Weight Loss Surgery

The weight loss surgery landscape has changed drastically over the past few decades and has been transformed from mostly experimental technique to a safe and effective mainstream alternative to living with morbid obesity. Advances in surgical techniques and medical device manufacturing have allowed bariatric surgeons to perform the procedures with less risk, fewer complications and less scarring. The laparoscopic, or minimally invasive approach, has become the new standard for weight loss surgery and 95% of the surgeries we perform are minimally invasive.

Most minimally invasive procedures start with the surgeon making a few tiny incision, in the abdomen, versus the traditional open procedure which requires a large, single abdominal incision. Trocars, which act as passageways for the medical devices, are placed in these tiny incisions. One of these medical devices is a laparoscope. Tube-shaped, the laparascope allows the surgeon to visualize the surgical field, essentially providing a view inside the abdominal cavity. With these devices, the surgery can be performed as effectively as with an open procedure.

The primary goal of bariatric surgery is to reduce or eliminate health problems associated with obesity. Also referred to as co-morbidities, these diseases include: type-II diabetes, high blood pressure, high cholesterol, sleep apnea and others. Weight loss surgery has also been effective in possibly preventing some disease altogether. For example, obesity can even predispose patients to a higher risk of some forms of cancer. Weight loss can reduce that risk. Patients may be able to avoid developing diabetes or other diseases if weight loss is achieved early enough.

Here at the Bariatric Surgical Center Tuscaloosa, we perform three major bariatric procedures: gastric bypass, gastric banding and sleeve gastrectomy. In certain cases, we also perform Single Incision Laparoscopic Surgery or Minimal Incision Laparoscopic Surgery (SILS or MILS), in which the surgeon accesses the abdominal cavity through a single incision or through less incisions than normal. The result is more cosmetically pleasing through less or less visible incisions.

Gastric Bypass (Roux-en-Y)

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The gastric bypass procedure formerly was the most performed weight loss procedure in the United States but has recently been overtaken by the banding procedures. It is however widely considered as the gold standard because of its exceptional results. It was first performed in the late 1960s as an open procedure and then laparoscopically since the late 1990s.

How Does Gastric Bypass Work?

During the gastric bypass procedure a large portion of the existing stomach is excised leaving a pouch that is approximately 15 to 30cc in volume to act as the reservoir for food consumed. By removing a portion of the stomach, the amount of food one can eat is restricted, therefore less food is consumed at each sitting. The second part of the procedure is the rerouting of the small intestine by bypassing part of it. As a result, fewer calories are absorbed through the intestinal walls, referred to as malabsorption. The combination of restriction and malabsorption leads to exceptional weight loss. This procedure has been shown to eliminate over 70% of an average patient’s excess weight in some studies. Even better, the vast majority of patients are able to maintain that weight loss long-term when accompanied by proper diet and exercise.

Results of Gastric Bypass

Gastric bypass generally results in the greatest weight loss of any procedure we offer. Performed laparoscopically to minimize pain and recovery time, exceptional resolution of obesity related diseases is common.

Risks and Considerations

As with any surgery, there are risks. These risks should be fully discussed with you by your surgeon. There are however also risks to not losing weight such as acquiring or worsening medical problems and a shortened lifespan.

Gastric Banding (Lap-Band® & Realize® Band)

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Gastric banding, also known by trade names Lap-Band® and Realize® Band, is another form of bariatric surgery that we offer. The Lap-Band® was approved for use in the United States in 2001 by the FDA and has become the most popular procedure performed in the US. This is due to patient preference and should not be misconstrued by the patient deciding on the type of surgery that is the best. The patient and the surgeon should decide on which surgery is right for them and usually the patients choice is honored unless there are circumstances the surgeon feels might make a procedure less effective or safe for the patient.

How Does Gastric Banding Work?

The gastric band is placed around the top of the stomach and tightened to form two interconnected chambers. The smaller, upper chamber becomes the reservoir for the majority of food that is consumed. Because of the restriction the band provides, the amount of food one can eat before feeling full is reduced. This, in turn, limits the number of calories that are consumed, resulting in weight loss. The band is fully adjustable through an access port attached to the inside wall of the abdomen during surgery. The access port is invisible, however it is attached to the band, allowing the surgeon to use a special needle to inject or remove saline, tightening or loosening the band as necessary. Tightening the band allows less food to pass through, resulting in greater weight loss. Loosening the band does the opposite. If needed, the band can be removed, and studies have shown that in most cases the stomach will return to its normal shape and functionality.

