Bariatric Surgery Options

The Procedure:

A surgical stapling device divides the upper stomach to create a new, smaller stomach pouch. The pouch is about the size of a thumb and holds 15 ml or less (about the size of an egg yolk). The stomach pouch is attached to a segment of the small intestine (the Roux limb), which carries food out of the stomach pouch and downstream for digestion. With the new smaller pouch, patients find that they can eat much less and still feel satisfied. About 99% of the time, we do this procedure laparoscopically. Patients spend 1-2 nights in the hospital, and recovery time is usually about 2 weeks.

The Results:

The gastric bypass has a history of success dating back to the early 1980′s. Among common bariatric procedures, the gastric bypass is the most long-lasting and helps patients lose the most weight and achieve the most positive health impacts. The gastric bypass is particularly effective for patients with diabetes and GERD (reflux).

Additional Considerations:

A key effect of this surgery is that the intestine can no longer handle concentrated sugars or starches. If a patient consumes sweets or starchy foods, they have a temporary illness called Dumping Syndrome. While it’s not dangerous, the unpleasant symptoms include nausea, a “clammy” feeling, vomiting, diarrhea and weakness. Dumping syndrome is actually one of the helpful features that helps steer Gastric Bypass patients away from sweets.

Animated Procedure

The Procedure:

A surgical stapling device is used to remove the large reservoir section of the stomach. The operation leaves a narrow tubular section of stomach that has 10-15% of the capacity of the original stomach. This narrow tube of stomach carries food to the intestines, without moving intestines or re-routing the flow of food. Patients spend 1-2 nights in the hospital, and recovery time is about 2 weeks.

The Results:

The stomach fills quickly with small amounts of food, so patients feel satisfied after eating less. Medical research also seems to show that some hunger-related hormones such as ghrelin are reduced or even eliminated by removing the stomach that produces them; the sleeve gastrectomy seems to eliminate some of the hunger system. The sleeve gastrectomy improves health by assisting in significant weight loss and helping to correct the abnormal physiology caused by obesity.

Additional Considerations:

The Sleeve is a relatively new procedure, long-term research won’t be available until around 2015. Our practice has seen very positive results with the Sleeve, but there may be a small percentage of cases in which the stomach pouch may expand over the course of years, and the staple line can potentially leak or bleed. The stomach tube may kink or become blocked, requiring surgical revision.

Animated Procedure

The Procedure:

This is the least complex of all of the surgical procedures, with no division of the stomach or intestine. An adjustable band is placed around the patient’s upper stomach to create a tiny stomach pouch that is easily filled with small amounts of food. The Band creates a narrowing at the bottom of the stomach pouch, and food flows out slowly, like sand through an hourglass. This restriction helps patients to feel satisfied with small amounts of food, and for longer. Patients are usually home the same day as their surgery and back on their feet within a week or two.

After the initial surgery, the band is gradually tightened by filling a balloon inside the band to provide increased food restriction. This adjustment is accomplished using an access port buried under the skin. At New Dimensions, Band adjustments are done using real-time X-ray guidance to help calibrate the Band to each individual patient more accurately.

While the band can be removed with little residual impact on the stomach, we don’t recommend it. Patients who remove their band almost always see a substantial weight gain. If a patient’s Band is to be removed, the New Dimensions team will almost always offer an alternative surgical procedure such as the Sleeve or the Gastric Bypass to provide continued weight control.

The Results:

Patients experience a slow and steady weight loss of 1 or 2 pounds per week that may continue up to 30 months after surgery.  There seems to be a very high percentage of weight regain , beginning at 3-5 years after Band placement.  There also seems to be a significant chance of stretching/weakening of the esophagus caused by the Band.

Animated Procedure

The Procedure:

It is possible for any bariatric surgical procedure to require surgical revision at some point. Many patients had surgery in the 80’s and 90’s using techniques that are now abandoned because of long-term problems such as persistent vomiting or reflux. Even when modern procedures are performed by skilled surgeons, variations in patient healing can cause nutritional or surgical problems in a few cases over time.

We have extensive experience with all types of revision surgery.  Patients can be confident that we are well placed to gain a good understanding of their existing anatomy and its problems, and then implement a plan that will safely lead to better health and function. In all revision cases, the surgeon will have a highly individualized discussion with the patient about the proposed surgical plan, the expected outcomes, and the risks vs. benefits.

The Results:

In a revision surgery, weight loss may or may not be the primary goal. Often, a patient needs revision surgery in order to swallow more normally or to correct a nutritional problem. When the goal is weight loss, the loss is often less than the amount lost with the first surgery, but it is usually still enough weight loss to correct problems and help patients regain their health.

The Risks:

Repeat surgery on the stomach is significantly more difficult and more risky. The prior operation always leaves scar tissue that distorts the normal anatomy. Organs that normally separate easily are often “stuck together” by scar tissue, so that the risk of abdominal organ damage is significantly higher in a revision operation. Furthermore, the scar tissue does not heal as well as tissue that has never been operated on, so the chance of leakage is much greater after revision surgery than with the first operation.