The term "bariatric" is derived from the Greek word "baros" meaning "weight." Bariatric surgery is surgically induced weight loss. There are two categories of bariatric procedures. The first are called Restrictive (Adjustable gastric banding, Sleeve Gastrectomy) which limit the amount of food one can eat and thereby decrease the calories consumed. The second are called Combination (Roux en Y gastric bypass, Duodenal Switch) which not only limit 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.
There are two categories of bariatric procedures. The first are called Restrictive (Adjustable gastric banding, Sleeve Gastrectomy) which limit the amount of food one can eat and thereby decrease the calories consumed. The second are called Combination (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.
The "LAP-BAND" was approved by the FDA in June 2001 and became increasingly more popular 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 depends on a patient's commitment to regular and consistent follow up to be effective.
The Gastric Sleeve, also known as the Sleeve Gastrectomy, reduces weight through "restriction," or creating a smaller stomach. The Laparoscopic Gastric Sleeve involves using a special surgical stapler to remove about 80% of the stomach. This creates a "sleeve" the size and shape of a small banana. The new stomach can hold about 4-5 ounces of food at one time, resulting in significant restriction, less caloric intake and significant weight loss. The digestion and absorption of food and vitamins is not affected by this procedure.
The most important metabolic advantage of a gastric sleeve is that by removing 80% of the stomach the production of the "hunger hormone" ghrelin is also significantly reduced. This causes patients not to feel hungry after surgery. Without hunger patients are able to make better choices with their food and stick to a healthier lifestyle. Through good nutrition and smaller portion sizes, patients can lose 70-75% of their extra body weight in one year.
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.