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Surgical Operations for Morbid Obesity

We consider Gastric Bypass to be the premium operation, offering the best combination of maximum weight control, and minimum nutritional risk.

Gastric Bypass, Roux en-Y: The Gastric Bypass, Roux en-Y is considered the "gold standard" of modern obesity surgery -- the benchmark to which other operations are compared, for evaluation of their quality and effectiveness.

This operation achieves its effects by creating a very small stomach pouch (thumb-sized, actually), from which the rest of the stomach is permanently divided and separated. The small intestine is cut about 18 inches below the stomach, and is re-arranged so as to provide an outlet to the small stomach, while maintaining the flow of digestive juices at the same time. The lower part of the stomach is bypassed, and food enters the second part of the small bowel within about 10 minutes of beginning the meal. Click here to view an animation of the procedure.

There is very little interference with normal absorption of food - the operation works by reducing food intake, and reducing the feeling of hunger. The result is a very early sense of fullness, followed by a very profound sense of satisfaction. Even though the portion size may be small, there is no hunger, and no feeling of having been deprived: when truly satisfied, you feel indifferent to even the choicest of foods.  Patients continue to enjoy eating - but they enjoy eating a lot less.

The Gastric Bypass provides an excellent tool for gaining long-term control of weight, without the hunger or craving usually associated with small portions, or with dieting. Weight loss of 80 - 100% of excess body weight is achievable for most patients, and long-term maintenance of weight loss is very successful -- but does require adherence to a simple and straightforward behavioral regimen.

Laparoscopic Gastric Bypass, Roux en-Y

The techniques for performing the Gastric Bypass by laparoscopy, or limited access, was first performed in 1993. This operation duplicates the anatomy and physiology of the standard, open procedure.

General incisions for laparoscopic bariatric surgery.Laparoscopic surgery first became available around 1990, when small, light-weight, high-resolution video cameras were developed, allowing surgeons to "see" into the abdomen using a pencil-thin optical telescope, and to project the picture from the video camera on a TV monitor at the head of the operating table. The surgeon must develop skills in operating by this new method, without being able to feel tissue directly, and by learning to determine where instruments are by seeing them on TV.

The benefits of the laparoscopic approach come from the very small incisions which are necessary, which cause much less pain, and very little scarring. Patients are able to get up and walk within hours after surgery, can breath easier, and move without discomfort. Bowel activity usually is not affected, as it is with an open incision. Most persons find they can return to normal activities within 10 – 12 days, or even sooner.

The risks of surgery performed laparoscopically are comparable to those the standard operation – when done by an experienced and skilled laparoscopic surgeon. Some bariatric surgeons have been unable to master the techniques of advanced laparoscopic surgery, and therefore do not offer this method – or may even try to claim that it is less effective – which is certainly not true.

With the Gastric Bypass procedures, using the laparoscopic technique, results have been equal to, or better than, those obtained with the open operation, but with major reduction of discomfort and disability, and excellent cosmetic results as an additional benefit.

Of 500 patients who have undergone laparoscopic surgery, weight loss averages over 80% of excess body weight, one year after surgery, and has been maintained over 80% for over 5 years. Over 95% of all health problems (co-morbidities) associated with their obesity have been resolved following surgery. Patients enjoy a normal-style diet, and are satisfied to eat smaller portions. Click here to learn more about Laparoscopic surgery.

Laparoscopic Adjustable Gastric Banding

Gastric Banding is a variation on the gastroplasty, in which the stomach is neither opened nor stapled -- a band is placed around the outside of the upper stomach, to create an hourglass-shaped stomach, and to produce a small pouch with a narrow outlet. The special device used to accomplish this is made of implantable silicone rubber, and contains an adjustable balloon, which allows us to adjust the function of the band, without re-operation. This device enjoys considerable advantage over the standard gastroplasty:

  • It can be inserted laparoscopically, without the usual large incision.
  • It does not require any opening in the gastrointestinal tract, so infection risk is reduced.
  • There is no staple line to come apart.
  • It is adjustable. 

This operation may be particularly suited to persons between 200 and 270 lb weight, who need to find a rapid and more convenient solution, and to return to full activity very quickly:  businesspersons, salespersons, and the self-employed.  Although its effects may not be as profound as the gastric bypass, the risk of the procedure appears to be less, and the recovery time is the shortest.

The most significant problem associated with the LapBand has been alteration in the size of the stomach pouch which is isolated above the band.  This pouch may enlarge in some cases, either due to slippage of the band, or stretching of the wall of the pouch.  This occurrence may cause poor weight loss, reflux of gastric acid causing heartburn, and can lead to obstruction of the stomach outlet.  Stretching of the stomach wall can cause irreversible damage to the upper stomach, and the result in many cases is a need to remove the band, and convert to a better operation - which might have been done in the first place.

 

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