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​Surgical Options

Types of Weight Loss Surgery

The American Society for Metabolic and Bariatric Surgery describes two approaches to weight loss surgery:

  • Restrictive procedures that decrease food intake
  • Malabsorptive procedures that alter digestion, thus causing food to be incompletely absorbed and eliminated in the stool

The MultiCare Rockwood Weight Loss Surgery Center offers three different types of procedures that incorporate both of these approaches.

Roux-en-Y Gastric Bypass

This procedure combines both restrictive and malabsorptive approaches. According to the American Society for Metabolic and 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.

How It Works

In this procedure, a small stomach pouch is created by stapling part of the stomach shut, which restricts food intake. The newly formed pouch is then modified to empty directly into a Y-shaped section of the small intestine, thus bypassing parts of the digestive tract where calories would normally be absorbed. The length of this segment of the intestine can be adjusted to increase or decrease malabsorption. A malabsorptive approach results in an early sense of fullness and satisfaction that reduces the desire to eat.

Advantages

  • The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
  • One year after surgery, weight loss can average 77 percent of excess body weight.
  • Studies show that after 10 to 14 years, 50–60 percent of excess body weight loss has been maintained by some patients.
  • A 2000 study of 500 patients showed that 96 percent of certain health conditions associated with obesity, such as back pain, sleep apnea, high blood pressure, diabetes and depression, were improved or resolved.

Potential Risks and Drawbacks

  • Poor absorption of iron and calcium can result in low amounts of iron in the body and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis, should be aware of the potential for heightened bone calcium loss.
  • Nutrient deficiencies can cause some patients to develop metabolic bone disease, resulting in pain, loss of height, humped back and fractures of the ribs and hip bones. However, these deficiencies can be managed through taking diet and vitamin supplements.
  • Chronic anemia due to vitamin B12 deficiency may occur. The problem can usually be managed with vitamin B12 pills or injections.
  • A condition known as dumping syndrome can occur when the stomach contents empty too rapidly into the small intestine. This can be triggered by eating too much food, particularly foods high in sugar. While not considered to be a serious health risk, the symptoms of dumping syndrome can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
  • In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched or if it is left larger than 15–30 cubic centimeters.
  • The bypassed portion of the stomach, the duodenum and segments of the small intestine, cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

Laparoscopic Surgery

For the last decade, laparoscopic procedures (minimally invasive procedures) have been used in a variety of general surgeries. In fact, laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for a number of years.

MultiCare Rockwood Weight Loss Surgery Center performs two laparoscopic weight loss procedures:

  • Adjustable Gastric Band: Gastric banding is one of the least invasive approaches to obesity because neither the stomach not the intestine is cut. Laparoscopically placed around the upper part of the stomach, the band divides the stomach into a small upper pouch above the band and a larger pouch below the band. This small pouch limits the amount of food that a patient can eat at any one time, and will result in a feeling of fullness after eating a small amount of food. Because the band is adjustable and does not permanently alter the anatomy, it provides an option for patients who may not otherwise consider surgery for treatment of their obesity. Other advantages include a shorter hospital stay and no effects on the absorption of nutrients.
  • Sleeve Gastrectomy: A sleeve gastrectomy is a restrictive surgical weight loss procedure that reduces the size of your stomach. During this procedure, a thin vertical sleeve of stomach is created using a stapling device, and the rest of the stomach is removed. This procedure limits the amount of food you can eat and helps you feel full sooner. Because food does not bypass any of the intestines, there is no malabsorption. Since this procedure removes most of your stomach, the “appetite hormone” created by the stomach is reduced and hunger is reduced.

How It Works

When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures.

The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. The American Society for Metabolic and Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.

Advantages

  • Laparoscopic procedures employ the same principles as their "open" counterparts and produce similar levels of weight loss.
  • A recent study shows that patients who have had laparoscopic weight loss surgery experience less pain afterward, resulting in improved lung function and higher overall oxygen levels.
  • There are fewer wound complications such as infection or hernia with laparoscopic procedures.
  • Patients return more quickly to pre-surgical levels of activity when laparoscopic procedures are performed versus other procedures.

Potential Risks and Drawbacks

  • Not all patients are candidates for this approach.
  • Not all bariatric surgeons are trained in the advanced techniques required to perform this less invasive surgical method.