Laparoscopic Adjustable Gastric Banding (LAGB)
Adjustable gastric bands are prosthetic devices that are placed around the upper part of the stomach. The band acts as a “govener” to regulate how fast healthy foods flow into the stomach. Older banding devices (vertical banded gastroplasty) were not adjustable and patients had difficulty swallowing healthy food. By adjusting the tightness of the band, you can control the amount of healthy food you eat at one time. By reducing the volume and calories of food ingested, patients experience weight loss.
Gastric sleeve (laparoscopic sleeve gastrectomy)
In the Sleeve Gastrectomy procedure, also called the Vertical Sleeve Gastrectomy (VSG), 70-80% of the stomach is surgically removed, resulting in a sleeve or banana-shaped tube. The procedure is normally performed laparoscopically using small instruments inserted into tiny incisions in the upper abdomen. By limiting the size of the stomach, the amount of food you can eat is restricted. The procedure also prompts hormonal changes that help relieve conditions associated with obesity.
The Vertical Sleeve Gastrectomy is relatively new as a standalone weight loss surgical procedure. It is the first part of the Biliary Pancreatic Diversion with Duodenal Switch (BPDDS, DS) operation for the super obese patient (BMI > 50). There are instances where the VSG may be the best option when:
- The patient desires a restrictive operation without a foreign body.
- A stand-alone weight loss surgical procedure for a patient with a BMI < 50 who does not want their intestine bypassed is desired.
- A staged operation for patients with excessively high surgical risk and BMI is desired. Staging procedures may reduce the risk of complications for the patient.
Gastric bypass (laparoscopic Roux-en Y)
Once the most popular weight loss surgical option, the Roux-en-Y gastric bypass (RYGB) has been performed for over 50 years. After RYGB, a typical patient may expect to lose about 75% of their excess weight and improve their health dramatically. A patient’s appetite is significantly depressed after RYGB, which can help patients make the necessary healthy dietary changes needed to be successful.
Roux-en-Y Gastric Bypass surgery is designed to help reduce the amount of food you eat by decreasing hunger and overall calorie absorption from fat. In addition to significant weight loss, RYGB dramatically reduces the health risks posed by obesity-related health conditions, including diabetes, sleep apnea, hypertension, and many others.
Biliary Pancreatic Diversion with Duodenal Switch
Biliary Pancreatic Diversion with Duodenal Switch is growing in popularity with surgeons because it is a natural revision option for patients that have had weight regain after Sleeve Gastrectomy. Also known as BPD/DS, this procedure can help patients suffering from severe obesity achieve significant weight loss and provide long-term resolutions for a number of obesity-related health conditions.
BPD/DS is basically a combination of a “limited” sleeve gastrectomy with a significant small bowel bypass. It is a limited sleeve gastrectomy because, instead of removing 80% of the stomach as with the Sleeve Gastrectomy surgery, only about 50% of the stomach is removed during BPD/DS. The small bowel bypass is an important component of the surgery because the small bowel is where we absorb our nutrition, such as protein, carbohydrates, and fat, from the food we eat. When you bypass (reroute the bowel so that food only goes through part of the small bowel) over half of the small bowel, you create a situation where a patient’s ability to absorb calories is limited.
After BPD/DS, patients can only absorb 60% of the protein and carbohydrates and only 30% of the fat from a meal. If the patient follows the dietary recommendations then the patient may only absorb 1200-1700 calories per day, even if they consume 3000! This inability to absorb calories helps patients avoid weight regain after surgery.
The operation is performed laparoscopically, using small instruments and incisions to minimize scarring and recovery time. The BPD/DS is particularly advantageous for the super-obese patient (BMI > 50). With other options, the super-obese often fail to lose the desired weight; however, with the BPD/DS, excess weight loss of 85% is common. This operation is also particularly effective for the severely diabetic patient, with long-term diabetes remission rates (95%) that are far superior to the other operations.
Single Anastomosis Duodeno-Ileostomy (SADI)
The Single Anastomosis Duodeno-Ileostomy, or SADI, is only recommended as part of an investigational or experimental protocol.
It is often referred to as a simpler version of the Biliary Pancreatic Diversion with Duodenal Switch procedure. The latter treatment has proven to be a very effective surgical weight loss option for many patients; however, the procedure is known for its complexity.
Revision and Conversion Surgery
For a variety of reasons some patients may experience the need for a revision, correction or conversion of their original bariatric operation. Sometimes individuals may benefit from an additional procedure to help them lose weight again or treat specific symptoms. Just because a previous bariatric procedure or program has failed you it does not mean that there is no hope.