Types
of
Weight
Loss
Surgery
Roux-en-Y
Gastric Bypass
Weight loss has been
shown to occur more
rapidly and over a
longer period of
time with gastric
bypass as opposed to
stapled
gastroplasty. The
reasons for superior
weight loss stem
from the small
degree of
malabsorption caused
by bypassing nearly
all of the stomach
and the first two
feet of the small
intestine. To date,
weight loss with
gastric bypass has
been much more
consistent than with
stapled
gastroplasty.
Laparoscopic
(Minimally Invasive)
Gastric Bypass
This approach uses
five or six tiny
incisions instead of
one large incision
to perform the
operation. These
operations require
two skilled,
well-trained
surgeons, skilled
assistants and many
new specialized
instruments. During
the procedure, a
laparoscope is
inserted into the
abdomen. This
provides the
surgeons with a
magnified view on a
TV monitor. The
result is better
visualization
throughout the
procedure, allowing
for more precise
work.
By eliminating the
large abdominal
incisions, bowel
manipulation and
extensive
dissection, patients
are assured a faster
recovery. Further
advantages of the
laparoscopic
approach include
less pain following
the surgery, less
scarring, and likely
an earlier
discharge.
Biliopancreatic
bypass (BPB)
Biliopancreatic
bypass (BPB)
combines a modest
amount of eating
restriction with
lack of complete
digestion or
absorption of food.
This procedure and
similar operations
including the distal
Roux-en-Y technique
and duodenal switch
are becoming
increasingly
popular. However,
all of the BPB type
operations have the
potential for
developing
nutritional
deficiencies.
In a BPB, about one
half of the
intestine is
excluded (bypassed)
before it is
rejoined to the
ileum (near the end
of the small
intestine) at a
point between 2 and
4 feet above the
colon (large
intestine), forming
the so called common
channel.
Some surgeons have
modified the
standard BPB
operation to further
reduce stomach
capacity in the
heaviest patients
(BMI ≥ 50). Surgeons
have also lengthened
the common channel
in less obese
patients (BMI 40-50)
to reduce the
incidence of
malabsorption-related
complications. The
duodenal switch
operation is so
named because the
functional portion
of the duodenum (the
upper small
intestine) is
bypassed from
digestive continuity
in a reversal or
"switch" technique.
Lap Band
(Gastric Banding)
In adjustable
gastric banding (the
Lap Band®
procedure), the
stomach is encircled
with an inflatable
band that provides
restriction of food
intake. This allows
only a small portion
of the stomach to be
used for holding
food. A person feels
“full” on much less
food. Weight loss
achieved is less
than with gastric
bypass since no
intestine is
bypassed and there
is no malabsorption.
This procedure is
superior to
gastroplasty (see
below), as it is
adjustable to
optimize weight
loss. Absence of
stapling during this
procedure makes it
the least invasive
and lowest risk.
Gastroplasty
The upper stomach is
stapled in a
vertical direction
with a pre-measured
plastic band
separating the upper
and lower stomach.
The band prevents
the stomach from
stretching at this
point. We use
specific criteria
pertaining to an
individual's health
and potential risks
when deciding who
should have a
gastroplasty and who
should have a
gastric bypass. Most
patients will
qualify for
laparoscopic gastric
bypass surgery.
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