Surgery for Obesity
There are two types of surgeries to control obesity. A restrictive procedure decreases the ability to take in large amounts of food. A malabsorptive procedure causes food to be poorly digested and incompletely absorbed. There are also procedures which are a combination of the two.
Adjustable Gastric Banding
A band made of synthetic material is placed around the stomach near the upper end to make a small pouch and narrow passage into the rest of the stomach. The advantage of this is that normal anatomy is maintained so food and vitamin absorption is maintained. The size of the band can be adjusted as needed. Most patients need approximately (5) five adjustments in the first year; 1-2 each year for the next 2 years. The adjustments are an additional cost. Most patients will lose weight for 3 years after this procedure.
Restrictive procedures depend on a small pouch (1 to 2 tablespoons) and small outlet to reduce food intake and help the patient stay feeling full longer. If a patient overeats, they will get sick and vomit. This is a form of behavior modification. Over time, overeating can stretch the pouch and allow regain of weight. As with all of the operations, readmission to the hospital may be required for fluid replacement or nutritional support if adequate intake cannot be maintained. Life-long vitamin supplements and monitoring by a physician who understands your procedure is required.
The REALIZE Band is made of strong, flexible silicone and has a soft balloon that fits around the stomach. The amount of saline in the balloon controls the tightness around the stomach.
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The majority of weight loss sleeve gastrectomies performed today use a laparoscopic technique, which is considered minimally invasive. Laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures.
Laparoscopic sleeve gastrectomy can be the first step before gastric bypass or it can be a single procedure for weight loss. If a sleeve gastrectomy is used as part of a two-step procedure, the first step is for the surgeon to create the small stomach sleeve.
After a period of time determined by the surgeon, another procedure would be done in which the surgeon attaches a section of the small intestine directly to the stomach pouch. This allows food to bypass a portion of the small intestine. Doing so enables the body to absorb fewer calories, in addition to consuming less food. This two-step procedure may be done because patients may not be able to tolerate both procedures during a single operation. Studies show that the two-step procedure has been used successfully in patients with a body mass index greater than 50 or in high-risk patients.27
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Roux-en-y Gastric Bypass
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This procedure provides gastric restriction as well as some malabsorption. It is the most widely accepted form of obesity surgery in the United States. The stapling is positioned vertically at the top of the stomach. The stomach is completely stapled shut and a new outlet is created. This is done by dividing the small bowel just beyond the duodenum and bringing it up to the pouch to create the new outlet. The other open end of the bowel is sewn back into the side of the Roux limb of intestine, completing a Y-shape which gives the procedure its name. The length of either segment of bowel can be increased to produce more malabsorption which in turn produces more weight loss. This also increases risks and side effects. There is the risk of staple line disruption as well as staple line leaks.
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