Weight-loss surgery (also known as bariatric or gastric bypass surgery) is a procedure on the stomach and/or intestines to help a patient with severe obesity to lose weight. It is a surgical procedure that should generally be used for people who have a body mass index (BMI) above 40. Surgery is advisable for people with a BMI between 35 and 40 who also suffer from life-threatening health problems.*
Understanding the issues associated with weight-loss surgery begins with fully educating yourself about severe obesity, including its causes and potential effects on your health, your lifestyle and the people around you.
For us at Chilton Memorial Hospital, it's important to make sure that you as a patient know as much as you can about weight-loss surgery, so that you can make an informed decision about whether it's right for you.
- Roux-en-Y Gastric Bypass (RGB) Surgery
Roux-en-Y Gastric Bypass (RGB) surgery is generally considered to be the gold standard surgical procedure for the treatment of severe obesity. In recent years, it has been the most common weight-loss surgery procedure in the United States.
In this operation, a small stomach pouch is created to restrict food intake. The capacity of the stomach is reduced to only about 30 cc (equivalent to two tablespoons) by stapling a line across the stomach with a special device. About 90 percent of the stomach is outside of, or below, the staple line and is therefore isolated from the food and beverages you consume.
In addition, a Y-shaped section of the small intestine (about 50-100 cm) is attached to the new stomach pouch to allow food to bypass the lower stomach, as well as the duodenum (the first part of the small intestine) and the first part of the jejunum (the second part of the small intestine).
The severely reduced size of the stomach in combination with the narrow diameter (1 cm) of the connection between the newly created pouch and the small intestine significantly limit the patient's ability to eat large meals after the operation. This effect typically causes patients to lose 75 percent of their excess body weight during the first 18-24 months after surgery.- Laparoscopic Gastric Bypass
- Laparoscopy is a surgical technique using a small camera (or laparoscope) placed in the abdomen. Originally, the laparoscope was used during surgical removal of the gallbladder (laparoscopic cholecystectomy) and appendix (laparoscopic appendectomy). Laparoscopy is often used for hernias, heartburn and many other problems, as well as for diagnostic purposes to view the abdomen after trauma and in cases of abdominal illness.
The laparoscope permits physicians to perform minimally invasive surgery through several very small incisions in the abdomen. The technique is known as laparoscopic-assisted surgery or simply laparoscopic surgery. It can enable the removal of the colon, the kidney (such as for living donors in kidney transplants) and weight reducing procedures such as gastric bypass and Adjustable Gastric Banding(AGB).
The advantages of the laparoscopic approach to weight-loss surgery are less pain, shorter recovery, faster return to normal life activities and reduced risk of complications.
- Gastric Banding
There are several choices in gastric-restrictive operations.
- Adjustable Gastric Banding (AGB)
- In adjustable gastric banding, a hollow band is placed around the stomach near its upper end, creating a small pouch and a narrow passage into the larger, lower portion of the stomach (Figure 2). The band is then inflated with a saline solution. It can be tightened or loosened, as needed, over time to change the size of the passage by simply increasing or decreasing the volume of the saline solution.
- Benefits & Risks
- Although gastric-restrictive operations do lead to weight loss in virtually every patient, they are less successful than so-called "restrictive-malabsorptive" operations in achieving substantial, long-term weight loss.
While about 80 percent of those who undergo ABG generally lose weight, only 30 percent achieve normal weight. Some patients eventually even regain weight. Others are unable to adjust their eating habits and fail to lose the desired weight. Successful results depend on the patient's willingness to adopt a long-term plan of healthy eating and exercise. Recent studies comparing ABG to Roux-en-Y gastric bypass demonstrated greater weight loss with the bypass procedure.
Vomiting is often caused when the small stomach is overly stretched by food that has not been chewed adequately. Other risks may include band slippage and saline leakage after AGB.
Although AGB is a significantly easier procedure, the weight-loss results achieved by AGB are less consistent than those from gastric bypass.
Infection or death from complications occur in less than one percent of all gastric banding patients.
For more information about any of these weight-loss procedures, please call 1-888-CHILTON (244-5866).
