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Tiny Incisions
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Less Discomfort
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Shorter Hospital Time
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Quick Recovery
Laparoscopic
surgery began to be performed widely in the United States in
the early 1990's, when it first began to be used for removal
of the gallbladder. Using a thin tubular telescope and a tiny
high-resolution video camera, the surgeon can see, on a TV monitor,
what the camera sees inside the abdomen, through a pencil-sized
"portal" passed through the abdominal wall. Other
"ports" are placed, through which long, slender instruments
can be inserted, to do the actual surgery. The surgeon must
learn to move the instruments, based upon what he sees on the
screen, not what he feels. Sometimes lasers are used as well,
although many operations are accomplished just as well, without
the need for lasers. Although the operation achieves the same
result, there is no large and painful incision. Patients who
have undergone Laparoscopic Gallbladder surgery can attest to
reduced discomfort and rapid recovery, and excellent cosmetic
results that are usually achieved with this method.
In
just a few years, a wide variety of instruments have been developed,
including sophisticated stapling and suturing devices, which
permit laparoscopy to be applied to many other types of surgical
operations. The use of laparoscopy for more complex operations,
in which the stomach or bowel is cut and re-connected, is called
"Advanced Laparoscopy".
Gastric
Bypass, Roux en-Y has been the "gold standard" operation
for the treatment of Morbid Obesity, for several years. It is,
in our opinion, the procedure with the best combination of benefits
and risks, for most patients. The operation is complex and difficult,
and can be organized into three steps:
- Division
or partitioning of the stomach into two parts - an upper small
pouch, and a lower, large pouch.
- Creation
of a Y-connection in the small bowel, to make a new end to
connect to the stomach.
- Connection
of the new small bowel end to the upper stomach pouch, to
bypass the stomach.
You can read more about the effects of this operation, in
Surgical Operations for Morbid Obesity.
We have recreated the Gastric Bypass, Roux en-Y as an advanced
laparoscopic procedure, using the same anatomy and connections,
and varying only the instruments used to perform it laparoscopically.
The
results of this operation, which we have published and presented
internationally, show:
- Operating
time is slightly longer than the open operation (about 75
-120 minutes laparoscopically, versus 60 - 90 minutes open).
- Recovery
time is shorter: typically 2 days in the hospital, and 10
-14 days to return to full activity.
- Weight
loss is excellent, averaging 80% of excess body weight after
one year, and maintained at 80% for over five years following
surgery (for as long as the operation has been done this way).
- Over
95% of all weight-related health problems (co-morbidities),
such as high blood pressure, diabetes, sleep apnea, gastroesophageal
reflux, stress incontinence, and degenerative arthritis pain,
are relieved by one year after the operation - often much
sooner.
- Mortality
rate has been less than 0.07%, in our series. This compares
with reported mortality rates of 0.5 to 2.5 % in other bariatric
surgery series.
- Complication
rate has been similar to that with the open operation, except
that no incisional hernias (hernias occurring through the
scar of the incision) have occurred, with the laparoscopic
technique. We emphasize that one should not think of the laparoscopic
operation as reducing the risks of bariatric surgery. It reduces
pain and discomfort, inconvenience, recovery time, and scarring.
- Cosmetic
results have been an added benefit for some of our younger
patients, who now are proud to wear a two-piece bathing suit.
- Laparoscopic
Gastric Bypass can be performed on all but the very severely
obese, where length of the instruments may limit the technique.
We advise against attempting the technique when patients have
had prior open operations in the upper abdomen, especially
on the stomach.
The
Laparoscopic Adjustable Silicone Gastric Band (LASGB) is a device
designed to produce a small upper gastric pouch, and a narrow
opening from it into the lower stomach. It causes a sense of
fullness after only a few bites of food, and it helps the decision
to reduce food intake, and to lose weight.
The
LASGB has several potential advantages, if it can be shown to
be safe:
- It
is inserted laparoscopically, without a major incision., with
a short hospital stay - usually just overnight.
- There
is no opening made into the GI (gastrointestinal) tract, so
the risk of leakage and infection is likely to be reduced.
- There
is no staple line (like in the gastroplasty, the nearest other
procedure) to potentially break down.
- It
is adjustable.
- It
is readily convertible to another operation, if the procedure
fails to maintain the desired weight loss.
This
operation is especially attractive to persons who can spare
only a small amount of time, and who need to return quickly
to full activity. With one to two days hospitalization, a busy
executive can return to his desk, and gain control over troublesome
weight problems.
A
more accurate evaluation awaits the final results of the FDA
protocol study, which will not be available for about 3 more
years. Until then, a person who choses this technique must accept
the possibility of some uncertainty about the ultimate safety
and results of the operation.
The
bottom line on the laparoscopic approach:
- Laparoscopic
Gastric Bypass, Roux en-Y: a proven effective operation,
with dramatic weight loss, 2 - 3 day hospital stay, and low
risk of morbidity and mortality.
- Laparoscopic
Adjustable Silicone Gastric Banding: a 1-2 day hospital
stay, and (probably) the lowest risk of morbidity and mortality.
If
shorter hospital stay, reduced discomfort and disability, and
superior cosmetic results are important to your decision, the
choice of Laparoscopic Gastric Bypass or Laparoscopic Adjustable
Silicone Gastric Banding is one you should consider.
