© 2012-2020  by Gastro, Bariatric & Endocrine Surgery. All rights reserved. BCLW

Weight Loss Surgery

Surgical Proceedure

Gastric Banding

 

This is a simple operation that can be carried out by Single Incision (3cm) Laparoscopic (keyhole) Surgery (SILS). An inflatable silicon band is placed around the top of the stomach. The band is connected to a port placed under the skin for inflation. The band is inflated to create a small stomach pouch (large egg size) by making you feel full with smaller portion of food. This is like tightening your belt when you feel hungry. This operation is reversible and the tightness of the band can be adjusted at any time.

 

All surgery carries risks. Insertion of a gastric band has the lowest risk in comparison to other weight loss surgical procedures. The main early risks for this operation are deep vein thrombosis (clots in legs) and clots in your lungs (pulmonary embolism). The risk of death from the operation is 1 in 200 and the majority of these are from clots in the lungs. Because of this you will receive blood-thinning injections to reduce these risks. Longer-term problems occur in about 2 in 10 people. These include problems with the injection port and the band when the band erodes into the stomach and the band slipping into a wrong position. It is important to remember that the majority of people do not have any problems with this procedure.

 

Results of Gastric Banding

 

Excess weight loss is far quicker and more effective. Target weight loss is typically achieved at one year following surgery with an average excess weight loss of about 50%. This translates to losing on average about 70lbs over 2 to 3 years . In addition many of the medical problems are cured or greatly improved. 50% patients with diabetes are cured by gastric band with similar patients with high blood pressure and high cholesterol improve or be cured following surgery.

 

Long term problems with gastric band is now being increasingly recognosed which in many cases may require further corrective surgery or have the gastric band removed.

Gastric Bypass

 

Also known as gastric Roux-en-Y bypass. This procedure is preferred in people with higher BMI (greater than 50) and is performed laparoscopically (keyhole). It is a complex procedure that combines a restrictive component by creating a small gastric pouch and small bowel diversion by attaching a section of the small intestine to the pouch to allow food to bypass a part of the small intestines resulting in malabsorption. Though not impossible to reverse, this operation is extremely difficult to reverse and should be treated as irreversible.

 

This operation like gastric band will restrict the volume of food you eat by making you feel full with smaller meals. In addition to this the food consumed will only be partly absorbed and therefore further reduce the amount of food (energy) you consume.

 

Due to its complexity, gastric bypass carries slightly higher risks than for gastric band insertion. The risk of deep vein thrombosis and clots in the lungs are doubled (1 in 100) that of gastric banding. In exchange for this slight increase in short-term risk, this procedure has far less long term problems compared with gastric

banding. Patients will require supplements to correct vitamin deficiencies with an otherwise normal diet. 

Results of Gastric Bypass

 

Excess weight loss is far quicker and more effective. Target weight loss is typically achieved at one year following surgery with an average excess weight loss of about 60-70%. This translates to losing between 40 to 140lbs (21 to 63kg) or an average of 100lbs (47kg). In addition many of the medical problems are cured or greatly improved. The majority of people (84%) with diabetes are cured by gastric bypass and between 90% to 95% of people with high blood pressure and high cholesterol improve or be cured following surgery.

Laparoscopic Sleeve Gastrectomy
 

Laparoscopic sleeve gastrectomy is a new restrictive procedure that was developed in 2003. This is a restrictive procedure like gastric banding without using any foreign body. The stomach is divided using staples along the inside leaving a narrow banana shaped stomach tube. Unlike gastric bypass the excess stomach (85%) is removed completely thereby eliminating the main source of the Ghrelin hormone (appetite hormone) and reduce hunger. 

 

The new stomach tube holds approximately 100ml. The weight loss mechanism is much like gastric banding where the amount of food consumed is limited by the reduced stomach volume and feeling of fullness. The loss of the appetite hormone also helps with coping with certain food urges. The advantages of this procedure over gastric band are no foreign body and therefore there are no problems with band erosion, slippage. 

 

The disadvantage of this is irreversibility, leak and greater risk with deep vein thrombosis, bleeding, damage to spleen and insufficient weight loss in the very obese patient (BMI>55).

 

Results of Sleeve Gastrectomy

 

The rate and amount of weight loss is greater than gastric band  averages around 60% of excess body weight). By virtue that this procedure is used in super and super obese people (BMI >50), the absolute weight loss is in the region of 90 to 130lbs (40 to 60kg) in about 12 to 18 months after surgery.

Results of Weight loss after Weight Loss Surgery 

 

Nutritional problems following weight loss surgery is uncommon with the appropriate follow-up and dietary monitoring. Dehydration, protein deficiency, vitamin and mineral deficiencies may occur following restrictive procedures (gastric bypass & BPD-DS) and much less common after gastric banding and sleeve gastrectomy.

 

Iron, folate, calcium vitamin B12, B1, D and E deficiencies and raised parathyroid hormone can occur with malabsorptive procedures. These can be easily treated by using appropriate supplementation and careful monitoring.  

 

Failure to lose expected weight following weight loss surgery can occur in any types of weight loss surgery. It is important to understand that weight loss surgery is only a tool and has to be used properly for it to work to its full effect. Any wieght loss surgery is like a pair of crutches, they can help you walk but they cannot walk for you.