Bariatric Surgery Options
The Sleeve Gastrectomy
The Sleeve Gastrectomy surgery has become more widely available under insurance plans that cover bariatric surgery. This surgical procedure is permanent and is not reversible. There are no long term statistics available for this procedure in the US.
The Sleeve Gastrectomy surgery is performed under general anesthesia and takes approximately 45 minutes. Most patients can expect to go home the following day.
The Sleeve Gastrectomy is a restrictive bariatric surgery. The restriction comes from the new size of the stomach which is 2/3 smaller. The stomach is cut and stapled creating a long cylindrical tube (banana shape) that will hold about 2 to 3 ounces of food. The new smaller stomach allows a person to eat a smaller amount of food to feel satiated.
A decrease in physical hunger occurs because a large part of the stomach is removed from the body, reducing the level of Ghrelin, a hunger-promoting hormone produced in the stomach tissue.
No malabsorption occurs because the food is absorbed the same as before surgery. The Sleeve Gastrectomy also preserves the pyloric valve, the muscular area at the end of the stomach that regulates passage of stomach contents into the small intestine. Despite not having the malabsorption that occurs in the Gastric Bypass procedure, patients with a Sleeve Gastrectomy achieve almost the same weight loss results (between 55 and 75 percent of excess body weight) but without the risk of some of the major complications of Gastric Bypass patients.
Benefits of The Sleeve Procedure
- The size of the stomach is smaller
- 45 minute average surgical time
- Low Major surgical risks of 1.49%
- Discharged usually 1st day after surgery
- Return to non-physical strenuous job in 14 days
- The new cylindrical shaped stomach will hold enough food your body needs -2 to 3 ounces of food
- A smaller stomach means smaller food portions which is getting back to back is normal consumption
- Reduction in “hunger promoting hormone” Ghrelin.
The Roux-en-Y Gastric Bypass
Gastric Bypass surgery has been performed for weight loss since 1966. The Roux-en-Y gastric bypass is a safe and effective procedure. It creates a small stomach pouch that allows an individual to feel satiated from eating a small meal. The procedure causes a degree of maldigestion and malabsorbtion.
The Gastric Bypass surgery is performed under general anesthesia and takes approximately 1 hour 15 minutes. Most patients can expect to be in the hospital for two nights.
The Gastric Bypass causes both restriction and some malabsorption of food. The restriction comes from the small size of the new stomach pouch. The malabsorption comes from the food bypassing a portion of the small intestine (the duodenum and a portion of the jejunum), so fewer calories and nutrients are absorbed. Studies show that bypassing this portion of the upper digestive tract appears to result in increased levels of a hunger-suppressing hormone called GLP (glucagon-like polypeptide). This hormone is also partly responsible for the improvement of blood sugar regulation in Type 2 diabetic patients immediately after surgery.
The new stomach pouch can hold about an ounce of food at one time. It is important that you consume food and liquids at a rate not to exceed one ounce every five minutes. By eating larger amounts of food or by eating too fast, you may stretch the pouch over time.
The majority of your weight loss will occur during the first 12 to 18 months after surgery. The goal during this time is to develop the healthy eating and lifestyle habits that will enable you to maintain the weight loss for the rest of your life!
What changes occur to the digestive system after gastric bypass surgery?
• The first physical change that occurs is that the size of your stomach is made smaller. The stomach is separated into 2 parts. Your smaller stomach is referred to as a pouch, which is about the size of an egg.
• The stomach is separated with the use of staples to create the small pouch. The small stomach pouch causes the restrictive part of the gastric bypass surgery. The remaining part of the stomach is left in place to continue producing digestive juices.
• The middle part of the small intestine (jejunum) is cut and one part is brought up to the stomach pouch where it is attached (anastomosed) to create the bypass effect for food. This attachment site is called gastro-jejunostomy. The food now bypasses the large part of the stomach and the first part of the small intestine causing malabsorption of food. Malabsorption means a decreased absorption of calories/nutrients.
