Roux en-Y Gastric Bypass

The Roux en-Y Gastric Bypass has long been considered the “gold standard” for obesity surgery; all other procedures are compared to this when establishing their effectiveness. It is primarily a “restrictive” procedure with some, minimal, malabsorption of digested food.

This operation accomplishes weight loss through satiety (fullness), achieved by a one to two ounce pouch created out of the old stomach. The small intestine is divided some 70 to 90 cm downstream from the stomach, and is reconnected to the stomach with a double-stapled anastomosis, which is buttressed with additional sutures. The other end of the bowel is reconnected to itself at point via a stapled anastomosis. Food flows from point to point, where it mixes with digestive enzymes from the stomach, liver and pancreas introduced by the body. These enzymes then work to break down food for digestion. The real key to weight loss is in the radically reduced volumes of food that can be eaten at any one meal. All of this is accomplished with very rare, if ever, sensations of hunger during the first year after surgery.

The result is a very early sense of fullness, followed by a very profound sense of satisfaction, on the most minimal meal volumes. Most patients are full on one to two ounce meal portions originally. After six months, they are satisfied with three to five ounce servings, still quite small. Even though the portion size may be small, there is rarely hunger, and no feeling of having been deprived. When truly satisfied, you feel indifferent to even the choicest of foods. Patients continue to enjoy eating – but they enjoy eating less volume.

The Gastric Bypass provides an excellent tool for gaining long-term control of weight. Now, without the hunger or craving usually associated with small portions or with dieting, It is entirely normal for patients to lose 75-100% of their excess weight, often as early as the first anniversary after surgery. Long-term success is dependent on accepting new rules for eating and food selection that will be taught in the follow-up period after surgery. Your new-found energy levels and activity interests will lead to increased planned exercise and a more active lifestyle.

This procedure may be performed either open (full, upper, midline incision) or as a minimally-invasive procedure (laparoscopic), depending on the patient preference and also upon individual, anatomical / technical considerations. On rare occasions, a planned laparoscopic procedure will have to be converted to an “open” procedure, for safety reasons. Both approaches have similar risks and complications; both have excellent long-term success potential.

Laparoscopic Adjustable Gastric Banding (Lap-Band®)

Gastric Banding with the Lap-Band® is a variation on the banded gastroplasty, in which the stomach is neither opened nor stapled—a band is placed around the outside of the upper stomach, and creates an hourglass-shaped stomach. It also produces a narrow, controlled and adjustable outlet that allows for management of the rate at which food travels from the upper to the lower stomach. Patients are satisfied with smaller meals that easily fill the small upper stomach. The Lap-Band® constriction causes food to slowly pass through the outlet and maintain stretch on the upper pouch – leading to a prolonged sense of fullness and lack of hunger. The Lap-Band® is made of a non-reactive, durable elastomer that can be surgically implanted during a relatively short laparoscopic procedure (less than an hour, on average). The inflation port, which is placed under the skin near but below the patient’s ribs, allows for periodic adjustments to the volume of the outlet; making it tighter, if weight loss is too slow, or looser, if weight loss is too fast. These adjustments can usually be done without hospitalization and always with the utmost of safety.

True advantages to the Lap-Band® are:

• It can almost always be inserted laparoscopically, without the usual large incision.
• It does not require any opening in the gastrointestinal tract, so infection risk is reduced.
• There is no staple line to come apart.
• It is adjustable.
• If necessary, it is reversible (Band can be removed).

This device has now been approved by the Food and Drug Administration (FDA) for use in the United States. One-hundred thousand have been implanted here and abroad, and the track record of safety is well-established.

This procedure may be particularly suited to persons of lower BMI (35-48), who may wish to have a quicker recovery, less risk, and the ability to undergo a surgical procedure without the obvious outward evidence of surgery. Most can return to work quickly, and dietary changes are less obvious. Although its effects may not be as profound or rapid as the gastric bypass, the risk of the procedure are less, and the recovery time is the shortest.

The Lap-Band® is also an excellent tool in the treatment of morbid obesity. In the latest study out of the journal of Obesity Surgery (Rubenstein, 2002), the average weight loss at three years was approximately 54%, range: 21-94%. The resolution of comorbidities (weight-related illness and injury) in the same interval, was similar to the Gastric Bypass procedure.

Sleeve Gastrectomy

The laparoscopic sleeve gastrectomy (SG) consists of making a stomach that looks like a pouch into a long tube, therefore the name “sleeve”. The new stomach can hold about 100 – 120 cc in volume, resulting in a restrictive weight loss. The SG preserves the pylorus, the valve that regulates emptying of the stomach, which acts as “nature’s band” and provides for the normal process of stomach emptying to continue and allows for the feeling of fullness. The remainder of the stomach is removed.

It can be done either as a standalone procedure or as part of a staged operation. The weight loss is projected to be in the range of 55 to 70& of excess body weight. There is no malabsorption created and no foreign body or implant involved. Long-term results are not yet available but early data suggests that the weight loss is close to that seen with gastric bypass.

StomaphyX Coming Soon!

This revolutionary procedure is now available for individuals who have had previous gastric bypass surgery and who are regaining weight; who want an alternative to invasive weight loss surgery. This procedure involves no incisions and in most cases, no recovery. It involves placing an endoscope through the mouth into the stomach pouch and suturing the connection between the stomach pouch and small intestines resulting in slower emptying of the stomach and earlier satiety and more weight loss. The procedure also shrinks the stomach pouch and makes it small like soon after the original gastric bypass procedure.

Benefits of the StomaphyX procedure include:

• No need for abdominal or internal surgical incisions.
• Enables the surgeon to reduce the size of the stomach.
• Preserves future treatment options.
• In most cases, is performed on an outpatient basis.
• Essentially painless.
• Faster recovery than with open or laparoscopic procedures.

The StomaphyX device is an endoluminal fastener and delivery system that consists of an ergonomic, flexible fastener delivery device and sterile polypropylene fastener implants.