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Weight Loss Surgery - Surgical Treatment Options

Learn about the various Surgical Weight Loss Treatment Options:

 

     

Laparoscopic surgery is a modern, minimally-invasive surgical technique that uses multiple small (1/4-1/2 inch) incisions, special long-handled instruments, and a small videocamera (laparoscope) to perform abdominal surgery.  The abdomen is insufflated with carbon dioxide gas which provides a safe working space, and the procedure is visualized on a video monitor.  This is in contrast to traditional "open" abdominal surgery which involves larger incisions and traditional surgical instruments.  There are numerous advantages to laparoscopic surgery:

 
  • Smaller scars
  • Less bleeding
  • Less post-operative pain
  • Shorter hospital stay
  • Faster return to work
  • Lower risk of wound complications
 

 
Roux-en-Y Gastric Bypass
 
The Roux-en-Y gastric bypass is the most common weight-loss surgery in the United States and has been utilized in various forms since the 1960’s.  It is a major abdominal surgery involving permanent anatomic rearrangement of the gastrointestinal tract and is usually performed laparoscopically.  The gastric bypass causes weight loss by limiting the amount of food one can eat (restriction) and by reducing the amount of food that is absorbed by the intestines (malabsorption).
 
The gastric bypass does not guarantee weight loss.  Rather, it is a powerful tool that patients may use to help lose weight and improve their health.  Successful weight loss requires intense life-long efforts to adopt healthy eating habits and a regular exercise program, as well as regular office visits for follow-up.  With the proper motivation and significant lifestyle changes, patients may lose up to 50-80% of their excess body weight with the gastric bypass.  This weight loss is very rapid, especially within the first 3-6 months.  The patient’s weight generally stabilizes between 12 and 18 months after surgery and most patients are able to maintain this weight loss long-term.  
 

Weight Loss Surgery - Gastric Bypass from Sibley Hospital on Vimeo.

Illustrated explanation of gastric bypass surgery at the Sibley Center for Weight Loss Surgery in Washington DC

 
It is also important to remember that weight loss is not the only goal of surgery.  Some of the other major benefits of gastric bypass include:
 
  • Resolution or improvement of most weight-related medical problems, especially type 2 diabetes which resolves over 80% of the time
  • Improved quality of life
  • Reduced health care costs
  • Increased life expectancy
 
Bariatric surgery is major abdominal surgery and there are always risks involved.  Some of the potential risks or complications associated with gastric bypass include:
 
  • Leaks from staple lines may result in infection or death
  • Anastomotic strictures may lead to stomal obstruction and vomiting
  • Internal hernias can cause small bowel obstructions 
  • Marginal ulcers can cause pain or bleeding
  • Dumping syndrome which is a reaction to eating sweets and symptoms may include nausea, abdominal pain, diarrhea, sweating, or weakness
  • Nutritional deficiencies may result if patients are not compliant with long-term nutritional supplementation and follow-up
  • Weight regain may result if patients are not compliant with long-term follow-up, diet, and exercise
  • Mortality risk of approximately 0.5%
 
To learn more about laparoscopic gastric bypass as well as other weight-loss surgery options, please attend one of our free patient education seminars.
 

 
  • REALIZE Band
  • LAP-BAND
 
Laparoscopic adjustable gastric banding is a procedure which involves the placement of an adjustable prosthetic device around the stomach.  This procedure has become an increasingly popular form of weight loss surgery in the United States since its approval by the Food and Drug Administration in 2001, though the procedure has been available outside of the U.S. since the early 1990s.   There are currently two different devices available in the U.S., the REALIZE Band and the LAP-BAND, both of which are utilized at Sibley.  
 
The adjustable gastric band causes weight loss by limiting the amount of food one can eat (restriction) and by reducing appetite.  The level of restriction is customized by performing periodic band adjustments or "fills" in the office, where a small amount of saline is injected into the implanted port just under the skin. 
 
The adjustable gastric band does not guarantee weight loss.  Rather, it is a powerful tool that patients may use to help lose weight and improve their health.  Successful weight loss requires intense life-long efforts to adopt healthy eating habits and a regular exercise program, as well as regular office visits for adjustments and follow-up.  With the proper motivation and significant lifestyle changes, patients may lose up to 50-60% of their excess body weight.  Typically, weight loss after gastric banding is very gradual, and the desired goal rate of weight loss is 1-2 lbs per week during the first year.  Weight loss after banding may continue for up to 3-4 years after surgery and most patients are able to maintain this weight loss long-term.
 

Weight Loss Surgery - Gastric band from Sibley Hospital on Vimeo.

