Weight Loss Surgery Options

Several factors determine if you are a candidate for bariatric surgery or non-surgical weight loss guidance. During your first consultation, they will discuss options that are appropriate for you.

The surgical weight loss solutions are:

Combined Restrictive and Malabsorptive Procedure

In recent years, a better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum to bring it up and construct a connection with the newly formed stomach pouch. The other end is connected to the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages

• Rapid initial weight loss

• Resolution of co-morbidities (obesity-related health issues)

• Decreased hunger

• Laparoscopic approach

• Longer experience in the USA

Disadvantages

• Stomach cutting, stapling and intestinal re-routing required

• Portion of the digestive tract is bypassed, resulting in lifetime nutritional monitoring

• Non-adjustable

“Dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much refined sugar or foods that are high in fat are consumed.  The results can be extremely unpleasant and can include heart palpitations, nausea, weakness, sweating and fatigue.

Alternative to a Roux-en-Y Gastric Bypass

The Vertical Sleeve Gastrectomy is a laparoscopic procedure that generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically. About 85 percent or more of the stomach is removed. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from two to four ounces. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the function of the stomach while drastically reducing the volume. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potential long-term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.

The Vertical Gastrectomy is a reasonable alternative to a Roux-en-Y Gastric Bypass for a number of reasons:

• Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and protein deficiency is minimal

• The pylorus is preserved so dumping syndrome does not occur or is minimal

• There is no intestinal obstruction since there is no intestinal bypass

• It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur

• The limited two-year and six-year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data (see Lee, Jossart, Cirangle Surgical Endoscopy 2007)

You and your surgeon will determine the right procedure to fit your needs.

Vertical Sleeve Gastrectomy Advantages

• Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, in small amounts

• Eliminates the portion of the stomach that produces the hormones that stimulate hunger (Ghrelin)

• Dumping Syndrome is avoided or minimized because the pylorus is preserved

• Minimizes the chance of an ulcer occurring

• By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.

• Very effective as a first-stage procedure for high BMI patients (BMI > 55)

• Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures

• Appealing option for people who are concerned about the foreign body aspect of Banding procedures

 Vertical Sleeve Gastrectomy Disadvantages

• Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass

• Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Remember, two stages may ultimately be safer and more effective than one operation for high BMI patients. Be sure to discuss your options with your surgeon

• Soft calories such as ice cream, milkshakes, etc. can be absorbed and may slow weight loss

• This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur

• Because the stomach is removed, it is not reversible. However, if maximum weight loss is not achieved it can be converted to a Gastric Bypass

Duodenal Switch

Bariatrics at Halifax Health has the top-rated bariatric surgeons in Volusia county. The program at East Coast Bariatrics is unlike any other in our area as our focus is to provide support for you before, during and after bariatric surgery. We are one of the only programs in Volusia county to offer four surgical weight loss procedures that are all noninvasive.

The Duodenal Switch is a procedure where part of the stomach is removed and re-routed to the digestive tract. For this procedure, almost 70% of the stomach is removed, as well as the duodenum.  A long portion of your small intestine is rerouted into two pathways.  The shorter pathway takes food from the stomach to a common channel. The longer pathway carries bile from the liver to the common channel.  The objective is to reduce the amount of time the body has to capture calories and to selectively limit the absorption of fat.  The result is that your body will only be able to absorb around 20% of the fat you would normally intake. As with all surgeries, there is a chance for complications, however, the risk is very low and can be detected and treated with routine post-operative care.

The majority of obesity related health issues and co-morbidities can be greatly reduced, if not eliminated.

• Sleep Apnea up to 99% improved or resolved

• Hypertension up to 95% improved

• Diabetes up to 95% improved or resolved

• Arthritis up to 85% improved

• Hyperlipidemia up to 95% improved

• Gastroesophageal Reflux up to 99% resolved

• Asthma improved

• Depression improved, medications will be stopped or adjusted