• Simple and relatively safe
• Short recovery period
• Major complication rate is low
• No removal of any part of the stomach or intestines
• No altering of the natural anatomy
• Very short recovery periods

Disadvantages of this weight loss surgery:

• About 5% failure rate because of
  • Balloon leakage
  • Band erosion/migration
  • Deep infection
• Identifying patients who will not eat through the operation is difficult

For additional support and information about this surgery visit the Lap-Band? Forum

 2.Vertical Sleeve Gastrectomy (also called vertical Sleeve Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction and even Vertical Gastroplasty) is performed by approximately 15 surgeons worldwide. The originally procedure, conceived by Dr. D Johnston in England, was called The Magenstrasse and Mill Operation. It generates rapid weight loss by restricting the amount of food that can be eaten (removal of stomach or vertical gastrectomy) without any bypass of the intestines or malabsorption. The stomach pouch is usually made smaller than the pouch used in the Duodenal Switch.

 3. Vertical Banded Gastroplasty (VBG) (see figure 3) VBG uses both a band and staples to create a small stomach pouch, resulting in quick weight loss. Once the most common restrictive operation, VBG is not often used today.

Advantages: Restrictive weight loss surgeries are easier to perform and are generally safer than malabsorptive operations. AGB is usually done via laparoscopy, which uses smaller incisions, creates less tissue damage, and involves shorter operating time and hospital stays than open procedures. Restrictive weight loss surgeries can be reversed if necessary, and result in few nutritional deficiencies.

Disadvantages: Patients who undergo restrictive weight loss surgeries generally lose less weight than patients who have malabsorptive operations, and are less likely to maintain weight loss over the long term. Patients generally lose about half of their excess body weight in the first year after restrictive procedures. However, in the first 3 to 5 years after VBG patients may regain some of the weight they lost. By 10 years, as few as 20 percent of patients have kept the weight off. (Although there is less information about long-term results with AGB, there is some evidence that weight loss results are better than with VBG.) Some patients regain weight by eating high-calorie soft foods that easily pass through the opening to the stomach. Others are unable to change their eating habits and do not lose much weight to begin with. Successful results depend on the patient's willingness to adopt a long-term plan of healthy eating and regular physical activity.

Risks: One of the most common risks of restrictive operations is vomiting, which occurs when the patient eats too much or the narrow passage into the larger part of the stomach is blocked. Another is slippage or wearing away of the band. A common risk of AGB is breaks in the tubing between the band and the access port. This can cause the salt solution to leak, requiring another operation to repair. Some patients experience infections and bleeding, but this is much less common than other risks. Between 15 and 20 percent of VBG patients may have to undergo a second operation for a problem related to the procedure. Although restrictive operations are the safest of the bariatric procedures, they still carry risk in less than 1 percent of all cases, complications can result in death.

Because combined weight loss surgeries result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.

Combined Restrictive/Malabsorptive Weight Loss Surgeries

Combined operations are the most common bariatric procedures. They restrict both food intake and the amount of calories and nutrients the body absorbs.

1. Roux-en-Y Gastric Bypass (RGB)This operation is the most common and successful combined weight loss surgery in the United States. First, the surgeon creates a small stomach pouch to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This reduces the amount of calories and nutrients the body absorbs. Rarely, a cholecystectomy (gall bladder removal) is performed to avoid the gallstones that may result from rapid weight loss. More commonly, patients take medication after the operation to dissolve gallstones. 

 

Note (figure 4): This is the RNY without the stomach being transected or divided. This type RNY is not widely done anymore. Most surgeon perform the RNY with the stomach divided with no staple line. Transected means: stomach is completely separated from the new stomach

For additional support and information about this surgery visit the Roux-en-Y Forum
 

Advantages: Most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure. With the Roux-en-Y gastric bypass, many patients maintain a weight loss of 60 to 70 percent of their excess weight for 10 years or more. With BPD/DS, most studies report an average weight loss of 75 to 80 percent of excess weight. Because combined operations result in greater weight loss than restrictive operations, they may also be more effective in improving the health problems associated with severe obesity, such as hypertension (high blood pressure), sleep apnea, type 2 diabetes, and osteoarthritis.

Disadvantages: Combined procedures are more difficult to perform than the restrictive procedures. Such weight loss surgeries are also more likely to result in long-term nutritional deficiencies. This is because these weight loss surgeries causes food to bypass the duodenum and jejunum, where most iron and calcium are absorbed.

Menstruating women may develop anemia because not enough vitamin B12 and iron are absorbed. Decreased absorption of calcium may also bring on osteoporosis and related bone diseases. Patients must take nutritional supplements that usually prevent these deficiencies. Patients who have the biliopancreatic diversion procedure must also take fat-soluble (dissolved by fat) vitamins A, D, E, and K supplements.

