easily, however. Even successful weight loss can be associated with a significant psychological impact. Patients often benefit from peer support groups; sometimes formal counseling is appropriate.

Risks of Surgery

As with any surgery, there are potential risks to consider. Although death and major surgical complications are infrequent, some problems require additional surgery or hospitalization. Ask your surgeon to explain the specific risks of the procedure planned for you. The most commonly occurring complications associated with bariatric surgery are as follows:

• Leak - Seepage of digestive fluid from a hole in the gastric band or along any of the staple or suture lines
• Bowel obstruction - Blockage in the small intestine passageways
• Pulmonary embolus - A blood clot which forms in the pelvis or lower extremity, breaks loose and travels to the lungs
• Other pulmonary problems - Inadequate breathing or pneumonia
Pulmonary complications frequently occur in patients who smoke and therefore are avoidable.
• Wound infection - Thick layers of abdominal wall fat tissue are less able to fight infection from bacteria that may enter through incisions.
• Splenectomy - Since the spleen is close to the stomach, uncontrollable bleeding from adhesions or trauma may necessitate its removal.
• Incisional hernia - Inadequate wound healing may need later surgical repair.
• Stricture/esophagitis - Irritation or narrowing in the gastric pouch or its outlet. If this occurs, a gastroenterologist may need to use an instrument called an endoscope to stretch the stricture.
• Gallstones - Symptomatic gallbladder disease may require its removal
• Vitamin/mineral deficiency - Inadequate amounts of iron, calcium, or B12 may be corrected by oral supplementation or injections.
• Pancreatitis - Infection of the pancreas.
• Band slippage – The gastric band may move from its proper position requiring additional surgery or removal.
• Band erosion – The gastric band may wear down and imbed itself in the stomach wall requiring additional surgery or removal.
• Port site infection/hernia – The area around the gastric band port may heal inadequately or become infected. Additional hospitalization or surgery may be required.

Other Concerns

• Hair loss - inadequate amounts of protein in the post-surgical diet can contribute to temporary hair loss.
• Complications with pregnancy and childbirth - women are strictly advised to use effective birth control* methods for at least 12 months after weight loss surgery to avoid problems with fetal development. Gastric band patients who become pregnant will be evaluated for band tightness or continued band placement.
*Obesity is often associated with infertility. 1 Women who’ve had trouble conceiving prior to surgery, may in fact, become fertile after significant weight loss.
• Excessive skin - some patients may develop irritations or other problems related to saggy, redundant skin after dramatic weight loss. This may require surgical removal, commonly from regions of the abdomen, upper arms, breasts, and thighs.
• Nausea/vomiting - food intolerances may occur
• Lactose intolerance - Unpleasant symptoms like diarrhea, cramping, and abdominal discomfort may develop after dairy consumption
• Weight regain - Patients who do not adhere to the guidelines recommended for proper nutrition, regular exercise, and behavior change are at risk for weight regain