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Weight Loss Surgery Options

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Weight loss surgery is not “one size fits all.” There is no specific procedure that is best for every patient. Factors that impact the choice of the procedure include the patient’s age, the current state of health, current weight, and desired outcome.

The weight loss surgery options we offer are:

  • Laproscopic Sleeve Gastectomy
  • Laproscopic Gastric Bypass
  • Lap Band
  • Bariatric Surgery Aftercare
  • Revisional Bariatric Surgery

For more information, contact our program coordinator at (937) 498-5573 (M-F 8 a.m.-4:30 p.m.)

Laparoscopic Gastric Bypass

The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.

The Procedure

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

gastric_bypass-1

 

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Advantages

  1. Produces significant long-term weight loss (60 to 80 percent excess weight loss)
  2. Restricts the amount of food that can be consumed
  3. May lead to conditions that increase energy expenditure
  4. Produces favorable changes in gut hormones that reduce appetite and enhance satiety
  5. Typical maintenance of >50% excess weight loss

Disadvantages

  1. Is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates
  2. Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate
  3. Generally has a longer hospital stay than the AGB
  4. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

 

Laproscopic Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

The Procedure

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

sleeve-gastrectomy

 

Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Advantages

  1. Restricts the amount of food the stomach can hold
  2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
  3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
  4. Involves a relatively short hospital stay of approximately 2 days
  5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

Disadvantages

  1. Is a non-reversible procedure
  2. Has the potential for long-term vitamin deficiencies
  3. Has a higher early complication rate than the AGB

 

Lap Band

The Adjustable Gastric Band – often called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.

The Procedure

The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.

lap_band

 

Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged by studies that show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed as it would be normally.

The clinical impact of the band seems to be that it reduces hunger, which helps the patients to decrease the amount of calories that are consumed.

Advantages

  1. Reduces the amount of food the stomach can hold
  2. Induces excess weight loss of approximately 40 – 50 percent
  3. Involves no cutting of the stomach or rerouting of the intestines
  4. Is outpatient surgery with rare overnight stay
  5. Is reversible and adjustable
  6. Has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures
  7. Has the lowest risk for vitamin/mineral deficiencies

Disadvantages

  1. Slower and less early weight loss than other surgical procedures

  2. Greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed

  3. Requires a foreign device to remain in the body

  4. Can result in possible band slippage or band erosion into the stomach in a small percentage of patients, especially those who have not followed-up regularly.

  5. Can have mechanical problems with the band, tube or port in a small percentage of patients

  6. Can result in dilation of the esophagus if the patient overeats

  7. Requires strict adherence to the postoperative diet and to postoperative follow-up visits

  8. Highest rate of re-operation

 

Bariatric Surgery Aftercare

We are learning more and more that surgery is just a tool. If not used and maintained properly, like any tool, it may not work. We know patients do better with maintaining weight loss if they follow up and attend regular support groups. Follow-up is recommended yearly for post-surgical patients, and sometimes more often if you have a band or have problems. If you have had surgery elsewhere and need follow-up care, you may be a candidate to join our program. Attend a seminar or support group to learn more.

Advantages

  1. You are more likely to maintain weight loss and wellness.
  2. You have a connection to a local surgeon if you happen to develop problems.
  3. You can meet others like you who can help keep you on the right path, and conversely, you may be able to help others. (Support groups are open to the public and are free!)
  4. Follow-up care closer to home.

Disadvantages

  1. Time to go to the office.
  2. There may be a cost if your insurance has changed. Most after care should be covered.

 

Revisional Bariatric Surgery

If your sleeve, bypass or band has quit working for you, rarely there is an anatomic reason. We can evaluate this and possibly recommend revisions to your surgery.

Advantages

  1. This can help get you back on track.
  2. Revisions can sometimes diminish pain and improve your outcome.

Disadvantages

  1. Weight loss surgery has 10 times increased risks as first-time surgery.
  2. Revisions can often be done laparoscopically, but there is a much higher chance of open surgery.
  3. Weight loss after revisional surgery is usually much lower and much slower than first time surgery.