Advantages of the Band

The gastric band is fully adjustable and reversible. It doesn’t involve any cutting or stapling of the stomach and since the intestine is not rerouted, patients rarely need long-term vitamin supplements. However a multi-vitamin a day is recommended.

Risks and Considerations

Gastric banding requires additional follow-up appointments to adjust the band and the percentage of excess weight loss is slower than that of gastric bypass patients.

Comparing Gastric Bypass with Gastric Banding

Gastric bypass and gastric banding achieve similar goals in drastically different ways. Generally speaking the gastric bypass procedure achieves the greatest results while the gastric band is considered the safest weight loss surgery procedure we offer.

Methods: The gastric bypass is a more invasive procedure that involves cutting the stomach and rerouting the intestine. The Lap-Band requires no digestive tract cutting, however does require the use of a permanently implanted medical device in the abdominal cavity. Both procedures are performed in a minimally invasive manner.

Results: Gastric bypass patients can lose up to nearly 80% of their excess body weight and keep it off out to ten years and beyond. Gastric banding patients will lose about 50% but can achieve losses of over 70% of their excess body weight in the same period of time. Weight loss after gastric bypass surgery tends to be extreme in the short term while gastric banding weight patients lose weight at an ideal rate of 1-2 pounds per week.

Adjustability/Reversibility: While both procedures are meant to be permanent, the gastric band is adjustable (and will be adjusted several times over the first two years) and reversible in cases of need. Gastric bypass should be viewed as a permanent solution as reversal of this procedure carries high risk of complications.

Hospital Stay: Generally speaking the gastric band is performed as an outpatient procedure and the patient can go home the day of surgery after observation. Gastric bypass patients will typically spend one to two nights in the hospital.

Costs: The cost of gastric bypass on average is about double the cost of gastric banding. In both cases, recent studies have shown that the cost savings in medication, doctor’s visits and other obesity related expenses after surgery can pay for the surgery itself in up to 2 years.

Gastric Sleeve (Sleeve Gastrectomy)

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The gastric sleeve, also known as sleeve gastrectomy, is a procedure that was originally the first part of a two-part weight loss surgery for those with extreme BMIs (greater than 60). Over time, it became clear that the gastric sleeve surgery was effective as a standalone procedure for some patients, and today most surgeons perform it as such.

How Does Gastric Sleeve Work?

The gastric sleeve has become a popular weight loss surgery procedure because of its simplicity. During this procedure, surgeons cut away about 75% of the existing stomach. The remaining stomach is about the size and shape of a banana or sleeve and hence the name.

Advantages of the Sleeve

The gastric sleeve removes the part of the stomach that produces ghrelin - the hunger hormone - reducing food cravings. The intestine is not rerouted, so gastric sleeve patients can eat a broader spectrum of foods. Patients may not need to stay on vitamin supplements in perpetuity but a multi-vitamin is recommended.

Risks and Considerations

The gastric sleeve carries all the risks of major surgery. The staple line may leak and require additional surgery to correct the issue. There is very little long-term data substantiating the safety and effectiveness of the procedure. Ask your surgeon about the complications.

SILS/MILS

Single Incision Laparoscopic surgery or SILS is a very specialized procedure in which all the medical devices used in the surgery are passed through one port in the abdomen. This allows for little or no visible scarring after surgery. The rest of the procedure will be performed in the same way as other laparoscopic surgeries.

In traditional laparoscopic surgery, the surgeon will create four to five small incisions in the abdomen – about _ to 1 inch wide. While these scars will generally heal well, the SILS technique allows for even less scarring and in cases where the entry is made through the navel, the scarring is virtually invisible. This may also reduce recovery time and pain after surgery. During gastric banding, the access port can be placed behind the navel meaning that once again, only one area of the abdomen need be accessed.

Please speak to our office about whether you qualify for SILS and learn more about the specific benefits and risks of this procedure.

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