Center for Bariatrics
About Our Bariatric Procedures
Bariatric surgery requires just one surgery, but offers an option between three different procedures – gastric bypass, gastric band (LAP-Band®), and sleeve gastrectomy.
Gastric band (LAP-Band)
The laparoscopic adjustable gastric banding procedure, better known as LAP-Band, is a purely restrictive procedure in which a band is placed around the uppermost part of the stomach. The band divides the stomach into two portions: one small and one larger portion. Since the stomach is divided into smaller parts, most people feel fuller, faster. The band is completely adjustable, so if the rate of weight loss is not where you would like it to be, the band can be adjusted. Food digestion happens through normal digestion.
- LAP-BAND is the only FDA approved weight-loss surgery option
- Least invasive surgical option, providing small incisions, minimal scarring, reduced pain, shorter hospital stays, and quicker recovery
- No stomach stapling or intestinal re-routing
- Adjustable and completely reversible, allowing individualized degree of restriction for ideal rate of weight loss, adjustments are non-surgical, supports pregnancy by allowing stomach outlet size to be opened to accommodate increased nutritional needs
- 10 times safer than gastric bypass
- Fewer risks and side effects, including reduced risk of hair loss and no “dumping syndrome” related to dietary intake restrictions
Risks & Disadvantages
- Access port may leak or twist, which may require an operation to correct the problem
- Surgery may not provide the necessary feeling of satisfaction that one has had enough to eat
- Possibility that the band may erode into the stomach wall
- Possibility that the band may move or slip
- Slower rate of weight loss than that following gastric bypass surgery
The laparoscopic vertical sleeve gastrectomy is a bariatric procedure that offers an excellent alternative to both gastric bypass and adjustable gastric banding, and 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.
Sleeve gastrectomy may also be 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).
- Stomach volume is reduced, but tends to function normally so most food can still be consumed in smaller amounts
- Allows normal absorption of most medications
- Eliminates the portion of the stomach that produces a hormone that stimulates hunger.
- Eliminates chance of “dumping syndrome”
- Minimal chance of ulcers
- Reduced risk of intestinal blockage, anemia, osteoporosis, protein deficiency and vitamin deficiency
- Greater potential for inadequate weight loss or weight regain than with other procedures
- Greater chance of higher BMI patients needing 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)
- Not reversible
- Considered investigational by most insurance companies
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
- Improves blood sugars and many other weight-related problems
Risks & Disadvantages
- Poor absorption of iron and calcium can cause low total body iron and increased risk of iron-deficiency. 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.
- Increased risk of 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.
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