Bariatric Surgery Center

Understanding Bariatric Surgery

Types of Surgery

Weight loss operations fall into three categories:

  • Restrictive procedures, which make the stomach smaller to limit the amount of food intake.
  • Malabsorptive techniques, which reduce the amount of intestine that comes in contact with food so the body absorbs fewer calories.
  • Combination operations, which employ both restriction and malabsorption.

Restriction Operations

These procedures are the least commonly performed. They encourage weight loss in two ways:

  • Reduce the amount of food you can eat. We shrink your stomach by creating a small pouch at the top of the stomach where food enters from the esophagus. This makes it impossible for you to each much. At first, the pouch only holds about 1 ounce of food. It expands to hold 2-3 ounces over time.

  • Slow the speed food empties from your stomach. The lower outlet of the pouch is only about 1/4 inch in diameter. Because it's so small, food empties slowly and you feel full longer.

Vertical banded gastroplasty

Vertical banded gastroplasty

There are two types of restrictive operations:

  • Gastric banding ("lapband"). A band of special material is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach.
  • Vertical banded gastroplasty. This common procedure creates the pouch with both a band and staples.

Gastric Bypass Operations

Gastric bypass procedures are combination operations. That is, they combine both restrictive and malabsorptive techniques:

  • Create a small stomach pouch to restrict the amount of food you can eat.
  • Construct a bypass of the duodenum and other parts of the small intestine to cause malabsorption.

There are two types of gastric bypass procedures:

View Roux-en-Y gastric bypass View Roux-en-Y gastric bypass
  • Roux-en-Y Gastric Bypass (RGB). This is the most common bariatric procedure. First, we create a small stomach pouch with staples or a vertical band. This restricts food intake. Then, we attach a Y-shaped section of the small intestine to the pouch to allow food to bypass the first and second segments of the small intestine. This reduces your body's ability to absorb nutrients and calories. More about Roux-en-Y gastric bypass.
  • DISTAL Gastric Bypass (Duodenal Switch, Biliopancreatic Division). In this procedure, a portion of the stomach is removed. The remaining small pouch is then directly connected to the last portion of the small intestine. The risk for nutritional deficiencies is highest with this procedure.

Comparing the Procedures

  • Patients generally have more success with gastric bypass operations than restrictive procedures.
  • Risks are similar for both restrictive and gastric bypass procedures. Except the risk of nutritional deficiencies for iron, calcium, and Vitamin B12—are higher in patients who undergo gastric bypass operations. Also, there is risk of intestinal leaking.
  • Gastric bypass operations also may cause "dumping syndrome." This is when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness, and sometimes diarrhea.
View incisions for open surgery
View incisions for open surgery

Open vs. Laparoscopic Surgery

Open and laparoscopic refer to how abdominal cavity is entered and not the type of surgery being performed. So each type of weight loss surgery may be performed as either an open or a laparoscopic procedure.

When performing open surgery, surgeons create a single incision to open the abdomen for the operation. Typically, for women it is 4 1/2 to 6 inches, and for men, it is 5 1/2 to 7 inches.

With laparoscopic surgery, multiple, small incisions are made in the abdominal wall to accommodate a small video camera and surgical instruments. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them a better view and access to key structures.

View incisions laproscopic incisions View incisions for laparoscopic surgery

Recent studies show patients who have had laparoscopic weight loss surgery experience:

  • Less pain after surgery
  • Easier breathing and lung function
  • Fewer wound complications such as infection or hernia
  • Quicker return to pre-surgical levels of activity

Although open surgeries are still more common, most surgeons now offer the less invasive laparoscopic procedure whenever possible. Speak with your surgeon to find out if you are a good candidate for laparoscopic surgery. And remember, laparoscopic surgery uses all the same techniques as open surgery and has similar results in terms of excess weight loss.

Our Specialties

At Strong Health, we perform the following types of bariatric surgery: