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Types of Bariatric Surgery

Types of Bariatric Surgery

Bariatric surgery has evolved and improved rapidly over recent years, making important strides toward even better results and easier operations with each advance. Lourdes bariatric services offer each of the several most successful approaches to this safe weight-loss option, and the staff advises on and recommends these options individually, as appropriate and according to each patient’s needs.

Lourdes’ experienced bariatric surgeons perform each of the various types of operations laparoscopically, to minimize the invasiveness of the procedure and reduce recovery time. In select cases at Our Lady of Lourdes Medical Center, robotic surgery utilizing the daVinci Surgical System may be offered and further reduces the invasiveness of the procedure.

The laparoscope is a thin endoscope, inserted into to the abdomen through ports, with fine surgical instruments inserted through additional ports, each port offering access to the stomach area through a small external incision. Bariatric surgery requires four or five of these small laparoscopic punctures. These access points leave very little residual marks. (Only the rare patient with special surgical circumstances may undergo an open bariatric surgical procedure.)

All three of the main approaches to bariatric surgery create a smaller stomach pouch that fills rapidly with food during a meal, creating a sense of fullness that reduces food intake. The smaller stomach area also physically limits the volume of food that an individual can take in at any one time.

Individuals undergoing bariatric surgery have several choices in achieving this reconfiguration of the portion of the stomach receiving food. But those living with serious obesity-related medical conditions ─ heart disease, mobility issues, high blood pressure and diabetes ─ may chose the stomach sleeve or stomach bypass procedures (described below), because these approaches typically produce faster results than stomach banding. See table.

Sleeve gastrectomy

This newer procedure has surpassed gastric banding and other types of bariatric surgery at Lourdes and many other centers, and results have been excellent for this operation.

In sleeve gastrectomy, the surgeon removes the left side of the stomach, leaving the stomach’s connection to the esophagus and small intestine intact. The resulting stretch of the digestive tract — including the bottom of the esophagus attached to the remaining stomach attached to the beginning of the small intestine — remains continuous and is closed into in a tube configuration about the size and shape of a banana. Sleeve gastrectomy has these advantages:

  • Avoiding cutting and reconfiguring the small intestine makes for a simpler operation and helps to safeguard digestive absorption.
  • Unlike stomach banding, there is no need to implant an artificial device inside the abdomen.
  • Nerves of the stomach and the outlet valve (pylorus) of the stomach remain intact, preserving the digestive functions of these neuromuscular structures.
  • The part of the stomach that produces ghrelin, a hormone that stimulates appetite, is removed, noticeably reducing appetite.
gastrectomy-before gastrectomy-after

Sleeve gastrectomy removes approximately three quarters of the volume of the stomach without the need for disconnecting the digestive tract.

Gastric bypass (Roux-En-Y Bypass)

In this operation, the surgeon first divides the stomach into a small upper pouch and a much larger lower “remnant” pouch and then configures a small-intestine connection to both. Typically, the surgeon cuts the small intestine near its middle and brings this connection to the outlet of the smaller upper stomach pouch. (The larger stomach pouch and portion of intestine still connected to it are also connected to the latter portion of the small intestine.) The reduced length of small intestine involved in digestion also reduces the amount of calories absorbed from food.

Stomach band (gastric banding, LAP-BAND®)

In this procedure, the bariatric surgeon implants an artificial ring near the top of the stomach to create a smaller initial stomach pouch. This band is a foreign body that acts like a belt around the top of the stomach. The surgeon can adjust the amount of tension exerted by the ring on the stomach by injecting fluid into a port also implanted under the skin against the abdominal wall. These adjustments regulate the rate at which food can be passed from the smaller pouch, further influencing the amount an individual can consume at any one time. The bariatrics team makes these adjustments on a monthly basis for the first year. Lourdes surgeons have performed fewer gastric band operations in recent years, in part because of the occasional need for subsequent removal of the bands or revision of their positioning.

Revision surgery

The Lourdes bariatric surgery staff is also experienced in performing secondary or follow-up surgery for patients who have previously undergone bariatric surgery and require repairs, adjustments or other surgical solutions to their operations.

Different types of bariatric surgery also have different features in the experience after surgery and over the long term. Here are other comparative factors:

Comparing surgical approaches to one another ➜ stomach band (LAP-BAND®) stomach sleeve (sleeve gastrectomy) stomach bypass (gastric bypass)
invasiveness least low higher
recovery time after surgery shortest short longer
speed of weight loss more gradual rapid fastest
average weight loss least (but still about 30 percent of excess weight) medium (about 30 percent greater than with gastric banding) most
digestive absorption normal normal reduced
lifetime adjustments needed periodic none none
reversible? yes no no

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