RGB and BPD operations may also cause “dumping syndrome,” an unpleasant reaction that can occur after a meal high in simple carbohydrates, which contain sugars that are rapidly absorbed by the body. Stomach contents move too quickly through the small intestine, causing symptoms such as nausea, bloating, abdominal pain, weakness, sweating, faintness, and sometimes diarrhea after eating. Because the duodenal switch operation keeps the pyloric valve intact, it reduces the likelihood of dumping syndrome.

Risks with these weight loss surgery procedurs:In addition to risks associated with restrictive procedures such as infection, combined operations are more likely to lead to complications. Combined operations carry a greater risk than restrictive operations for abdominal hernias (up to 28 percent), which require a follow-up operation to correct. The risk of hernia, however, is lower (about 3 percent) when laparoscopic techniques are used.

As with any surgery, there can be complications. This list can include:

• Deep vein thrombophlebitis

• Non-fatal pulmonary embolus

• Pneumonia

• Acute respiratory distress syndrome

• Splenectomy

• Gastric leak and fistula

• Duodenal leak

• Distal Roux-en-Y leak

• Postoperative bleeding

• Duodenal stomal obstruction

• Small bowel obstruction

• Death

Laparoscopic Bariatric Surgery
In laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. Patients who are super-obese (more than 350 pounds) or have had previous abdominal operations may not be good candidates for laparoscopy, however. Adjustable gastric banding is routinely performed via laparoscopy. 

This technique is often used for Roux-en-Y gastric bypass, and although less common, biliopancreatic diversion can also be performed laparoscopically. The small incisions result in less blood loss, shorter hospitalization, a faster recovery, and fewer complications than open operations. However, combined laparoscopic procedures are more difficult to perform than open procedures and can create serious problems if done incorrectly.

Weight Loss Surgery for Adolescents
With rates of overweight among youth on the rise, weight loss surgery is sometimes considered as a treatment option for adolescents who are severely overweight. However, there are many concerns about the long-term effects of weight loss surgery on adolescents’ developing bodies and minds. Experts in pediatric overweight and bariatric surgery recommend that surgical treatment only be considered when adolescents have tried for at least 6 months to lose weight and have not been successful. Candidates for weight loss surgery should be severely overweight (BMI of 40 or more), have reached their adult height (usually 13 or older for girls, 15 or older for boys), and have serious weight-related health problems such as type 2 diabetes or heart disease. In addition, potential patients and their parents should be evaluated to see how emotionally prepared they are for the operation and the lifestyle changes they will need to make. Patients should also be referred to a team of experts in adolescent medicine and bariatric surgery who are qualified to meet their unique needs.

Benefits of Surgical Weight Loss

• High Blood Pressure can often be alleviated or eliminated by weight loss surgery
• High Blood Cholesterol in 80% of patients can be alleviated or eliminated and in as little as 2-3 months post-operatively.
• Heart Disease in obese individuals is certainly more likely to be experienced when compared to persons who are of average weight and adhere to a strict diet and exercise regimen. There is no hard and fast statistical data to definitively prove that weight loss surgery reduces the risk of cardiovascular disease, however, common sense would dictate that if we can significantly reduce many of the co-morbidities that we experienced as someone that is obese, we can likewise that our health may be much improved if not totally restored.
• Diabetes Mellitus can usually helped and based upon numerous studies of diabetes and the control of its complications, it is likely that the problems associated with diabetes will be arrested in their progression, when blood sugar is maintained at normal values.
• Abnormal Glucose Tolerance, or Borderline Diabetes is even more likely reversed by gastric bypass. Since this condition becomes diabetes in many cases, the operation can frequently prevent diabetes, as well.
• Asthma sufferers may find that they have fewer and less severe attacks, or sometimes none at all. When asthma is associated with gastroesophageal reflux disease, it is particularly benefited by gastric bypass.
• Sleep Apnea Syndrome sufferers can receive dramatic effects and many within a year or so of surgery find their symptoms were completely gone, and they had even stopped snoring completely!
• Gastroesophageal Reflux Disease can be greatly relieved of all symptoms within as little as a few days of surgery.
• Gallbladder Disease can be surgically handled at the time of the weight loss surgery if your doctor has cause to believe that gallstones are present.
• Stress Urinary Incontinence responds dramatically to weight loss, usually by becoming completely controlled. A person who is still troubled by incontinence can choose to have specific corrective surgery later, with much greater chance of a successful outcome, with a reduced body weight.
• Low Back Pain and Degenerative Disk Disease, and Degenerative Joint Disease can be considerably relieved with weight loss, and greater comfort may experienced even after as few as 25 lost pounds.

Weight loss surgery is a highly personal decision; it is also a medical decision. Your doctor should discuss the risks and help you measure the probability of benefits so that you can make an informed decision

Always get the advice from your attending surgeon on the best surgical option for you. Information provided here is to give an understanding on the different surgery types available. Obesity Help strives to be the top weight loss site on the Web by providing you with helpful and complete information about weight loss surgery, but the advice of your attending surgeon should always supercede anything you learn here.