{Bariatric Surgery}

Bariatric Surgery Procedures

In just the past few years, the number of weight-loss operations has grown to about 50,000 annually. There generally are two approaches to the surgical treatment of morbid obesity: restrictive and malabsorptive procedures.

Restrictive surgery decreases or limits the amount of food that can be eaten by reducing the size of the stomach from the size of a grapefruit to the size of a golf ball. Malabsorptive procedures combine the reduction of stomach size through the bypass of a large amount of the intestine, reducing the absorption of calories.

Surgical Associates performs the laparoscopic Roux-en-Y procedure (a malabsorptive procedure), as well as the REALIZE™ Adjustable Gastric Band procedure (a restrictive, laparoscopic technique).


Malabsorptive Procedures

Malabsorptive procedures are the most common gastrointestinal surgeries for weight loss. They restrict both food intake and the amount of calories and nutrients the body absorbs. These procedures generally produce more weight loss than restrictive procedures and are more effective in reversing the health problems associated with severe obesity. Patients who have malabsorptive operations generally lose two-thirds of their excess weight within two years.

Roux-en-Y (RGB)

The Roux-en-Y or gastric bypass procedure changes the original shape of your stomach, decreases its capacity to hold food and re-routes the direction of food, creating a “new stomach.”

Gastric bypass may be performed as an open surgery or as a laparoscopic procedure. Laparoscopic gastric bypass is performed through several small incisions, which may help reduce your recovery time and post-surgical pain.

In this procedure, your stomach is stapled to create a small pouch. The remainder of your stomach is not removed, but it is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the small intestine, which causes your body to absorb fewer calories.

This re-routing is done by dividing the small intestine to connect it with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine, creating the “Y”

shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of calorie absorption and weight loss.

Success: If you follow the strict dietary guidelines and exercise regime provided by your physicians, you are more likely to successfully lose weight and keep it off post Roux-en-Y surgery. One year after surgery, the average patient has lost 77 percent of their excess body weight. Studies show that after 10 to 14 years, patients maintain 50 to 60 percent of their excess weight. About 96 percent of patients with certain associated health conditions (such as back pain, sleep apnea, high blood pressure, diabetes and depression) experience improvement or no longer experience any problems, according to these studies.

Risks: Because the Roux-en-Y procedure restricts your body’s ability to absorb calories, its ability to absorb important nutrients such as iron and calcium also can be diminished, lowering your levels of total body iron and increasing your predisposition to iron deficiency anemia. This is a particular concern if you experience chronic blood loss during excessive menstrual flow or suffer from bleeding hemorrhoids.

As a result of deficiencies, some Roux-en-Y patients have experienced metabolic bone disease, resulting in bone pain, loss of height, a humped back and fractures of the ribs and hipbones. Fortunately, these and other nutritional deficiencies can be managed with a proper diet and daily vitamin supplements.

A condition known as “dumping syndrome” can occur after surgery if your stomach contents rapidly empty into your small intestine. This is sometimes triggered after eating too much sugar or large amounts of food. While generally not considered to be a serious risk to your health, the results are extremely unpleasant and can include nausea, weakness, sweating, faintness and diarrhea after eating. Some patients are unable to eat any sweets after surgery.

Restrictive Procedures

Quite simply, the concept behind restrictive procedures is that when you feel full, you’re less likely to feel hungry. When you don’t feel hungry, you’re not as likely to eat as much, nor will you feel deprived. With a reduced stomach size, it takes much less food to make you feel full.

REALIZE™ Personalized Banding Solution

The REALIZE™ Adjustable Gastric Band or laparoscopic adjustable gastric band procedure limits food intake by creating a small pouch in the upper part of the stomach, dramatically reducing its capacity. An adjustable gastric band device is inserted via small incisions in the abdomen and is placed around the uppermost part of the stomach to create this pouch, which ultimately serves as your “new stomach.” The gastric band, which is filled with saline, can be inflated or deflated to reduce the size of your stomach opening, making you “feel” of full longer. The band can easily be adjusted at any time after the REALIZE™ Band operation to let in more or less food, allowing you to lose weight steadily and healthily until you reach your weight-loss goal. This out-patient procedure is done through an access port under the skin and is quick and painless.

The REALIZE™ Band procedure takes between 30 minutes and an hour to perform under general anesthesia. During recovery from surgery, you must adhere to strict dietary guidelines and restrictions as directed by your surgeon. Once you have graduated to eating “regular” food, you must learn to adapt to a new way of eating. For example, at each meal you may eat up to 1 cup of food, and after that much, you may be uncomfortably full.

Success: The REALIZE™ Band procedure has the lowest complication rate and lowest mortality rate of any weight-loss surgery. Because the procedure does not involve intestinal rerouting or cutting or stapling of the stomach, there is less chance of infection after surgery. Rarely, infections can develop around the gastric band or near the stomach port. If this happens, the infection is usually treated with antibiotics.

Risks: Although restrictive operations such as the REALIZE™ Band surgery lead to weight loss in almost all patients, they are less successful than malabsorptive procedures in achieving substantial, long-term weight loss. Some patients regain weight, and others are unable to adjust their eating habits and fail to lose the desired weight.

Success of the surgery depends on learning to eat slowly, eating less and limiting fluids, particularly carbonated beverages. If you continue to consume high-calorie, high-fat foods, the stomach pouch and opening may be stretched, defeating the purpose of the surgery.