Overview

There are two types of surgeries to control obesity: restrictive (decreasing intake of food) and malabsorptive (causing food to be poorly digested and incompletely absorbed). There are also procedures which are a combination of the two mentioned above. The following is a list of the procedures done across the country as well as those performed here at The Nebraska Medical Center.

View how bariatric surgery is done.

Gastric Restrictive Procedures

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. The adjustments are an additional cost.

Restrictive procedures depend on a small pouch (1 to 2 tablespoons) and small outlet to reduce food intake and help you to 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 for morbid obesity, readmission to the hospital may be required for fluid replacement or nutritional support if there is excessive vomiting and adequate intake cannot be maintained. Life long vitamin supplements and monitoring by a physician who understands your procedure is required.

Roux-en-y Gastric Bypass

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 either positioned horizontally at the top of the stomach of vertically, as in the gastroplasties, to create the small pouch. 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 brining 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. As with the vertical banded gastroplasty, there is the risk of staple line disruption as well as staple line leaks.

Malabsorptive Procedures

Biliopancreatic Diversion with Duodenal Switch

The outer margin of the stomach is resected, leaving the pylorus (valve that allows food to leave the stomach). The duodenum (upper portion of the small bowel) is divided so that bile and pancreatic juices are bypassed. The near-end of the "alimentary limb" is then attached to the beginning of the duodenum creating the "common limb" where the food joins the bile and pancreatic juices.

All malabsorptive procedures require a period of intestinal adaptation. Some patients will have frequent bowel movements, possibly 5 or 6 a day. We have found the majority of the patients here at the University of Nebraska have 1 to 3 bowel movements daily. This will vary with the individual. Malodorous stools or flatus can be an annoying side effect also. In spite of these side effects there is a great degree of patient satisfaction.

The size of the stomach pouch and the length of the bypassed bowel are very important in preventing excessive malnutrition. Staple line leaks are a risk. Close monitoring for protein malnutrition, anemia and bone disease is required after these operations. Nutritional supplements, vitamins, and life-long follow up are critical to maintain health and well being.