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Surgery Options
Choosing to undergo weight loss surgery is a very serious decision. The Laparoscopic Gastric Bypass Roux-en-Y procedure is a major surgery and requires careful consideration by both the patient and the doctor. The LAP-Band® is also a major surgical procedure. As a patient, you need to think about more that just benefits of the surgery – you must consider the risks and the complications. You need to understand what you can expect after surgery. Most importantly, you must be willing to change your lifestyle for the rest of your life.

Types of Surgery:

• Restrictive- The amount of food intake is restricted by altering the digestive system such as the Lap-Band procedure.

• Malabsorptive- The body’s digestive system is altered so that food is poorly digested so that excess calories are incompletely absorbed and eliminated in the stool. Purely malabsorptive surgeries can lead to nutritional deficiencies and other health issues, however.
  Medical Center Hospital Bariatric Clinic does not endorse or perform these types of surgeries.

•  Restrictive/Malabsorptive- A combination of the two classifications.

At the Medical Center Hospital Bariatric Clinic, we specialize in both the Laparoscopic Gastric Bypass and the LAP-Band® procedures. The LAP-Band® procedure is a restrictive type of weight loss surgery, while the Gastric Bypass is primarily restrictive, with some malabsorptive characteristics.

In laparoscopic surgery, the camera and surgical instruments are inserted into the abdomen through five or six small incisions. This gives the surgeon better visualization of the anatomy and better access to key anatomical parts.

Compared with traditional “open” incisions, laparoscopic surgery with small incisions offers a better surgical outcome. A recent study shows that patients with laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and higher overall oxygen levels-and with better healing. There are also fewer wound complications such as infection or hernia with patients returning to normal pre-surgery activity levels more quickly.

The Digestive System
Understanding how your body works is a key to understanding how weight loss surgeries work. When you eat the job of your digestive system is to break down and absorb food. Your body turns food into energy for use, and if it isn’t used, excess energy is stored in your body as fat. After surgery, your body will use this fat for energy and as a result, you lose weight.

The key parts of your digestive system are:

• Mouth
  As you chew food, your salivary glands secrete enzymes that help begin the process of digestion.

• Esophagus
  When you swallow food, muscle action brings the food down your esophagus, or food pipe, and empties through a one- way valve into the stomach.

• Stomach
  This organ is considered the food “reservoir”- storing food and sending it slowly to the small intestine. In the stomach, protein, fats and carbohydrates are partially digested into smaller portions. As food leaves the stomach through another one-way valve, it empties into the small intestine. Normally, the stomach can hold about three pints of food after a single meal.

• Small Intestine
  Also known as the small bowel, the small intestine is responsible for most digestion and absorption of food - protein, vitamins, minerals, and essential fats. The mixture of digestive juices helps break down the food so that it can be absorbed through the walls of the small intestine and into the bloodstream. The small intestine is divided into 3 sections: the duodenum- the first section and attached to the stomach; jejunum-the middle section responsible for most of the digestion and absorption of food; and the ileum-the third section and attached to the large intestine.

• Liver
  The liver produces bile - an important chemical aiding digestion. Bile drains into the gallbladder where it is stored until needed for digestion.

• Gallbladder
  The gallbladder is attached underneath the liver, it stores and concentrates bile. When food enters the stomach, it ‘signals’ the gallbladder to squeeze out bile into the duodenum for digestion.

• Pancreas
  The pancreas is located behind the stomach and produces enzymes essential to digestion. The enzymes are also released into the duodenum when food in the stomach” signals” the start of the digestion process.

• Large Intestine
  Also known as large bowel, most fluids are absorbed in the large intestine. The leftover waste products from food digestion are concentrated and passed through the rectum as stool.

The Human Digestive System

Click image to enlarge

The Laparoscopic Gastric Bypass Roux-en-Y
The gastric Bypass Roux-en-y, also simply know as gastric bypass, is considered the gold standard of weight loss surgery by the American Society of Bariatric Surgeons and the National Institutes of Health. Studies show that the Gastric Bypass helps many patients lose about 75% of their excess weight and maintain the weight loss for years after surgery. Now with modern refinements of the operation, there are many patients losing 85% to 100% of their excess weight and keeping it off.

The Procedure
Laparoscopic gastric bypass surgery uses stapling to create a small stomach pouch at the very top of the stomach just below the esophagus, restricting the amount of food a patient can eat. The remainder of the stomach is not removed, but is completely stapled shut and divided from the new pouch. The small intestine is then divided at the beginning of the jejunum - the middle section of the small intestine. The jejunum is then brought up and attached to the pouch.  Since food empties directly into the jejunum without mixing with normal digestive juices, calories and nutrients are less completely absorbed. The end of duodenum, the first section of small intestine, is then reattached downstream from the pouch.

The normal digestive juices from the stomach, liver and pancreas are now mixed with the food for digestion. This section of jejunum from the new pouch to the duodenum is the bypass - named because it bypasses the old stomach and digestive juices.

Clinical studies show the new, smaller pouch contributes greatly to higher overall weight loss success and long-term weight control.

Gastric Bypass Roux-en-Y


Click image to enlarge

Additional Info & Photo

Why the Procedure Works
The smaller stomach pouch now holds about 15cc (a tablespoon), or less than an ounce of food in the beginning. This restricts food intake and the body mostly burns fat for everyday energy. The smaller pouch also creates an early sense of fullness, even after eating less than an ounce. As a result, you will fill satisfied and feel less desire to eat.

Weight loss with the Laparoscopic Gastric Bypass is greatest in the first 12 months. After a few months, the pouch will continue to expand until it can hold what is necessary to maintain a healthy weight.

Because normal digestive juices are not present, the bypass does not tolerate food with fats, sugars, and starches well. A phenomenon know as “dumping” occurs when these “unhealthy” foods are eaten in large quantities or without eating enough protein at the same time. Dumping causes a rapid heart rate, nausea, sweating and a general feeling of illness.

As uncomfortable as this side effect is, this physically reinforced behavior modification actually works in your favor – promoting healthy post-surgery eating behavior.

The Laparoscopic Gastric Bypass is a powerful tool in the journey to successful weight loss. In order for this procedure to work in the long term however, you must be committed to changing you lifestyle completely – eating less, maintaining proper nutrition and exercising regularly.

Possible Risks and Complications
As you make a decision to undergo a laparoscopic gastric bypass, you need to consider not only the positive things it can do for you but also the risks. Please study these carefully. These risks and complications can include:

• Pulmonary Embolism
  A pulmonary embolus usually comes from a deep venous thrombosis or blood clot that forms in the veins of the pelvis. A part of the blood clot breaks away and goes up to the lungs, blocking blood returning to the heart. It can be fatal but occurs in less than 1% of patients who have weight loss surgery.
  
  Before surgery, we take every medical precaution possible to help prevent blood clots. First, when you are prepped an hour prior to surgery, we treat you with a blood thinner that guards against clotting. Second, you are fitted with pulse stockings for your legs that pneumatically “squeeze” the blood vessels in your legs – actually “bruising” your blood and helping to prevent clotting. Third, we get you out of bed four to five hours after surgery and make you walk. Except for about six hours in the middle of night for sleep, you will be required to walk every two hours for your entire stay in the hospital. This is very important. To help avoid a pulmonary embolism, you need to walk as much as you can while you are in the hospital and when you return home. These precautions are meant to minimize your risk of a pulmonary embolism, but it can still occur in rare cases.

• Blockage at a Site Where Tissue is Stapled or Sewn Together
  Blockage only occurs in about 2.5% of patients. When it does occur, it is usually caused by tissue swollen by surgery. Normally, this internal swelling will go down and doesn’t require re-operations. In rare cases, the patient will need to be re-operated on to open a blockage.

• Leakage From a Staple Line
  When leakage occurs, it will usually be within the first week post surgery. We test the staple line twice: once in the operating room and once the morning after surgery. We also leave a small drain in the area to catch any fluid that leaks out. This complication occurs in 1-4% of the patients who have weight loss surgery.

• Pneumonia
  This is an infection in the lungs resulting from collapsed air sacks. It occurs in less that 1% of patients. Patients must work hard on their walking, breathing and coughing exercises after surgery to help prevent pneumonia.

• Hernia
  A hernia is an opening in the muscle of your abdomen, which allows the intestines to come out underneath the skin. It appears as a large bulge under the skin. Hernias occur in patients undergoing laparoscopic surgery at a very low rate of about 1%. The incidence of hernias is much higher in “open” versus laparoscopic surgeries.

• Bleeding
  The most common problem with bleeding comes from the raw staple lines and occurs very rarely. This blood is passed out of the rectum with the stool. Almost all patients pass a little blood in their first few stools. Patients rarely need a blood transfusion from post-op bleeding, but it can occur. A second type of bleeding comes from bleeding into the abdomen outside of the intestine. This type of bleeding is extremely rare. Patients must stop any anti-inflammatory medications, herbal supplements, vitamins, and aspirin prior to surgery. We will review your medications with you prior to surgery to make sure you have stopped any medication that increases your risk of bleeding.

• Vomiting
  Almost all patients experience this complication but it’s usually more like “spitting up” than vomiting. If you begin having a persistent problem with this after surgery, you need to contact the office. Frequent vomiting is usually caused by eating too fast and not following the FOUR RULES:

1. When you eat, you will eat your protein first and finish it before you move on to any other food. Small bites and chew well, stop when you feel full.

2. Absolutely no snacking!!! If you must, make it protein.

3. You must exercise at least 5 times a week.

4. Drink at least 64 oz of water a day. Do not drink Soda!!!
   Not even diet.

• Hair Loss
  It will happen, usually between the 4th and 6th month.  It usually isn’t noticeable to anyone but you.  Nothing can really prevent the hair loss, but adequate protein intake will make it come back quicker and healthier than before

• Death
  The approximate risk of death is 0.5% of patients having weight loss surgery in the United States. This means that 1 in 200 patients will die this year having a weight loss procedure.

Laparoscopic Gastric Band

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Why the Procedure Works
The procedure works by limiting the amount of food a person can eat, and by slowing the flow rate of food from the upper part of the stomach into the lower part of the stomach. This lets you feel full sooner and helps the feeling last longer.

Possible Risks and Complications

• Gastric Perforation: 1% of patients in study
  Gastric perforation, or a tear in the stomach wall, can occur during or after the procedure and might lead to the need for another surgery. This occurs in about 1% of patients.
• Nausea and Vomiting: 51% of patients in study
  Nausea and vomiting may occur spontaneously, but are most often associated with eating too fast, eating too much or not chewing your food well.
• Gastroesophageal Reflux: 34% of patients in study
  Gastroesophageal reflux can occur after surgery, most often due to eating too fast or too much at a time.
• Band Slippage/Pouch Dilatation: 24% of patients in study
  Band slippage can occur, resulting in dilatation of the pouch above the band.
• Stoma Obstruction: 14% of patients in study
  Your stoma can become blocked at the outlet between the upper and lower stomach. This can be caused by:
        1. food
        2. swelling
        3. improper placement of the band
        4. band over inflation
        5. band or stomach slippage
        6. stomach pouch twisting
        7. stomach pouch enlargement
• Erosion of the band into the stomach
• Esophageal dilation: 11% of patients in study
  Esophageal dilatation may be caused by a number of things, including:
        1. Improper placement of the band
        2. Over-tightening of the band
        3. Stoma Obstruction
        4. Binge eating
        5. Excessive vomiting

There is also a risk for pulmonary embolism, and pneumonia, as with the gastric bypass. There is a 1 in 1,000 chance a person can die following gastric banding.