Illustrated explanation of Gastric band surgery for weight loss at the Sibley Center for Weight Loss Surgery in Washington, DC.

It is also important to remember that weight loss is not the only goal of surgery.  Some of the other major benefits of adjustable gastric banding include:
 
  • Adjustability - It is the only major weight-loss surgery that is adjustable.
  • Reversibility - While it is intended for long-term use, the band can be removed surgically, if necessary.
  • Lowest mortality rate of any major weight-loss surgery
  • Resolution or improvement of most weight-related medical problems
  • Improved quality of life
  • Reduced health care costs
  • Increased life expectancy
 
Bariatric surgery is major abdominal surgery and there are always risks involved.  Some of the potential risks or complications associated with adjustable gastric banding include:
 
  • Slippage of the band
  • Erosion of the band into the stomach wall
  • Device malfunction (tubing disconnection, leaking, etc.)
  • Dilated stomach pouch if the band is too tight for a prolonged period
  • Failure to lose weight or weight regain may result if patients are not compliant with long-term follow-up, diet, and exercise
  • Mortality risk of less than 0.1%
 
To learn more about laparoscopic adjustable gastric banding as well as other weight-loss surgery options, please attend one of our free patient education seminars.
 

 
 
The laparoscopic sleeve gastrectomy is a newer procedure involving the resection or removal of most of the outer portion of the stomach, which leaves a narrow tube or sleeve-shaped stomach.  It was originally used in conjunction with an additional weight-loss surgery in extremely obese patients, but more recently, it has been shown to be very successful as a primary procedure.  It causes weight loss by decreasing stomach size and limiting the amount of food one can eat (restriction).  Additionally, the production of a hunger hormone (Ghrelin) is significantly reduced which decreases appetite.
 
The sleeve gastrectomy does not guarantee weight loss.  Rather, it is a powerful tool that patients may use to help lose weight and improve their health.  Successful weight loss requires intense life-long efforts to adopt healthy eating habits and a regular exercise program, as well as regular office visits for follow-up.  With the proper motivation and significant lifestyle changes, sleeve gastrectomy patients may lose up to 50-80% of their excess body weight.  This weight loss tends to be rapid with most of that weight loss occurring within the first year.  
 
It is also important to remember that weight loss is not the only goal of surgery.  Some of the other major benefits of sleeve gastrectomy include:
 
  • Resolution or improvement of most weight-related medical problems
  • Improved quality of life
  • Reduced health care costs
  • Increased life expectancy
 
Bariatric surgery is major abdominal surgery and there are always risks involved.  Some of the potential risks or complications associated with sleeve gastrectomy include:
 
  • Leaks from staple lines may result in infection or death
  • Staple line strictures may lead to obstruction and vomiting
  • Bleeding
  • Reflux
  • Lack of long-term data though short and mid-term data demonstrate very good results and low complication rates
  • Weight regain may result if patients are not compliant with long-term follow-up, diet, and exercise
  • Mortality risk of approximately 0.2%
 
To learn more about laparoscopic sleeve gastrectomy as well as other weight-loss surgery options, please attend one of our free patient education seminars.
 

 

Although most patients who undergo bariatric surgery have an uneventful procedure and recovery period, complications can and do occur.  Your weight, age, and medical history play a significant role in determining your specific risks.  As a patient considering weight loss surgery, it is your responsibility to understand the role and risks of this surgery.  Some additional complications that can occur with bariatric surgery include but are not limited to the following:
 
  • Conversion to open surgery
  • Injury to other abdominal organs
  • Deep vein thrombosis (DVT) or blood clots
  • Pulmonary embolism (PE)
  • Bleeding
  • Wound infection
  • Respiratory complications / pneumonia
  • Cardiac complications / heart attack
  • Stroke
  • Nausea and vomiting
  • Dehydration
  • Constipation
  • Diarrhea
  • Inadequate weight loss
  • Weight regain
  • Incisional hernia
  • Bowel obstruction
  • Micronutrient deficiencies
  • Excess skin folds
  • Gallstones
  • Chronic pain
 
Bariatric surgery and pregnancy
Due to possible nutritional risks for a developing fetus, pregnancy should be strictly avoided by women of reproductive age during the first year following bariatric surgery.    Additionally, weight loss can result in increased fertility in women previously thought to be infertile so contraception or abstinence must be used in that first year.  However, oral contraceptives should be avoided from one month before until one month after surgery to reduce the risk of blood clots.  Healthy bariatric surgery patients can have successful pregnancies but must consult with their obstetrician and their bariatric surgeon for any special care that may be necessary.

Join us at one of our upcoming free weight loss surgery seminars. Click here to view the schedule or call (202) 370-6565 for more information.
 
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