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Memorial Bariatric Services offers three types of surgical options:
- Laparoscopic Roux-en-Y Gastric Bypass
- Laparoscopic Adjustable Gastric Banding (LAP-BAND)
- Laparoscopic Vertical Sleeve Gastrectomy.
Each bariatric procedure offers unique benefits and risks to the patient. Patient age, health status and preferences factor into the decision of which procedure is appropriate.
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Gastric Bypass (Roux-en-Y) Procedure
- Involves surgically separating the stomach into two sections using parallel rows of titanium staples
- The small upper segment of the stomach, which connects to the esophagus, continues to receive food much as it did prior to surgery, while the lower portion, or "remnant stomach," no longer comes in contact with food.
- A portion of the small intestine is disconnected, allowing the surgeon to re-route food directly from the newly-created small stomach pouch directly into the remaining intestine for digestion.
- The gastric bypass can be performed laparoscopically, Typical hospital stay for a patient receiving laparoscopic gastric bypass surgery is three days, followed by two to four weeks of restricted activity.
- Follow-up care is an important component and several post-surgery appointments will be needed to monitor healing and progress.
- Gastric bypass is a non-reversible procedure, and leads to very rapid weight loss. Weight loss occurs more quickly following gastric bypass compared to the LAP-BAND.
LAP-BAND (Laparoscopic Adjustable Gastric Band) Procedure
- It involves the surgical placement of a silicone elastic ring around the upper part of the stomach. The ring is then filled, or inflated, with saline solution.
- The ring is accessed by tubing connected to a port placed beneath the skin of the abdomen, into which the doctor injects or withdraws saline until the ideal amount of tightening is reached.
- By increasing or decreasing the amount of saline in the ring, the opening from the upper stomach to the lower stomach can be tightened to a desired degree.
- The tightening of the band effectively leads to a decreased sense of hunger and allows the patient to eat less and still feel full.
- The ring is inserted laparoscopically, resulting in shorter hospital stays and faster recovery times compared to a procedure using an open incision.
- The LAP-BAND is often performed as an outpatient procedure.
- Following surgery, LAP-BAND patients require monthly clinic visits during the first year to monitor results and possible need for adjustment to the LAP-BAND device. The frequency of band adjustments decreases after the first year post-surgery.
- Adjustments must be completed by a qualified, appropriately trained healthcare provider.
- This is a completely reversible procedure; however, it is intended to be a permanent implanted device. Removal of the Lap-Band® would eliminate restriction and may lead to weight re-gain.
Laparoscopic Vertical Sleeve Gastrectomy
- Like the LAP-BAND, the sleeve gastrectomy is a purely restrictive procedure.
- The stomach is restricted by stapling and dividing it vertically. The portion of the stomach that receives food is shaped like a very slim banana (or sleeve).
- The nerves to the stomach and the valve leading from the stomach to the small intestine (pylorus) remain intact, thereby preserving the functions of the stomach while drastically reducing the volume. The small intestine remains intact.
- The Vertical Sleeve Gastrectomy is sometimes used as the first step in a two-staged procedure for very high-risk patients. The sleeve gastrectomy is performed first and, after several months of significant weight loss (thereby reducing risk), a second bariatric procedure (e.g., Duodenal Switch or Roux-en-Y gastric bypass) can be performed.
- Typical hospital stay after the Vertical Sleeve Gastrectomy is 2-3 days.
- As with any bariatric procedure, follow-up care is critical to long-term, safe weight loss. The patient can expect post-surgery appointments with the Bariatric Team will be needed to monitor healing and progress.
Possible Risks and Complications
As with any major surgical procedure, there are significant risks, particularly for those with morbid obesity. A patient considering any bariatric surgery must consider both the risks the potential benefit with weight loss surgery.