Weight Loss Surgery Options
There are two basic ways that bariatric surgery works to help patients lose weight and improve or resolve obesity-related health conditions:
- Restrictive procedures that limit food intake.
- Malabsorptive procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.
Both methods work to help patients lose excess weight, lower their BMI, and transform their health by resolving or improving co-morbidities. Weight loss surgery has many benefits that can lead to a healthier, higher quality of life, but also has certain risks. Read on to learn more about the different types of weight loss surgery:
Roux-en-Y Gastric Bypass Surgery
According to two organizations, the American Society for Metabolic & Bariatric Surgery and the National Institutes of Health, Roux-en-Y (pronounced Roo-en-why) gastric bypass surgery is the most popular weight loss surgery in the United States.
Roux-en-Y Gastric Bypass is both a restrictive and malabsorptive procedure. In this procedure, the surgeon creates a small (15-30cc) stomach pouch. The remainder of the stomach is not removed, but is completely shut off and divided from the stomach pouch. The surgeon then creates an outlet from this newly formed pouch (a “bypass” for food) that empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This bypass allows food to skip parts of the small intestine. By skipping a large part of the small intestine, the body cannot absorb as many calories or nutrients.
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Advantages:
- The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
- One year after surgery, weight loss can average 77% of excess body weight.
- Studies show that after 20 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
- A 2000 study of 500 patients showed that 96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.
Risks:
- Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
- Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
- A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
- A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious health risk, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
- In some cases, the effectiveness of the procedure my be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
- The bypasses portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.
Laparoscopic Adjustable Gastric Banding (Lap Band and Realize Band)
Gastric banding is a purely restrictive surgical procedure in which a silicone band is placed around the uppermost part of the stomach. This band divides the stomach into two portions: one small and one larger portion. Since the stomach is divided into smaller parts, most patients fee full faster. The band is connected to a small tube and reservoir placed under the skin that allow your surgeon to adjust the diameter of the band by making it tighter or looser depending on the patient’s individual degree of restriction. If the rate of weight loss is not acceptable, the band can be adjusted. At ASA we program both the Lap Band and Realize Band procedures.
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Advantages:
- A 2004 analysis of more than 22,000 patients showed that those who underwent a bariatric surgical procedure experienced complete resolution of improvement of their co-morbid conditions including diabetes, hypertension and sleep apnea.
- Patients lost roughly 47% of their excess weight.
- The amount of food that could be consumed at a meal was restricted.
- Food passed through the digestive tract in the usual order, allowing it to be absorbed fully into the body.
- Band can be adjusted to increase or decrease restriction via an access port just under the skin.
- Surgery can be reversed.
- In studies involving more than 3,000 patients, excess weight loss ranged from 28%-87%, with a minimum or two-year postoperative follow-up.
Risks:
- The access port may leak or twist, which can require an operation to correct the problem.
- Surgery may not provide the necessary feeling of fullness, signaling that one has had enough to eat.
- Dumping syndrome, which may provide important warning signs, does not occur.
- Band may erode into the stomach wall.
- Band may move or slip.
- Weight loss is slower than that following Roux-en-Y gastric bypass surgery.
Introducing the StomaphyX™ Procedure: Breakthrough Surgery, No Incisions
Advanced Surgical Associates is known for providing the latest in medically accepted surgical techniques. That is why we are proud to announce that ASA is one of the first surgical practices in the U.S. to offer our patients the next generation in the evolution of minimally invasive surgery – Natural Orifice Surgery (NOS) using the StomaphyX™.
Imagine, a surgical procedure with no incisions and no visible scars that enables most patients to return to work as early as the next day. StomaphyX™, a pioneering transoral device, is introduced into the body through the mouth. At ASA, this procedure is used primarily for patients after Gastric Bypass Surgery that have developed diarrhea, pouch dilatation, loss of restriction, or some weight regain. With NOS, we are able to perform a revisional procedure which reshapes the stomach by tightening the gastrointestinal tract, thereby reinforcing the original objective of limiting food intake.
StomaphyX™ has been proven safe in use in hundreds of procedures worldwide. At ASA, our specially trained surgeons have utilized this revisional surgical procedure safely and effectively with positive results for our patients. Dr. Feteiha recently was featured on Fox news performing StomaphyX™ (Click to see video).
Please contact our office for more information about StomaphyX™ and Natural Orifice Surgery.