Weight Loss Surgery

Laparoscopic Gastric Banding (Lap-Band)
With laparoscopic gastric banding (or Lap-Band surgery), an inflatable band is placed around the upper stomach to create a small pouch and narrow passage into the remainder of the stomach. This limits food consumption and creates an earlier feeling of fullness. Once the band is in place, it is inflated with saline. The band is adjusted over time by increasing or decreasing the amount of saline to change the size of the passage.
As the name suggests, this surgery is done with laparoscopy. In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. The small incisions generally result in less blood loss, shorter hospitalization, a faster recovery, and fewer complications than open operations.
The lap-band is intended for severely obese people (those who are at least 100 pounds overweight or who are at least twice their ideal body weight) who have failed to lose weight by other methods, such as a supervised diet and exercise plan. The band is intended to remain in place permanently, but it can be removed if necessary. People who get the band will need to diet and exercise in order to maintain their weight loss.
Complications of Lap-Band surgery for weight loss may include:
  • Nausea and vomiting
  • Heartburn
  • Abdominal pain (stomach pain)
  • Band slippage
  • Pouch enlargement.
Roux-en-Y Gastric Bypass (RGB)
In a Roux-en-Y gastric bypass (or gastric bypass), the surgeon makes the stomach smaller by using surgical staples to create a small stomach pouch. The pouch is attached to the middle part of the small intestine. Food bypasses the upper part of the small intestine and stomach, and goes into the middle part of the small intestine through a small opening. Bypassing the stomach limits the amount of food a person can eat.
Bypassing part of the intestine causes the amount of calories and nutrients the body absorbs to be reduced. The small opening also slows down the rate at which the food leaves the pouch.
Similar to Lap-Band surgery, this type of surgery can be done with laparoscopy, which has a shorter hospitalization, faster recovery, and fewer complications compared to an open gastric bypass.
Possible gastric bypass complications include but are not limited to:
  • Infection
  • Leaking
  • Pulmonary embolism (sudden blockage in a lung artery)
  • Gallstones
  • Dehydration
  • Vitamin and mineral deficiency.
One risk for patients who have had gastric bypass is "dumping syndrome." This happens when the stomach contents move too rapidly through the small intestine. Symptoms may include:
  • Nausea
  • Weakness
  • Sweating
  • Faintness
  • Diarrhea after eating.
Biliopancreatic Diversion (BPD)
Biliopancreatic diversion is not commonly used in the United States. In this procedure, a large part of the stomach is removed, restricting the amount of food the stomach can hold and decreasing the production of stomach acid. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing other parts of the small intestine. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs because most of the calories and nutrients are routed into the colon, where they are not absorbed.
This procedure is less frequently used than other types of surgery because of the high risk for nutritional deficiencies.
A variation of BPD includes a "duodenal switch," which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum.
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