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Weight Loss Surgery Options

The American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:

Restrictive procedures that decrease food intake.
Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.

Gastric Bypass Roux-en-Y - Combined Restrictive and Malabsorptive Procedure

Laparoscopic or Minimally Invasive Surgery

Laparoscopic Adjustable Gastric Band

Lap Band Demonstration Videos

Gastric Bypass Roux-en-Y - Combined Restrictive and Malabsorptive Procedure

In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but 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 intestine, thus bypassing some calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection 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 malabsorption.

Advantages

The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
One year after surgery, weight loss can average 77% of excess body weight.
Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.
Long-term success is improved when patients remain active in a comprehensive bariatric program.

Risks

Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
A condition known as "dumping syndrome" can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

Laparoscopic or Minimally Invasive Surgery

For the last decade, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still "experimental." In fact, laparoscopy has become the predominant technique in many areas of surgery and has been used for weight loss surgery for several years. Dr. Machado and Dr. Wolfe offer laparoscopic bariatric surgical procedures.
When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures.

The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. Other realized benefits with laparoscopy have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.

Laparoscopic procedures for weight loss surgery employ the same principles as their "open" counterparts and weight loss results are identical. Not all patients are candidates for this approach, but each patient will be evaluated individually by Dr. Machado or Dr. Wolfe. The American Society for Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.

Laproscopic Adjustable Gastric Band

The Laparoscopic Adjustable Gastric Band (Lap Band) is another surgical weight loss option that is offered by Sacramento Bariatric. The Lap Band has been in use in Europe and Australia for many years with good results and was FDA approved in 2001. There are now over 70,000 Lap Bands in place worldwide.

What is the Lap Band?

The Lap Band is a circular device that was designed to be placed around the upper portion of the stomach. The inner surface of the band has an inflatable balloon. As the balloon is filled with fluid, the balloon expands and tightens around the stomach.

How does the Band work?

The Lap Band works on restriction of meal size. The Lap Band is placed around the upper portion of the stomach creating a one ounce pouch. This results in decreased calorie intake and weight loss. Weight loss with the band is more gradual; the average patient loses 1-2 pounds per week. Patients will usually reach their weight loss goal in 36-48 months following surgery. Some early data suggests that long-term weight loss may be better maintained over the gastric bypass.

How is the Band adjusted?

The key feature of the Lap Band is its adjustability. It is connected by tubing to the "port". This port is placed under the skin in the upper abdomen. To adjust the band, a special needle is inserted into the port and fluid is added or removed. Adjustments are performed based on weight loss and patient symptoms, and are usually performed in the office. Office visits and adjustments may be as frequent as every 4-6 weeks until a patient reaches their weight loss goal.

Side View of the Lap Band with the inner balloon deflated and inflated.

Is the Band as good as the Bypass?

The Lap Band and the Gastric Bypass are different tools that we can use to help you achieve your weight loss goal. Both are able to provide durable, long-term weight loss and improvement in overall health. Dr. Machado will review the risks and benefits of each option and provide some insight on what procedure may benefit you the most.

The following table compares some of the differences between the Lap Band and the Gastric Bypass:

Lap Band vs. Gastric Bypass

Lap Band	Gastric Bypass
Reversible/removable	Permanent
Overnight hospitalization	2-7 day hospital stay
Vitamins are optional	Vitamins are required
More gradual weight loss	Faster weight loss
No alteration of anatomy	GI tract permanently altered
Band is a mechanical device	No foreign bodies
Long-term adjustments	Long-term weight regain?
Less risk/complications	Higher risk of complications

Lap Band Demonstration Videos

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