Surgical Options

There are two primary approaches to surgical weight loss: restriction alone via Lap band and gastric sleeve and restriction with malabsorption (a reduction of the body's ability to absorb calories) via gastric bypass.

Gastric bypass typically generate more weight loss than restrictive procedures, which only decrease food intake. People who undergo gastric bypass generally lose about 75% of their excess weight compared to those undergoing Lap band and gastric sleeve, who typically lose 50-65% of their excess weight.

Restrictive Procedures

Restrictive procedures restrict food intake but do not interfere with the normal digestive process. These procedures diminish food intake by creating a smaller stomach. The pouch initially holds about one ounce of food, an amount that expands to six to eight ounces with time.

Gastric Banding or Laparoscopic Placement of a Lap Band

lapbandIn this procedure, a band made of special material is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger remainder of the stomach. The pouch's lower outlet usually has a diameter of about 1/4 inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness. Lap band is placed via laparoscopic technique (minimally invasive surgery), a fiber-optic tube and light source through which some surgical instruments may pass.

After the operation, you can typically eat only 1/2 to 1 cup of food without discomfort or nausea. You will likely over time lose the ability to eat large amounts of food in one sitting and you must thoroughly chew your food. Ideally, you will progress to eating modest amounts of food without feeling hungry. One downside of having a Lap band is that the amount of weight loss is inconsistent among individuals. As a result many patients do not achieve the desired weight loss. Expected weight loss is approximately 50% of excess body weight.

Potential Complications

  • You may vomit if your food is not chewed thoroughly.
  • Very rarely, pressure by the band creates a hole in stomach and requires surgical repair.
  • The stomach slips under the band and gets trapped, which may require surgical repair.
  • Rarely, the body cannot adapt to the band around the stomach, and the band must be removed.  
  • The risk of death is very small.

Vertical Sleeve Gastrectomy

gastricsleeveThe surgeon turns the stomach into a long, narrow shape with reduced volume capacity. The term sleeve gastrectomy refers to the technique used to remove the stomach. This is achieved by surgically removing the majority of the stomach (sleeve resection), and the removed portion looks like a sleeve. About 75 percent of the stomach is removed via a minimally invasive technique. Expected weight loss is roughly 65 percent of excess body weight.

Potential Complications

  • You may vomit if your food is not chewed thoroughly.
  • Very rarely, the staple line breaks down.
  • Very rarely, stomach juices leak into abdomen, which requires emergency surgery.
  • The risk of death is very small.

Restrictive and Malabsorptive Procedures

These procedures encourage weight loss by achieving two things. First, a small stomach pouch is created to restrict food intake. Additionally, a bypass of the duodenum (first part of the small intestine) and other segments of the small intestine are constructed to cause malabsorption.

Roux-en-Y Gastric Bypass

rouxenygastricbypassThis operation is considered the gold standard for weight loss surgery. It is performed using minimally invasive surgery.

First, stapling or vertical banding creates a small stomach pouch to restrict food intake. Then, a Y-shaped section of the small intestine is attached to the pouch, allowing food to “bypass” the main stomach and approximately one-third of the length of the small intestine. The result is decreased calorie absorption.

Potential Complications

  • You may vomit if your food is not chewed thoroughly.
  • Very rarely, the staple line breaks down.
  • Very rarely, stomach juices leak into abdomen, which requires emergency surgery.
  • The risk of death is very small.

Revisional Procedures

This category of surgery is intended for individuals who already had weight loss surgery and need a correction, conversion or other surgical “tune up”. A high degree of expertise is required for these procedures to have successful outcomes. All of our surgeons have had specialty training in bariatric (weight loss) surgery and are considered experts in the field.

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