• The other end of the small intestine is attached (anastomosis) back to the small intestine (jejunum). This limb is also known as the Bilio-pancreatic limb. This limb carries digestive juices from the remaining stomach, pancreas, liver and duodenum into the lower portion of the small intestine.
The Benefits of The Gastric Bypass Procedure
- The stomach is stapled creating a workable small pouch
- A small stomach means smaller, more normal, portions
- Laparoscopic procedure
- 90-minute average surgical time
- Low surgical risk percentage of 1.49%
- Discharged usually 2nd or 3rd day after surgery
- Return to non-physical strenuous job in 14 days
- Average weight loss is 2 to 3 pounds per week (Based on following TSB dietary and exercise guidelines)
- After 1 year, patients can lose up to 70% of excess weight
Permanent Lifestyle Changes Patients who learn to make the necessary dietary and lifestyle changes are able to achieve sustained weight loss. But patients who do not fully commit to the necessary dietary lifestyle changes may see weight regain at about 2 years out from surgery. Weight regain occurs because of grazing (cheating a little here or there), not paying attention to those additional calories being consumed in the form of high calorie drinks, or eating more food than is recommended.
The Lap-Band® is a very safe, effective, and reversible surgical tool to assist patients with weight loss and maintenance of their weight loss. The properly adjusted band reduces physical hunger and provides satiety with small meals.
Description of Procedure. The Lap-Band is placed through 3 or 4 small laparoscopic incisions on the abdomen. The Lap-Band is an adjustable silicone band that is placed around the upper part of the stomach. It creates a small, proximal stomach pouch, with the larger part of the stomach below the Lap-Band.
The Lap-Band controls the opening between the two parts of the stomach. The upper part fills when solid food is eaten and this causes you to feel full with a smaller portion of food. There are receptors in the wall of the upper stomach. The Lap-Band sends a signal to the appetite center of the brain, known as the hypothalamus, via the vagus nerve. The ingested food empties into the lower stomach at a controlled rate. This creates a feeling of fullness after a very small amount of food is eaten and helps you feel full longer.
The Lap-Band is connected to a port that lies under the skin and fat of the abdominal wall by a thin tube. It is unlikely that you will be able to feel the port until there has been significant weight loss. Saline is injected into the port or removed from the port to vary the size of the band around the stomach. This is called an “adjustment” or “fill.” When your Lap-Band is adjusted, it changes the opening between the small stomach pouch on the top and the remaining stomach below the Lap-Band.
Benefits of The Lap-Band Procedure
- An adjustable silicon band is placed around the upper portion of the stomach
- A small portion is created above the band
- A small pouch means smaller food portions
- Lap band can be tightened to help slow food passage to the lower stomach
- Laparoscopic procedure
- 30-minute average surgical time
- Low surgical risk percentages of 0.30%
- Same day discharge after surgery
- Return to non-physical strenuous job in 6 days
- 1 to 2 pound weight loss per week (Based on following Tri State Bariatrics dietary and exercise guidelines)
- 45% of excess weight loss in first year
Adjustments, to your lap-band, are based on the Green Zone theory.
Lap-Band adjustments are performed in all five of our office locations and are primarily done by our Nurse Practitioners using ultrasound localization and local anesthesia to provide quick and painless adjustments.
When the Lap-Band is optimally adjusted, the patient feels satisfied after eating small meals and experiences prolonged satiety after these meals. Patients are losing 1-2 pounds a week or are able to maintain weight loss after goal weight has been reached. There is a range outside the Green Zone where the band may be too tight or too loose.
If the Lap-Band is too loose, the patient will feel hungry and small meals do not satisfy. Saline needs to be added to the Lap-Band.
If the Lap-Band is too tight, the patient will have difficulty swallowing. Night coughing, reflux and regurgitation may occur. The patient may choose foods that pass more easily despite being high in calories. Saline needs to be removed from the Lap-Band.
The Lap-Band requires strict adherence to a specific dietary regimen and mastery of proper eating techniques.
For further details about dietary guidelines and tips for proper eating techniques please see our Dietitians webpage.