Laparoscopic Sleeve Gastrectony
Roux-en-y Gastric Bypass
Biliopancreatic diversion ± duodenal switch
There are other options that are described as "new" procedures that are actually versions of old operations that did not work in the past but some surgeons are recommending these for obesity surgery. One such procedure has been called the "mini-gastric bypass". We do not perform this procedure due to many known documented problems.
Pure restrictive procedures lack the benefit of some malabsorption. The worry is that the long term weight loss will not be achieved. Also, in these procedures "foreign materials" are used (Gastric band). Erosion of these foreign materials, infection, and enlargement of the gastric pouch that is created are other potential complications. For certain patients this may be the only safe option but this is decided on a individual basis.
Pure malabsorptive procedures depend on the lack of absorption of the calories from the gut. While weight loss is achieved, the worry is that essential vitamins, minerals, and proteins will not be absorbed. Some of these procedures (Jejunoileal bypasses) are not performed today. In fact, many patients who have had this procedure have required reversal of the procedure due to complications.
Roux-en-y Gastric Bypass
The time-tested procedure to ensure the best chance of achieving a long lasting weight loss in patients is the Roux-en-y Gastric Bypass. The normal anatomy is altered to restrict the stomach, and to cause a more limited amount of malabsorption. Many bariatric surgeons consider this the "gold standard". Of course, some individuals will require different procedures for other reasons. It is important to discuss all options with your surgeon.
The procedure can be done both "open" or "minimally invasive". The minimally invasive approach is also known as the laparoscopic gastric bypass.
As shown below, small ports are place to perform the procedure. Using laparoscopic equipment, a connection between the stomach and small bowel is made. Also a new connection between the small bowel and small bowel is performed. The details of the operation are described in the video of procedure performed by Dr. Frantzides.
Performing a laparoscopic gastric bypass is an extremely technically challenging operation. Most surgeons are NOT trained to do this procedure. Some surgeons who do not have the laproscopic expertise try to perform "hand assisted" laparoscopic surgery. This involves a larger incision so the surgeon can place his/her hand in the abdomen. While this is easier for the surgeon, it has obvious disadvantages to the patient.
In the proper hands, the complication rates of true laparoscopic surgery should be better than that of open surgery. The laparoscopic surgery has all the advantages of minimally invasive surgery. Below the two procedures are compared:
|Small Incisions (most less than 1/4 inches).
Hospital stay is 1 to 2 days.
Patients usually return to work in 5 to 10 days.
Technically more difficult for surgeon.
Less chance of hernias.
Hospital stay of about 5 days.
Return to work in about 4 weeks.
Greater risk of infection
More chance of hernias.
Any operation that is planned to be done laparoscopically may have to be "converted" to an open operation. For this reason, you must be careful to choose a surgeon who is an expert in laparoscopic surgery.
Like any surgery, there are complications to a laparoscopic gastric bypass. While the overall complication rates are low, complications may occur. Many of these complications are similar to any operation on an obese patient. While complications should always be discussed between the patient and the surgeon, some of the complications include hernia, wound infection, heart attack, stroke, pulmonary embolism, abscess, and leak.
Complications of Laparoscopic Roux-en-Y Gastric Bypass" by Constantine T. Frantzides, MD, PhD, FACS, and Minh Luu, MD.
Success and Benefits
Although complications can occur, the benefits of surgery can outweigh the risk in the carefully selected patient. Recent studies have demonstrated that up to 80% of excess body weight can be lost. Also, 95% of co-morbidities (diseases related to obesity) can be controlled or cured.
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