Types and Techniques

Weight loss surgery entails several different procedures. Although each bariatric procedure is designed to induce weight loss, the operative techniques and fundamental principles vary with each. Knowing all of the options can help you to make an educated decision about which method is right for you. Most commonly, these are described by procedure type.

Restrictive procedures temporarily decrease the capacity of the stomach. Weight loss occurs because the amount of food that can be comfortably ingested is drastically reduced.

Malabsorptive procedures prevent the body from absorbing calories and nutrients from ingested food. Weight loss occurs because surgery changes the way food is digested.The principles which induce weight loss with malabsorptive procedures are often related to the most frequent complications. Patients are at risk for developing problems with malnutrition of nutrients and essential vitamins and minerals. Without compliance close lifelong monitoring for protein malnutrition, anemia and bone disease, it has been observed that at least 25% of patients develop problems that require treatment. Malabsorptive procedures are not commonly performed today.

Restrictive/malabsorptive procedures combine both principles of the previously described weight loss surgery methods. Weight loss occurs not only because the capacity of the stomach is greatly reduced, but because digestion and metabolism is altered from changes in stomach hormones and the absorption of nutrients.

Procedure Types

• 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.

Operating Techniques

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.