The Roux-en-y gastric bypass is considered the "gold standard" for bariatric surgery techniques, and is the best-understood, most-studied, and arguably the most effective long-term solution to morbid obesity.

Benefits of the surgery include two stages of weight loss mechanisms, restriction (dramatic reduction in the amount of food you can eat at a given time) and malabsorption (reduction in your body's capability to fully absorb all of what you do eat). Patients can expect statistically to lose 70-80% of their excess body weight with full aftercare compliance, and have shown an ability to maintain that loss 15 years with continued diligence to post-surgical dietary changes.

Negative aspects of the surgery include the potential for nutrient deficiencies due to the malabsorptive component, the need for stringent dietary and lifestyle changes, and the potential to experience dumping syndrome (negative body response to refined sugars, high-fat foods, and simple carbohydrates). Because of the extensive research done on the negative aspects of gastric bypass surgery, most programs are able to offer detailed diet modification plans to help the patient overcome any issues that could occur post-operatively.

The surgery program, with a committed follow-through by the patient, should be geared up toward a lifetime of monitoring and have a wide variety of programming for the patient's whole life needs.

The Benefits: Medical Results of Weight Loss Surgery and Subsequent Weight Loss

• Elimination or improvement of diabetes
• Decrease in or elimination of hypertension
• Elimination of GERD
• Elimination of most forms of sleep apnea
• Decreased risk of many forms of cancer, such as breast, pancreatic, esophageal
• Decrease in fat concentration in liver, reduced risk of steatohepatosis
• Decreased risk of cardiovascular event
• Increased life expectancy averaging 20 years
• Improvement in orthopedic conditions
• Improved quality of life

Description of the Procedure

Gastric bypass involves segmentation of the stomach into a small pouch (approximately one ounce in our technique), which provides the restrictive aspect. The small intestine is traced down between 75-100 centimeters, divided, and the distal portion brought up and anastomosed to the small gastric pouch, providing the malabsorptive component. The remaining lower stomach and bypassed intestine are then patched back into the small intestine at the point of separation.

The body requires fluids from the stomach for digestion, these are conducted down the bypassed intestine to combine with food passing out of the small gastric pouch at the point where the intestines are rejoined, forming a "Y" pattern; and digestion and absorption of nutrients takes place from this point forward through the remainder of the small intestine and colon. The lower stomach still has important function in the production of gastric fluids for digestion, and the bypassed small intestine is an important conduit for bile from the liver and pancreatic fluids which are also necessary for digestion.

Gastric bypass surgery is performed conventionally through a five-inch incision extending from just beneath the sternum to near the top of the navel. Laparoscopic techniques have been developed recently which involve small incisions and surgery performed with tiny instruments with visualization on a video screen. The laparoscopic approach offers less discomfort and quicker recovery times for the patient. We are happy to offer laparoscopic gastric bypass as our primary surgical technique, however, you will need to consult with your surgeon as to whether or not this approach is appropriate for you.

LAP-BAND® Adjustable Gastric Banding is a newer, more effective technique for pure restrictive weight loss surgery. There is no malabsorptive component to the procedure, and weight loss is achieved strictly by a reduction in the amount of calories consumed. What makes this procedure more effective than the other traditional restrictive procdures, such as the Vertical Banded Gastroplasty (VBG) is the adjustability of the band. LAP-BAND® Adjustable Gastric Banding gives flexibility in the amount of restriction you have, thus the ability to vary the amount of calories consumed, in a manner that can provide optimum weight loss with a minimum of potential for nutrition problems.

Advantages of LAP-BAND® Adjustable Gastric Banding are that the procedure is much less invasive than the malabsorptive or hybrid procedures, the patient difficulties are kept to a minimum, and the band's adjustability allows the flexibility to meet the changing needs of the patients. The procedure is relatively easy on both patient and surgeon, and is typically performed as an outpatient procedure. Generally patients will return to work within one week. Without a malabsorptive component to the operation, there will be more flexibility in the patient's diet and less dependency upon long-term vitamin and mineral supplementation to avoid deficiencies. There is no 'dumping syndrome' associated with LAP-BAND® Adjustable Gastric Band surgery, and thus no issues with food preferences.

Negative aspects of LAP-BAND® Adjustable Gastric Band surgery include the adjustment routine, which requires an office visit with a physician, a needle stick to inject or withdraw saline from the port, and typically a radiologic evaluation to verify flow through the gastric pouch. Current studies indicate a slower rate of weight loss than with malabsorptive or hybrid procedures, to a reported average of up to 75% excess weight loss, with most patients reporting in the 50-60% range.

We believe that LAP-BAND® Adjustable Gastric Band surgery can be equally effective as gastric bypass if the patient is committed to a life-long process of education and maintenance geared towards maximizing their outcomes. For someone who believes that their weight loss hinges strictly on the ability to reduce their consumption, this procedure can be tremendously effective. For someone who feels as though poor dietary choices are their biggest problem, the LAP-BAND® Adjustable Gastric Banding may not be as effective. Proper mechanical adaptation in eating habits, a sound approach to developing a balanced diet, and regular exercise are the keys to long-term success with LAP-BAND® Adjustable Gastric Band surgery.

Description of the Procedure

The LAP-BAND® Adjustable Gastric Banding procedure involves making several small incisions, introduction of a camera into the abdomen to visualize the upper stomach, and then placing the band around the fundus of the stomach. The band is fastened into place and then sutured to the stomach to prevent slippage. The adjustment tube coming off of the band is then passed through the abdominal wall and attached to the adjustment port, which is secured in a hollow between your involves a minimum of skin, subcutaneous layers, and the abdominal muscles. This dissection and tissue disruption, thus a reduction in discomfort for the patient. A radiologic evaluation is done, where the patient swallows some contrast, and the passage through the band is visualized to verify correct placement. The patient is then discharged to home on a liquid diet. We are excited about offering this option to motivated patients, as it offers the best of new, minimally invasive techniques while still providing an excellent tool for weight reduction.

The sleeve gastrectomy is a surgical procedure for weight loss that is particularly suited to those patients at highest risk for surgery, either because of their medical co-morbidities or their weight. This operation can be performed with traditional open techniques or with minimally invasive laparoscopy.

Whether or not you are a candiated for the laparoscopic technique is decided between the patient and surgeon during the consultation, and will be dependent upon prior surgery to the area. We offer this procedure for patients who have had prior esophageal surgery for GERD (gastroesophageal reflux), previous stomach surgery, or as a first-stage, lower-risk surgical alternative that can be the starting ground towards other bariatric surgery procedures such as Roux-en-Y gastric bypass.

The idea behind the procedure is to assist the patient in losing a fairly significant amount of weight (up to 30-40% of excess weight) without sustaining a significant amount of risk. As a patient loses weight (over a 6-18 month period), their risk for subsequent surgery decreases dramatically. At the appropriate time, they can be safely offered a second-stage operation. The surgery involves stapling off and separating about 60-70% of the stomach's natural carrying capacity without involving the intestinal tract. As there is no malabsorptive component, digestive function remains essentially the same.

The procedure produces a sense of early satiety, thus limiting the patient's ability to eat large meals. Used properly with a good, balanced diet and eating schedule, the sleeve gastrectomy can be an effective tool to producing significant weight loss and improved overall health.