The first, important step in making a decision about weight loss surgery is to understand the options available, along with the potential benefits and risks.
Surgery is appropriate for selected patients with a Body Mass Index (BMI) of 40 or greater, or a BMI of 35 – 40 for patients with obesity-related medical conditions. Candidates for weight loss surgery should have evidence of previous, unsuccessful attempts at non-surgical treatment for obesity. They should also demonstrate a commitment to follow-up care, including a clear understanding of the dietary, exercise and medical guidelines required following surgery and throughout the rest of their lives.
Types of Weight Loss Surgery
The American Society for Metabolic and Bariatric Surgery (ASMBS) divides weight loss procedures into three basic categories:
At the Bariatric Care Center at Palms of Pasadena Hospital, we offer three basic types of weight loss surgery — the Adjustable Gastric Band Procedure, which includes the LAP-BAND® and Realize™ Band weight-loss systems; Gastric Bypass surgery, also known as Roux-en-Y; and the Sleeve Gastrectomy. The adjustable gastric bands may also be offered as "revisions" to correct previous RNY or Sleeve surgeries that have failed over time.
With the Adjustable Gastric Band Procedures (either LAP-BAND® or Realize™ Band), an adjustable silicone band is fastened around the upper part of the stomach to create a new, smaller stomach pouch. The band is connected to an access port below the skin. Through the port, the surgeon can adjust the size of the band by adding or removing saline to an inflatable balloon on the inner surface of the band. Because the band is adjustable, the surgeon and patient can work together to customize the rate of weight-loss for each patient. The patient’s weight loss, the amount of food that can be comfortably eaten, the exercise regimen, and other issues surrounding the patient’s health determine adjustments to the band, which are performed during routine outpatient visits. The procedures are effective for weight loss because they reduce the capacity of the stomach, restricting the amount of food that can be consumed at one time.
Adjustable Gastric Band Surgery (LAP-BAND® or Realize™ Band) is performed through small incisions, resulting in less pain and scarring and short recovery times. Patients generally spend just one night in the hospital and can typically resume normal activities within about one week.
Adjustable Gastric Band Surgery (LAP-BAND® or Realize™ Band) has been shown to be an effective surgical option for weight loss, and it is rapidly gaining in popularity in the U.S. Since the LAP-BAND® and Realize™ procedures do not alter the digestive track, they are both fully adjustable and reversible. Weight loss with the Adjustable Gastric Band Procedures is more gradual than gastric bypass, but because of the adjustable nature of the band, the patient and surgeon can work together to control the rate of weight loss.
Watch video highlights of 2 live LAP-BAND® surgeries, along with pre- and post-operative commentary from the surgeons, Dr. Ernest Rehnke and Dr. Tiffany Jessee. (Click here for the videos.)
In Gastric Bypass surgery, a small pouch is created at the top of the stomach and permanently separated from the rest of the stomach. A segment of the small intestine is attached to the pouch, allowing food to bypass most of the stomach and the first part of the small intestine. The procedure is effective for weight loss because it reduces the amount of food that can be eaten at one time and because fewer calories are absorbed by the body.
Gastric bypass can be performed as open surgery or as a laparascopic procedure. In the laparoscopic procedure, the surgeon operates through five or six small incisions in the abdomen. Using smaller incisions reduces the trauma, scarring and recovery time associated with traditional open gastric bypass surgery. Patients undergoing the laparoscopic gastric bypass generally spend less time in the hospital and resume normal activity quicker. However, not all patients are candidates for the laparoscopic technique, especially patients with an extremely high BMI or previous upper abdominal surgeries.
Gastric bypass surgery has been shown to be a durable and effective surgical option for weight loss. In the U.S., it is still the most common form of weight loss surgery. Most patients lose about half of their projected weight loss in the first six months, with weight loss peaking between 18 – 24 months.
Gastric Bypass Procedure Animation
The vertical gastrectomy or sleeve gastrectomy is a type of restrictive weight loss surgery. The procedure generates weight loss by restricting the amount of food that can be consumed before feeling full. This procedure, like all other weight loss surgery, should be considered a tool and not a magic bullet. The individual who undergoes this procedure must make changes in food intake and lifestyle in order for the procedure to have a successful long-term outcome. Because the stomach has the ability to stretch to accommodate food, the stomach can expand from the small capacity the surgery initially allows.
The majority of weight loss sleeve gastrectomies performed today use a laparoscopic technique. This allows the surgeon to work using long instruments placed in the body via incisions a few centimeters long. In some cases, the surgery will be performed "open," with the traditional larger incision, or a surgery that begins lapaoscopically may be converted to the open procedure when the surgeon determines it is necessary.
The stomach is restricted by stapling and dividing it vertically, removing up to 85%. The remaining stomach is obviously smaller and tubular in shape. With a smaller stomach, patients eat less. It is also felt that the hormones that control the appetite are created in a portion of the stomach that is removed, and by taking out that portion of the stomach, the patient's appetite is reduced.
Sleeve Gastrectomy Procedure Animation
The term "revision" is applied when one weight loss procedure is converted or transformed to another.
We have seen that, over time, a percentage of gastric bypass patient will start regaining some of their weight. One reason for this is the fact that the gastric pouch can stretch and accommodate more food at each meal. In addition, the connection between the stomach pouch and small intestines may start to dilate and enlarge over time. As a result the stomach can empty faster and the patient loses the sense of satiety.
Our team can place the adjustable gastric bands (LAP-BAND® or Realize™ Band) over previously failed weight loss surgery with good results. The objective is to place the band around the highest part of the stomach and restricts the ability to over-eat. Patients regain early satiety and fullness after eating, which results in weight loss.
Benefits and Risks
Successful surgical weight loss can improve the quality of a patient’s life. It can lead to long-term weight control and reduce the health-related risks of morbid obesity, including diabetes, heart disease, arthritis, sleep apnea, and many other medical conditions. Many patients feel more energetic after surgery and their initial weight loss, which enables a more active lifestyle. Many patients also report an improved self-image and greater confidence after successfully achieving their desired weight loss.
All types of weight loss surgery are considered major operative procedures, and all surgeries carry the risk of complications. The risk for surgery in the obese patient is significantly greater than for the general population. Some of the risks associated with weight loss surgery include, pulmonary complications due to the stress of excess weight on the chest and lung cavities, blood clots, leaks or perforations of the stomach, and infections. In rare cases, the risks and complications can be fatal.
If you have any questions about our hospital, the surgeons, or the treatment options available to you, please contact us through our web form, by email, or by phone at 1-866-931-THIN (8446). We will be happy to give you any information you need.
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