Types of Weight Loss Surgery
For over two decades, minimally invasive or “laparoscopic” procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still “experimental.” In fact, laparoscopy, because of its many advantages has become the predominant technique in weight loss surgery.
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. This gives the surgeon excellent visualization and access to key anatomical structures.
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.
Patients that have “laparoscopic” weight loss surgery experience less pain after surgery, have fewer wound complications such as infections, and have fewer abdominal wall hernias. These benefits allow easier breathing after surgery and allows for quicker return to pre-surgical levels of activity.
In researching weight loss surgery, you will come across many different types of operations. Selecting which one is right for you can be difficult and requires a knowledge of the options and discussion with a bariatric surgeon. The two most common and most studied operations are the Gastric Bypass (also called Roux-en-Y bypass) and the Laparoscopic Gastric Banding. Other operations you may hear about are biliopancreatic diversion (BPD) or duodenal switch and sleeve gastrectomy. These other operations are felt by the surgeons at Advanced Laparoscopic Associates to be either too extensive to justify the added risks or too new to know fully the long term success rates. In this practice, both the Laparoscopic Gastric Bypass and the Laparoscopic Gastric Banding are offered. These operations as well as their risks and benefits are further discussed below.
Laparoscopic Gastric Bypass Surgery
Laparoscopic Gastric Bypass Surgery (Roux-en-Y) is generally considered to be the best surgical procedure for the treatment of morbid obesity. Weight loss is achieved by reducing the functional portion of the stomach to a pouch about the size of an egg, and by bypassing about 100 to 150 cm. of small intestine.
After the gastric bypass procedure, the egg sized stomach pouch causes the patient to have a sensation of fullness after eating only a small portion of food. Additionally, only very small opening from the stomach pouch to the intestine is intentionally created during surgery to delay stomach emptying, making the sensation of fullness last longer.
The intestinal bypass portion of the procedure separates the digestive juices from the food for about 100 to 150 cm. This prevents the digestion and absorption of food during the time it is separated from the digestive juices. Once the food does meet with the digestive juices the digestive process starts, however the creation of these permanent anatomic changes result in less absorption of nutrients and contributes to weight loss.
The following animation helps illustrate the gastric bypass procedure. Please click on the image to view the animation.
In the video, notice the creation of a small egg sized stomach pouch followed by the dividing and reconnecting of the small intestine. The pathway the food takes is illustrated by the blue color and the digestive juices are shown in green color.
After Surgery:
Patients will be on a clear liquid diet for the first week immediately following gastric bypass surgery, and then advance to a pureed diet for 1 week. These foods will be very soft, so as to pass through the small, newly formed pouch. The 3rd week consists of soft solid foods.
Approximately one month after the gastric bypass surgery, patients can expect to take more regular table foods. Patients at this point will still be learning how to eat right, including chewing food carefully, learning to drink liquids between rather than with meals, and learning that eating the wrong foods, such as sweets or fatty foods, can cause the “dumping syndrome.”
At 6 months after the gastric bypass surgery, most patients will be on their long-term maintenance diet, which is more or less what and how they will eat for the rest of their lives. The maintenance diet for the most part consists of regular table foods, but in small portions. Most patients describe their meals as child sized, and they often do not finish what they are served. Patients generally become comfortable eating these small meals, and almost always say the loss of the ability to enjoy large meals or certain foods is more than compensated for by being able to successfully control their weight.
Patients may expect to lose approximately 75% of their excess body weight during the first 2 years following surgery. Sometimes a weight regain of about 10% is seen between years 2 and 5, perhaps because the small pouch increases in size, and perhaps because patients learn how to take in extra calories without realizing.
Laparoscopic Gastric Banding (REALIZE ADJUSTABLE GASTRIC BAND AND LAP-BAND)
An adjustable device can be implanted around the top portion of the stomach to assist in weight loss in the morbidly obese. Over 250,000 of these devices have been implanted world-wide. Two such devices are approved by the Food and Drug Administration (FDA) for use in this country.
The LAP-BAND was approved by the FDA in 2001. Only surgeons successfully completing the authorized training course are permitted to insert this device. The surgeons at Advanced Laparoscopic Associates have the largest experience with LAP-BAND in the state and inserted our first LAP-BAND in October 2001.
The REALIZE ADJUSTABLE GASTRIC BAND was FDA approved in 2007.
Both of these devices are placed surgically around the top portion of the stomach. A small stomach pouch is created above the band, with the larger part of the stomach below. This reduces the food storage area of the stomach to only a small egg sized pouch. The opening into the rest of the stomach is limited by the band and this opening is easily adjusted depending on appetite.
Adjusting the band is accomplished in the office by injecting saline solution into a reservoir port embedded beneath the skin during surgery. The fluid fills a balloon along the inside of the band thereby tightening it. If the band is too loose and weight loss too small, adding more fluid will reduce the size of the opening. If the band is too tight, fluid can be removed. The ability to adjust the band as often as necessary is a unique feature of these devices, not available in other operations.
The video illustrates placement and adjustment of a gastric band. The path the food takes is illustrated with blue color. Please click on the image to view the animation.
After Surgery:
The surgery generally takes one hour or less. Most patients are sent home the day of surgery or the next morning. Worldwide, the general weight loss is about 40 to 60% of excess body weight over the first 2 – 3 years. You will be on a liquid diet immediately after surgery. This is followed by a slow transition to small, healthy meals of regular food.
The band is first adjusted about 6 weeks after surgery and future adjustments are determined by your weight loss, and the amount of food you can eat.
RISKS OF SURGERY
Although performed through small incisions, the above described operations are major abdominal operations under general anesthesia. They are operations that are subject to known risks, which include, but are not limited to:
intestinal leakage
abdominal infection
blood clots
pulmonary embolus
bleeding that may require transfusion
anesthesia complications
nutritional and vitamin deficiencies
cardiac complications
need for future operations
others
These risks will be explained further in the seminar and discussed further with your surgeon during the office consultation.
Advanced Laparoscopic Associates is fully aware of the risks associated with surgery and strives to minimize these risks as much as possible. We have structured a program that incorporates the best qualifed professionals to offer a strong pre-operative, operative, and post-operative experience. This approach has allowed Advanced Laparoscopic Associates to be one of the best surgical programs in the nation.
For more information about weight loss surgery in Paramus, New Jersey, please call Advanced Laparoscopic Associates at 201-646-1121 today!