There are several types of proven weight loss operations.
The first type, "restrictive," limits the amount of food you can consume by decreasing the capacity of your stomach. The second type, "malabsorptive," bypasses a large portion of your small intestine to prevent the absorption of fats and other sources of calories and nutrients. Frequently, a combination of the two types is necessary.
There are two approaches to obesity surgery. The classic incision or "open" procedure has a long history and is still performed by many surgeons. It is well proven, quick and has a low complication rate. This surgery does leave a scar and can lead to wound problems.
The other, and newer method is minimally or "laparoscopic." The procedure is basically the same as the open method, but the scars are smaller and patients can frequently get out of the hospital a day earlier. We have surgeons on staff who perform the procedures listed below both open and laparoscopicaly. When you schedule an appointment you should ask whether or not your surgeon performs the open or laparoscopic approach.
The operation you and your surgeon pick will be individualized according to your needs and what is best for your problem.
Gastric Bypass
Roux-en-Y gastric bypass operations have been conducted for more than 25 years. The initial surgery, developed by Dr. Edward Mason at the University of Iowa, involves stapling or dividing the stomach into small (1 ounce or 30cc) and large sections and connecting the small pouch to a limb of small intestine. The length of the limb determines if there is any malabsorption, which can be useful in very obese (BMI>50 Kg/M2) individuals. This is the most common operation done in the United States.
The vertical banded gastroplasty is another procedure that is very common. This procedure partitions the stomach by dividing it into a small and large section with the use of a stapling device. The opening between the sections of the stomach is approximately the size of a little finger and a band of plastic mesh permanently limits its size. No intestinal hook-up is undertaken. Two recent studies have indicated that gastric bypass results in significantly greater weight loss than gastroplasty. This procedure also is less successful in "sweets"eaters.
The duodenal switch procedure is more complex and requires more dietary modification than gastric bypass, but may be more successful in larger patients. This procedure may also be split into two smaller surgeries, which may be less risky to the patient. The first part of the procedure involves removing ¾ of the stomach, leaving only a stomach tube. This vertical gastroplasty has been successful as a single procedure in a select group of patients. The second stage of the duodenal switch involves disconnecting the duodenum, the first part of the intestine, and replacing it with another part of the small bowel, the jejunum, effectively bypassing a large amount of the absorptive part of the bowel.
A newer operation is the lap-band procedure. While this is a less invasive, less complex operation, results in the United States have been mixed. It has the advantage of being relatively safe and reversible, but requires close follow-up to slowly decrease the size of the stomach pouch as the band inflates over a period of weeks.
Video Educator
Click here to see short video explanations of Laparoscopic Gastric Banding, Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass.