Weight Loss Surgery
Gastric Bypass Surgery
Introduction
Gastric bypass surgery combines the creation of a small stomach pouch to restrict food intake and construction of bypasses of the duodenum and other segments of the small intestine to cause malabsorption (decreased ability to absorb calories and nutrients from food).
Types of Gastric Bypass Surgery
1. Roux-en-Y gastric bypass (RGB): This operation is the most common gastric bypass surgery performed in the U.S. First, a small stomach pouch is created by stapling part of the stomach together or by vertical banding.
This limits how much food you can eat. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of the jejunum. This causes reduced calorie and nutrient absorption.
This procedure can now be done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen) in some people. This involves using small incisions and generally has a more rapid recovery time.
Extensive gastric bypass (biliopancreatic diversion): In this more complicated gastric bypass operation, the lower portion of the stomach is removed. The small pouch that remains is connected directly to the final segment of the small intestine, thus completely bypassing both the duodenum and jejunum. Although this procedure successfully promotes weightloss, it is not as widely used because of the high risk for nutritional deficiencies.
Gastric bypass surgery that causes malabsorption and restricts food intake produces more weight loss than restriction operations like gastric banding, which only decrease food intake. People who have bypass surgery generally lose two-thirds of their excess weight within two years.
Laparoscopic Approach to Weight Loss Surgery
Laparoscopic Approach
All the procedures are performed Laparoscopically. When a Laparoscopic operation is performed, a small video camera inserted into the abdomen allows the surgeon to conduct and view the surgery on a video monitor.
The camera and surgical instruments are usually inserted through small incisions made in the abdominal wall.
Laparoscopic procedures for weight loss surgery employ the same principles as their 'open' counterparts and produce similar excess weight loss.
Compared to open surgery, some benefits of laparoscopic surgery include Faster recovery and return to pre-surgical level of activity.
Modern laparoscopic treatment offers the following advantages
1. Short stay
2. Practically pain free
3. No wound related complications.
4. Patients returns to work in less than a week.
5. Cosmetically 5 tiny scars 1/2 - 1 1/2 cm.
6. Low complication rate comparable to any other surgery.
7. Improves overall quality of life.
Risk All major surgery involves a certain level of risk. Risks involved with weight loss surgery vary according to procedure performed. Complications
1. Re-operation rate 1%
2. Anastomotic leak 1%
3. Anastomotic stricture 2%
4. Wound infection 1%
5. Obstruction 5%
6. Deep vein thrombosis 1%
Side Effects
1. Restriction of eating small meal indefinitely.
2. Occasional Vomiting / Regurgitations.
3. Minor hair loss.
4. Occasional constipation.
5. Loose / Boggy skin.
6. Deficiency of Protein /Vitamins if supplements are stopped.
Important Considerations For All Weight Loss Surgery
Surgery should not be considered until all other options have been evaluated
1. Weight loss surgery is not a cosmetic surgery.
2. The decision to elect surgical treatment requires an assessment of the risk and benefit to you and the meticulous performance of the appropriate surgical procedure.
3. The success of weight loss surgery is dependent on your long term lifestyle changes in diet, exercise and behavior modification.
At Gateway Clinics the most commonly performed Weight loss surgeries are following :
Laparoscopic Sleeve Gastrectomy
Procedure Type Restrictive Description
1. Approximately 2/3 of the stomach is stapled off. This results in a stomach, which is roughly the size and shape of a banana or Sleeve. Since this operation does not involve any "rerouting" or reconnecting of the intestines, it is a simpler operation than the gastric bypass.
Advantages of the Sleeve Gastrectomy
1. It does not require disconnecting or reconnecting the intestines and food absorption is normal.
2. It is a technically simpler operation than the gastric bypass.
3. It is known to reduce hunger because hunger stimulating hormone producing part of stomach is removed.
4. Unlike gastric bypass & gastric band, patients feels full with liquids as well.
Surgical Time* : 60 minutes
Hospitalization* : 24 hours
Recuperation Time* : 4 days
Results
1. Patients have achieved excess weight loss of 60-90% at the end of two years.
2. 90-98% resolution of Diabetes, Hypertension, hyperlipidemia, Sleep apnoea, knee joint pain and much quality of life.
3. Provides satiety with small amount of food.
4. No malabsorption.