Otherwise known as weight-loss surgery, bariatric surgery can be one of three procedures - gastric bypass, gastric band or sleeve gastrectomy - performed on patients who are morbidly obese and have failed to achieve and sustain weight loss by non-surgical methods such as diet, exercise, drug therapy and combination therapy.
Many of these patients have multiple severe medical problems ("comorbidities") related to their weight.
Surgery has been shown to promote significant and sustained weight loss for these individuals and improve or eliminate most of these problems.
Laparoscopic Gastric Banding (Lap-Band): A Restrictive Procedure
The laparoscopic adjustable gastric banding procedure is a purely restrictive surgical procedure in which a band is placed around the uppermost part of the stomach. This band divides the stomach into two portions: one small and one larger portion. Since the stomach is divided into smaller parts, most patients feel full faster. As the name indicates, the band is adjustable. So if the rate of weight loss is not acceptable, the band can be adjusted.
- Least invasive surgical option
- No intestinal rerouting
- No cutting or stapling of the stomach wall or bowel
- Small incisions and minimal scarring
- Reduced patient pain, length of hospital stay and recovery period
- Fewer risks and side effects
- Allows individualized degree of restriction for ideal rate of weight-loss
- Adjustments performed without additional surgery
- Supports pregnancy by allowing stomach outlet size to be opened to accommodate increased nutritional needs
Risks & Disadvantages
- The access port may leak or twist, which can require an operation to correct the problem
- Surgery may not provide the necessary feeling of satisfaction that one has had enough to eat
- Band may move or slip
Laparoscopic Sleeve Gastrectomy: A Restrictive Procedure
Laparosopic sleeve gastrectomy is a bariatric procedure that offers an excellent alternative to both gastric bypass and adjustable gastric banding. It is particularly effective for patients with mild to moderate Body Mass Index (BMI of 35 – 45) as a primary procedure and for very high BMI (greater than 70) as a staged procedure.
Sleeve gastrectomy works mainly by reducing stomach volume. During surgery, the stomach is divided vertically and 80 to 85 percent of it is removed. What is left is a long vertical "sleeve" that is shaped like a banana. The nerves to the stomach and the outlet valve (pylorus) remain intact to preserve the functions of the stomach while reducing the volume it is able to hold. There is no intestinal bypass with this procedure, only stomach capacity reduction. The portion of the stomach which is removed produces Ghrelin, a hormone that stimulates appetite. This reduces, but does not eliminate, a person's appetite.
Patients can expect to lose 50 to 70 percent of excess weight over a one to two year period after this procedure. Patients who may benefit from a sleeve gastrectomy over other procedures include those who have previously had small bowel surgery, very high BMI patients (>70) as part of a two stage procedure, or low BMI (35 – 45) patients who prefer not to or cannot have an implanted device (band) or a malabsorptive (bypass) procedure.
Other candidates include patients who have a family history of gastric cancer or need frequent EGD's, and patients who have a history of inflammatory bowel disease or who are scheduled to undergo another procedure (knee replacement, kidney transplant) and need a procedure to lose weight that will have minimal effect on absorption of medications.
- A stomach that is reduced in volume but tends to function normally so most food items can be consumed, albeit in small amounts. It also allows normal absorption of most medications, unlike gastric bypass.
- The elimination of the portion of the stomach that produces a hormone that stimulates hunger
- The elimination of "dumping syndrome
- A minimization of the chance of ulcers occurring
- A reduced chance of intestinal blockage, anemia, osteoporosis, protein deficiency and vitamin deficiency
- An appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures or procedures that require implants (such as gastric banding)
- The potential for inadequate weight loss or weight regain which can happen with any procedure is higher with gastric banding or sleeve gastrectomy
- Higher BMI patients will most likely need to have a second-stage procedure later to help lose remaining excess weight
- Soft foods that are high in calories – such as ice cream, milk shakes, etc. – can be absorbed and may slow weight loss
- The possibility that leaks and other complications will occur since this procedure does involve stomach stapling (this risk is similar to other bariatric procedures)
- A procedure that is not reversible
- A procedure that is considered investigational by most insurance companies
Gastric Bypass Surgery: A Restrictive and Malabsorptive Procedure
According to two organizations, the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y (pronounced ROO-en-why) gastric bypass surgery is the most popular bariatric surgery in the United States. In this procedure, the surgeon creates a small stomach pouch and then constructs a "bypass" for food. The bypass allows food to skip parts of the small intestine. By skipping a large part of the small intestine, the body cannot absorb as many calories or nutrients.
- Rapid weight loss
- Maximized weight loss
- Sustained weight loss
Risks & Disadvantages
- Because the duodenum and other sections of the small intestine are bypassed, poor absorption of iron and calcium can cause low total body iron and a greater chance of having iron-deficiency anemia. Patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids should be aware of the chance of iron-deficiency anemia. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the possibility of increased bone calcium loss. By taking a multivitamin and calcium supplements, patients can maintain a healthy level of minerals and vitamins.
- Bypassing the duodenum can cause metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back, and fractures of the ribs and hipbones. Eating foods rich in nutrients and taking vitamins can help patients avoid this.
- Chronic anemia due to vitamin B12 deficiency may occur. The problem usually can be managed with vitamin B12 pills or injections.
- A condition known as dumping syndrome can occur from eating too much sugar or large amounts of food. While it isn't considered a serious health risk, the results can be very unpleasant. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea. Some patients are unable to eat sugary foods after surgery. The bypassed portion of the stomach, duodenum, and parts of the small intestine cannot be seen easily using X-ray or endoscopy if there are problems such as ulcers, bleeding, or malignancy.