Types of Bariatric Weight Loss Surgery

State-of-the-Art Procedures

Bariatric surgery has come a long way since the days of "stomach stapling." There are now a variety of options, some even performed on an outpatient basis. The surgeons at Torrance Memorial have extensive experience in practically all the state-of-the-art procedures currently available. You and your surgeon can decide which one is appropriate for you.

Laparoscopic Adjustable Gastric Band

The laparoscopic adjustable gastric band is the least invasive option, and requires substantially less recovery time. In this procedure, the surgeon gradually tightens a band around the stomach. This will result in the sensation of being full after a much smaller meal.

There currently are two FDA-approved bands available, the LAP Band® and the Realize Band.

Advantages

• outpatient procedure, meaning no overnight hospital stay
• laparoscopy is a minimally-invasive procedure, meaning smaller incisions and less scarring
• adjustments are done without additional surgery

Disadvantages

• slower weight loss
• no immediate reversal of obesity-related illnesses (i.e, diabetes, hypertension)
• requires adjustments or fills
• may need corrective surgery
  if the band "slips"

Laparoscopic Gastric Bypass

The numbers are impressive. Gastric bypass patients can lose high percentages of excess body weight, and many are able to permanently remain at a healthy weight. That may be why it's the most popular bariatric surgery choice.

The gastric bypass works two ways: by physically reducing the stomach's size, and by causing physiological changes to your digestion.

The most common bypass is called a Roux-en-Y. The stomach is divided into two parts, with the new, smaller stomach pouch preventing large food intakes. This new stomach is then attached to the lower portion of the small intestine, so the rest of the stomach is "bypassed" during digestion.

There's another advantage to the gastric bypass. By changing the configuration of the digestive system, fewer calories are absorbed into the body. So you physically eat smaller portions and gain less weight from the food you do eat. This results in rapid weight loss following surgery.

While this is considered major surgery, the benefits are substantial. Weight-related illnesses like diabetes may be reversed within days of surgery. And the reduced calorie absorption makes it easier to continue losing weight. Most gastric bypasses can be performed laparoscopically (with smaller incisions) to cut down on pain and recovery time.

A common side effect is "dumping," which results in an inability to eat sweets. It occurs when simple sugars enter the bloodstream too quickly, causing nausea, diarrhea and weakness.

Advantages

• rapid weight loss after surgery
• food portions are restricted
• may resolve weight-related illnesses
• most can be performed laparoscopically

Disadvantages

• complex surgery, requiring a hospital stay
• possible vitamin and mineral deficiencies
• may cause ulcers and reflux
• may cause "dumping"

Laparoscopic Sleeve Gastrectomy

A newer option, the sleeve gastrectomy, permanently reduces the size of the stomach so patients feel full after eating smaller portions. Surgeons selectively remove the part of the stomach that produces the hunger-stimulating hormone ghrelin, so appetite automatically decreases. Since the intestines are not involved, food absorption remains the same, helping some patients avoid mineral and vitamin deficiencies. Weight loss outcomes have been extremely favorable with this surgical procedure.

A sleeve gastrectomy is a good option for patients who are considered too heavy or high-risk for a gastric bypass. After some weight is lost or the patient's health stabilizes, the patient may then have the sleeve gastrectomy converted into a gastric bypass if more weight loss is needed. Other candidates for the sleeve would be those with specific anatomic concerns limiting the ability to perform the bypass such as multiple intestinal surgeries in the past. Also, those patients concerned of the bypass but do not want the band may be candidates.

Advantages

• reduces hunger
• doesn't affect the digestive system
• doesn't lead to nutritional deficiencies
• no dumping syndrome
• most can be performed laparoscopically

Disadvantages

• lower weight loss results than gastric bypass
• smaller stomach pouch may stretch over time, resulting in weight gain
• not reversible
• long-term data not available