About Bariatric Surgery

Bariatric surgery is a term derived from the Greek words: weight and treatment. In simple terms, bariatrics concerns the causes, prevention and treatment of severe overweight, a condition known as obesity. Bariatric operations are major gastrointestinal procedures which alter the capacity and/or the anatomy of the digestive system. Some bariatric procedures are performed using general anesthesia via a midline abdominal incision. Some bariatric surgeons also use laparoscopic surgical techniques, involving smaller instruments connected to cameras through which they view the operational site. Bariatric weight loss surgery fall into three general categories:

• Restrictive procedures, like Lap Band®, which make the stomach smaller to limit the amount of food intake. Currently, most obesity clinics and bariatric centers favor the Lap Band adjustable gastric banding procedure and the Proximal Roux-en-Y Gastric Bypass.
• Malabsorptive techniques, which reduce the amount of intestine that comes in contact with food so the body absorbs fewer calories.
• Combination operations, - such as Roux-en-Y gastric bypass which employ both restriction and malabsorption.  Combination operations reduces stomach capacity and bypasses the upper part of the small intestine, causing a reduction in the number of calories and nutrients which the body absorbs. Stomach bypass operations differ in both how the stomach is sectioned (stapling, banding or gastrectomy), and how much of the duodenum and jejunum are bypassed.

Gastric Bypass Operations

• Create a small stomach pouch to restrict the amount of food you can eat.
• Construct a bypass of the duodenum and other parts of the small intestine to cause malabsorption.

• Roux-en-Y Gastric Bypass (RGB). This is the most common bariatric procedure. First, we create a small stomach pouch with staples or a vertical band. This restricts food intake. Then, we attach a Y-shaped section of the small intestine to the pouch to allow food to bypass the first and second segments of the small intestine. This reduces your body's ability to absorb nutrients and calories.

• DISTAL Gastric Bypass (Duodenal Switch, Biliopancreatic Division). In this procedure, a portion of the stomach is removed. The remaining small pouch is then directly connected to the last portion of the small intestine. The risk for nutritional deficiencies is highest with this procedure.

Restriction Operations

There are two types of restrictive operations: 

• Gastric banding ("lapband"). A band of special material is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach.

• Vertical banded gastroplasty. This common procedure creates the pouch with both a band and staples.

Restriction Operations are the least commonly performed. They encourage weight loss in two ways:

• Reduce the amount of food you can eat. We shrink your stomach by creating a small pouch at the top of the stomach where food enters from the esophagus. This makes it impossible for you to each much. At first, the pouch only holds about 1 ounce of food. It expands to hold 2-3 ounces over time.

• Slow the speed food empties from your stomach. The lower outlet of the pouch is only about 1/4 inch in diameter. Because it's so small, food empties slowly and you feel full longer.

Comparing the Weight Loss Procedures

• Patients generally have more success with gastric bypass operations than restrictive procedures.
• Risks are similar for both restrictive and gastric bypass procedures. Except the risk of nutritional deficiencies for iron, calcium, and Vitamin B12-are higher in patients who undergo gastric bypass operations. Also, there is risk of intestinal leaking.
• Gastric bypass operations also may cause "dumping syndrome." This is when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness, and sometimes diarrhea.

Open Vs. Laparoscopic Surgery 

Open and laparoscopic refer to how abdominal cavity is entered and not the type of surgery being performed. So each type of weight loss surgery may be performed as either an open or a laparoscopic procedure.

When performing open surgery, surgeons create a single incision to open the abdomen for the operation. Typically, for women it is 4 1/2 to 6 inches, and for men, it is 5 1/2 to 7 inches.

With laparoscopic surgery, multiple, small incisions are made in the abdominal wall to accommodate a small video camera and surgical instruments. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them a better view and access to key structures.

• Less pain after surgery
• Easier breathing and lung function
• Fewer wound complications such as infection or hernia
• Quicker return to pre-surgical levels of activity