Restrictive Procedures for Weight Loss
Restrictive operations, the most common surgeries for producing weight loss, reduce stomach size to limit the amount of food you can eat. To restrict food intake, surgeons create a small pouch at the top of the stomach where the food enters from the esophagus. Initially, the pouch initially holds about one ounce of food, but expands to two to three ounces with time. The pouch's lower outlet usually has a diameter of about 1/4 inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness. After a restrictive weight loss surgery, patients can usually eat only one half to one whole cup of food without discomfort or nausea. In addition, food must be well chewed. For most people, the ability to eat a large amount of food at one time is lost, which may result in feeling hungry. However, some patients return to eating modest amounts of food and avoid feeling hungry.
back to top
Gastric Bypass
In gastric bypass (Proximal or short limb Roux-en-Y gastric bypass), the most commonly recommended weight loss surgery in North America, the surgeon staples the stomach across the top, sealing it off from the rest of the stomach. This creates a small pouch at the top of the stomach. The surgeon then cuts the small intestine and sews part of it directly onto the pouch, “bypassing” most of the stomach and the first section of the segment of the small intestine. This limits the ability to absorb calories. Even though food never enters the lower part of the stomach, the stomach remains healthy and continues to secrete digestive juices to mix with food in the small intestine. Gastric bypass surgery may be performed using a minimally invasive approach, with a laparoscope.
back to top
Vertical Banded Gastroplasty (VBG)
In vertical banded gastroplasty, the surgeon divides the stomach into two parts — limiting space for food, which forces patients to eat less. There is no bypass. Using a surgical stapler, the surgeon divides the stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch — the rest of the stomach. At the dime-sized opening where the upper pouch empties into the rest of your stomach, the surgeon wraps the tissue with a band of nonstretchable plastic. This "banding" of the opening between the upper pouch and the rest of the stomach prevents the opening from stretching. This procedure is used less commonly by surgeons because it does not always lead to adequate long-term weight loss.
back to top
Gastric Partitioning or LapBand
In gastric partitioning, the surgeon uses an inflatable band to partition the stomach into two parts, then wraps the band around the upper part of the stomach and pulls it tight, like a belt. This creates a tiny channel between the two pouches. Designed to remain in place indefinitely, the band prevents the opening from expanding. However, it may be adjusted or surgically removed if necessary. This procedure may be performed using a minimally invasive approach, with a laparoscope.
Gastric partitioning or the Lapband is popular in Europe and Australia, but is used only on a limited basis in the United States.
back to top
Malabsorptive Procedures for Weight Loss
Malabsorptive procedures, which account for about one in 10 of all weight-loss surgeries performed in the United States, promote weight loss by limiting the amount of nutrients and calories absorbed in the intestine. Procedures in this category include biliopancreatic diversion and distal gastric bypass. Malabsorptive procedures generally offer the advantage of greater sustained weight loss than restrictive procedures, but present a greater risk of malnutrition and vitamin deficiencies, and require close monitoring and follow-up.
back to top
Minimally Invasive Surgery
Minimally invasive gastric bypass surgery offers tremendous benefits to appropriate patients. Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens hospital stays and leads to a faster recovery. Fewer wound-related problems also seem to occur. As a result, most patients resume their normal daily activities much sooner, rather than having to depend on others to help them with daily hygiene and household chores for an extended period following surgery. Minimally invasive gastric bypass surgery is performed using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen. The tiny camera on the tip of the scope allows the surgeon to see inside the abdomen.
Benefits of minimally invasive surgery include: - Less blood loss
- Less scarring and pain
- Less need for blood transfusions
- Reduced medication
- Shorter postoperative hospital stays
- Shorter recovery periods
- Fewer postoperative complications
- Reduced risk of wound infection
Philippe Quilici, M.D.
Specializing in Minimally Invasive Bariatric Surgery
Philippe Quilici, M.D., is board certified in general surgery and specializes in minimally invasive surgery with clinical interests in bariatric surgery, gastroesophageal reflux disease (GERD) and cancer.
back to top
|
 |
cc |
|
