|
Surgical Weight Loss
Operations for obesity fall into two categories: Restrictive and Malabsorptive. Restrictive procedures reduce the amount of calories or food ingested by limiting the stomach space available for the intake of food. Malabsorptive procedures
reduce the absorption of food that has been consumed.
detail of normal digestive system
Roux-en-Y Gastric Bypass
Roux-en-Y Gastric Bypass (RYGB) is recognized as the gold standard treatment for clinically severe obesity because of its low complication rate and long-term success in achieving weight loss. RYGB combines a gastric restrictive operation with a small amount of
malabsorption.
detail of digestive system after Roux-en-Y procedure
The stomach is divided in two parts. The upper pouch receives food from the
esophagus; the lower part of the stomach does not receive any food, but does
send stomach acid into the duodenum. After dividing the upper stomach, the
surgeon divides the small intestine in the upper jejunum and connects it to
the small stomach pouch with an opening approximately the size of a dime.
This joining together of the stomach pouch and the jejunum is called an
anastamosis. The other end of the jejunum is reconnected, creating a “Y”
shape. Absorption of food does not begin until the point where the two
pieces of jejunum come together.
You will experience a sense of fullness very quickly with this operation because your surgeon creates a very small stomach pouch. Appetite is reduced and the
intake of food is dramatically limited to enable weight loss. The food that is eaten is digested and absorbed quite well.
Results
In the first year, the average patient loses as much as 100 pounds or more, or
about two-thirds excess weight. Some patients lose more than this; some lose less. In the second year, weight loss will continue, but less rapidly.
Risks and Complications
RYGB has the highest long-term success and low rates of mortality, complications, and failures. The procedure carries a mortality rate of less than 1 percent, an operative complication rate of less than 5 percent and an effective loss of 50 to 75 percent of excess weight. In most cases, this is enough weight loss to reduce the life-threatening dangers that come with co-morbid conditions.
Adjustable Silicone Gastric Banding
The LAP-BAND® System is a relatively new technology that was approved by the
FDA in June 2001. The procedure uses a silicone elastomer band that is placed
around the upper part of the stomach to simulate a small stomach pouch that can
only hold a small amount of food. The remaining part of the stomach is below the
band. A small outlet created by the band connects these two parts. Food passes slowly through the outlet, creating a full sensation.
detail of LAP-BAND procedure
Use of the LAP-BAND System is adjustable to meet individual needs, which can change
as you lose weight, or if you were to become pregnant. To modify the size of the band, its inner surface can be inflated or deflated with saline solution. The band is
connected by tubing to a reservoir, which is placed well under the skin during surgery. After the operation, your surgeon can control the amount of saline in the
band by entering the reservoir with a fine needle through the skin.
Since there is no cutting, stapling or stomach rerouting involved in the LAP-BAND System procedure, it is a less traumatic
operation. If for any reason the LAP-BAND System needs to be removed, the stomach generally returns to its original form.
Results
A weight loss of 2 to 3 pounds a week in the first year after the operation is
possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less.
Risks and Complications
Use of the LAP-BAND System includes the same risks that come with all major surgeries. Other common
complications range from mild to severe and include nausea, vomiting, gastroesophageal reflux, band slippage and stomach-band outlet blockage.
Laparoscopic Surgery
We perform all of our procedures laparoscopically. In this technique, a fiber-optic instrument is inserted through an incision in the abdominal wall to display the
organs inside. It functions as an eye, sending signals that are processed and
displayed on a TV screen. This technique usually requires a total of 5 or 6 incisions, most of which are about 1 centimeter. Surgical instruments are inserted through these incisions. The surgeon operates by manipulating the instruments, using the laparoscope, to see what is happening on the TV screen rather than by feeling the actual organs with his hands.
Laparoscopic surgery results in a better cosmetic outcome, a shorter hospital stay, and quicker return to work. This procedure also results in fewer incisional hernias and infections.
Back
to Bariatric Center Home Page
|
