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.
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.
We now offer qualified patients an endoscopic procedure to reduce the volume of an enlarged pouch and the diameter of the outlet. This procedure is performed using a small flexible endoscope and specialized devices that allows real sutures to be placed through the endoscope. The scope and suturing devices are inserted through the mouth into the stomach pouch the same way as a standard endoscope. Sutures are then placed around the outlet to reduce the diameter, typically to about 10 mm. The same technique may then be used to place additional sutures in the stomach pouch to reduce its volume capacity.
The Gastric Sleeve, also known as the sleeve gastrectomy, procedure reduces weight through restrictions, or creating a smaller stomach. The laparoscopic Gastric Sleeve involves removing about 80% of the stomach, which creates a "sleeve" the size and shape of a small banana. The new stomach can hold about 3-4 ounces, resulting in significant restriction leading to weight loss. Gastric Sleeve patients experience an early sense of fullness, followed by a very profound sense of appetite satisfaction, with even the most minimal meal volumes.
The gastric sleeve also reduces the production of the "hunger hormone" ghrelin, which reduces the amount of hunger patients feel after surgery. When truly satisfied, patients feel indifferent to even the choicest of foods. At the same time, patients continue to enjoy eating delicious and gourmet foods - but they enjoy eating less volume. Through good nutrition and smaller portion sizes, patients lose weight while having a feeling of fullness.
This gastric sleeve procedure may be particularly suited to persons with a BMI of 35+ with co-morbidities such as diabetes, high blood pressure, sleep apnea, joint pain, fatigue and more who wish to have quick and enduring weight loss.
Long-term success is dependent on accepting new rules for eating and food selection that will be taught in the pre-operative and follow-up periods, with education before and after surgery. Do not worry, we will help you get there and stay there! Current data is demonstrating weight loss approaches seen with the classic gastric bypass surgery. Weight loss is projected to be in the range of 55 to 70% of excess body weight.
Laparoscopic greater curvature plication is also known as gastric imbrication or gastric plication. The word plication means fold, which is basically what is done during the surgery - the greater curve of the stomach is folded in on itself and secured with stitches. The stomach's volume is greatly reduced, and patients report reduced hunger which results in reduced food intake and weight loss. The stomach will not expand after the procedure, so the amount of food that can be consumed is immediately less than before.
The procedure is performed laparoscopically. Being that it is minimally invasive, the surgery usually involves five or six small incisions in the abdomen. A tiny video camera and instruments are used through the small incisions. There is no cutting, stapling, or removal of the stomach or intestines during the procedure.
Following the surgery, the patients' stay in the hospital averages 1-2 days. Patients are asked to stay on a liquid diet for 2-3 weeks after the surgery and then are transitioned to solid foods under the guidance of the surgeon and dietitian.
Patients trend toward losing 40-70% of their excess body weight during the first year following surgery. Many co-morbidities improve or resolve after weight loss surgery.
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 was FDA approved in 2007. REALIZE Band works in the following way:
REALIZE Injection Port
REALIZE Band works in the same way as the LAP-BAND by: