Bariatric Surgery General Information
Bariatric surgery can be an effective part of a treatment plan for weight loss. Learn more about the general facts of bariatric surgery in the interview below with Dr. Alexander Ramirez, a general surgeon at Tallahassee Memorial HealthCare.
How Gastric Bypass Surgery Works
Gastric bypass is a restrictive surgery technique that also alters the digestive process. The surgery restricts food intake by creating a smaller stomach pouch. It alters the body's normal digestive process by decreasing the amount of calories and nutrients the body is able to absorb. After surgery, food bypasses a large part of the stomach and most of the small intestine.
The Gastric Bypass Procedure
Gastric bypass surgery can be performed as an open procedure or a laparoscopic (minimally invasive) procedure. Laparoscopic surgery is performed using small incisions. This usually means a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. Most surgeons prefer the laparoscopic approach.
First the surgeon creates a small stomach pouch. Then a section of the small intestine is attached directly to the pouch. This causes food to bypass a portion of the small intestine, where calories and nutrients are absorbed. Having a smaller stomach pouch causes you to feel full sooner and eat less food. Gastric bypass patients report an early sense of fullness and satisfaction that reduces the desire to eat.
One study found, following laparoscopic gastric bypass, patients were able to leave the hospital after 3 days and return to work after 21 days.
How a Gastric Sleeve Works to Help You Lose Weight
During this procedure a thin, vertical sleeve of stomach is created and the rest of the stomach is removed. The sleeve is about the size of a banana. This procedure limits the amount of food you can eat and helps you feel full sooner. It allows for normal digestion and absorption. Food consumed passes through the digestive tract in the usual order allowing it to be fully absorbed in the body.
The majority of gastric sleeve procedures performed today use a laparoscopic (minimally invasive) technique. Laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures.
The length of time of the surgery varies. One study found that the average operative time was 1.5 to 3.5 hours and the average hospital stay was 2 to 5 days. Patients usually return to normal activities in 2 weeks and are fully recovered in 3 weeks.
One-Step and Two-Step Gastric Sleeve Procedure
Gastric sleeve procedure can be the first step before gastric bypass or it can be a single procedure for weight loss. If it is used as part of a two-step procedure, the first step is for the surgeon to create the small stomach "sleeve." After a period of time determined by the surgeon, another procedure would be done in which the surgeon attaches a section of the small intestine directly to the stomach pouch. This allows food to bypass a portion of the small intestine. This causes your body to absorb fewer calories and consume less food.
The two-step procedure may be done because patients may not be able to tolerate both procedures during a single operation. Studies show the two-step procedure has been used successfully in patients with a body mass index greater than 50 or in high-risk patients.
How Adjustable Laparoscopic Banding Surgery Works
During the adjustable laparoscopic banding (gastric band) procedure, a band is placed around the uppermost part of the stomach, dividing it into two parts: a small upper pouch and a lower stomach. The upper pouch can hold about 4 ounces (1/2 cup) of food. This causes you to eat less food at one time, feel full sooner, and feel satisfied longer. The goal of this surgery is to help you lose weight gradually, at a rate of 1 to 2 pounds per week.
No part of your stomach is stapled or removed during surgery, and your intestines are not rerouted, so you can continue to absorb nutrients from food.
The REALIZE Band
Our gastric band surgeons Dr. Crooms and Dr. Sieloff most often use the REALIZE Band for procedures. This band is made entirely of biocompatible materials, so it can be placed inside your body without causing harm. The side of the REALIZE Band that fits against your stomach is lined with a soft balloon. After the gastric banding surgery, saline (a safe fluid) is delivered into the balloon to control the band tightness.
The band is adjustable and the degree of band tightness affects how much food you can eat during a meal and the length of time it takes for food to empty from the upper pouch. After the surgery your body will stop storing excess calories and start using its fat supply for energy.
Placing the Adjustable Laparoscopic Band
The band is implanted using laparoscopic (minimally invasive) surgery while you're under anesthesia. Laparoscopic surgery is performed using small incisions. This usually means a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures.
A small incision (less than 1/2 inch) is made near the belly button. Carbon dioxide (a gas that occurs naturally in the body) is introduced into the abdomen to create a space for the surgeon to work. Then a small laparoscopic camera is placed through the incision into the abdomen.
The camera sends a picture of the stomach and abdominal cavity to a video monitor. This gives the surgeon a good view of the key structures in the abdominal cavity. A few additional, small incisions are made in the abdomen. The surgeon watches the video monitor and works through these small incisions using instruments with long handles to complete the procedure. The surgeon creates a small, circular tunnel around the stomach, inserts the gastric band through the tunnel, and locks the band around the stomach.
Band Adjustments Help You Meet Your Weight Loss Goals
Your bariatric surgeon will personalize your band fit over time. After an adjustment, you'll be satisfied with less food, so you can keep losing weight gradually (1 to 2 pounds per week).
As you lose weight, the lap band fit will change. Periodic band adjustments ensure the amount of saline in your band (often called a "fill level") is comfortable for you and keeps you on track to meet your weight loss goals.