Treatment Options
The term “bariatric” is derived from the Greek word “baros” meaning “weight.” Bariatric surgery is surgically induced weight loss. There are three categories of bariatric procedures: restrictive (adjustable gastric banding, sleeve gastrectomy) which limit the amount of food one can eat and thereby decrease the calories consumed, malabsorptive (biliopancreatic diversion) which limits the amount of fat and calories absorbed and combined restrictive and malabsorptive (Roux-en-Y gastric bypass) which not only limits the amount of food consumed but also does not allow absorption of all the fat and calories from that food. All of these procedures can be effective in controlling morbid obesity. However, depending on which procedure you choose these are complex operations which can be associated with potentially serious complications.
Laparoscopic Gastric Bypass
Roux-en-Y Gastric Bypass
The Gastric Bypass procedure remains the gold standard for weight loss surgery in the United States. It has been practiced since the 1960’s, however with the introduction of laparoscopic or minimally invasive techniques, this operation has become extremely popular. The operation is performed under general anesthesia and combines both restriction and malabsorption.
The stomach is divided into 2 parts, a small (15 to 20 cc) stomach pouch which is roughly the size of an egg and a larger remnant stomach which are completely separated from each other. The small pouch becomes the “new stomach” and holds a very small amount of food. The small pouch is then directly connected to the lower small intestine with stitches. This creates “malabsorption” by not allowing food to pass through the remnant stomach and intestine thus not allowing for fat and calories to be absorbed.
The remnant stomach and intestine are not removed but rather will transport enzymes and digestive juices lower down to help with the digestion of food. The result is a sense of fullness after a small amount of food, followed by the inability to absorb all the fat and calories from the food.
“Lap Band” Adjustable Gastric Banding
"Lap Band" Adjustable Gastric Banding
The “Lap Band” was approved by the FDA in June 2001. It has been actively practiced in Europe and Australia for many years and is the gold standard for weight loss surgery abroad. This operation has become increasingly more popular in the United States and is in high demand due to its simple yet effective results.
Adjustable gastric banding is a “restrictive” operation, meaning that it works by limiting food intake but does not interfere with normal digestion. In this procedure, the band is wrapped around the upper part of the stomach, squeezing the stomach like an hour glass. This divides the stomach into two parts, the smaller part or “stomach pouch” sits above the band, while the lower larger part of the stomach remains below the band.
The two parts of the stomach remain connected through a narrowing created by the band. The band is attached to tubing which is attached to a small port that lies underneath the skin and fat. The port is not visible but can be felt with deep palpation.
On the inside of the band is a balloon. An important aspect of the Lap Band is that it can be adjusted in the office without requiring further surgery. By accessing the port with a fine needle, saline or (salt water) can be inserted into the balloon narrowing the opening between the stomach pouch and larger part of the stomach. The band thus restricts the amount of food you can consume at a single meal and keeps the food in the small pouch allowing digestion to occur slowly as food passes through the opening into the larger part of the stomach. This delay which is customized to each patient, allows one to feel fuller faster and remain full for several hours until it is time for the next meal.
The Lap Band requires general anesthesia, and is usually performed in one hour. Certain patients can go home on the same day but most generally stay in the hospital overnight.
REALIZE Band
REALIZE Band was FDA approved in 2007.
click image to enlarge
Realize Band works in the following way
•Wraps completely around the upper part of the stomach
•Designed for your safety and comfort
•One size fits all
REALIZE Injection Port
•Attaches to the abdominal wall
•Wide septum design to make band adjustments easier
•Minimizes bulge as you start to lose weight
•Molds the stomach into two connected chambers
•Strong, flexible silicone structure
•360° coverage on stomach for maximum comfort and minimal dysphasia
•Inside of the band has a soft balloon
•Balloon can hold up to 9cc of saline
•Low-pressure balloon design to reduce tissue trauma
•Injection Port is approx. ½” high to minimize bulge as you start to lose weight
•Injection Port can be fastened to abdominal wall in less than one minute to minimize a patient’s time under
anesthesia
•Injection Port fasteners are 66% stronger than sutures
•Top of the port has a sturdy silicone layer called a septum
•During band adjustments, saline is injected with a needle into the port through the septum
•Realize Band works in the same way as the Lap Band by:
•Creating a small, circular tunnel behind the stomach
•Inserting the band through the tunnel
•Locks the band around the stomach
•Connects tubing to the port
•Fastens the port to the abdominal wall
•Does not staple or remove any part of the stomach
•Does not reroute intestines
Each Realize Band comes with a personalized internet support system entitled:
Realize mySuccess™
•Allows you and your doctor to set goals and continuously watch your progress together – especially for the first three years
•Enables your doctor to step in precisely when needed to keep you on track
•Designed to help you establish a tailored progress plan and develop new healthy habits
•Personalized and interactive online tool available day and night
Sleeve Gastrectomy
This procedure is still considered investigational by some insurance companies. It is generally reserved for patients with higher BMI’s of 60 or > and can be used as a single procedure or as the first stage of a gastric bypass.
The operation generates weight loss by restricting the amount of food one is able to eat. The stomach is divided vertically and more than 85% of it is removed. This part of the procedure is not reversible.
The stomach that remains is shaped like a banana and significantly reduces the volume of food that can be consumed. The stomach restriction that occurs allows these patients to lose more than 100 pounds and in many patients more than 200 pounds. This weight loss allows significant improvement in health and effectively “downstages” a patient to a lower risk group.
Once the patient’s BMI is lower, they can return to the operating room for the “second stage” of the procedure.