Weight loss surgery basics
Looking into weight loss (bariatric surgery) can be overwhelming. You may find yourself asking many questions.
The two most common bariatric surgeries are the laparoscopic Roux-en-Y gastric bypass and the laparoscopic sleeve gastrectomy.
The National Institutes of Health recognized bariatric surgery, in conjunction with diet modification, behavior changes and exercise as an effective treatment to combat severe obesity and maintain long term weight loss.
To be a candidate for weight loss surgery, most insurance companies require a BMI (body mass index) of at least 40 or a BMI of 35 with one weight related comorbidity (e.g. high blood pressure, sleep apnea, high cholesterol or diabetes).
It can take several years for a patient to ask for help. Unfortunately, obesity carries a negative stigma in our society which discourages people from seeking help.
At the Bariatrics Center, we want to put your fears to rest. You may find yourself trapped in a cycle of losing and regaining weight, regardless of what diet you have tried. We understand. Several of our employees have undergone bariatric surgery and understand the difficulties you face.
Laparoscopic Roux-en-Y Gastric Bypass
The Roux-en-Y Gastric Bypass is considered the gold standard for weight loss surgery. Studies show weight loss of 60%-80% excess body weight, with average weight maintenance of more than 50% of the weight lost. For example, if you were 100 pounds overweight we would anticipate you losing 60-80 pounds after weight loss surgery.
The bypass promotes weight loss from three different mechanisms.
- Restriction – which means you are not allowed to eat as much as you once could. This limits the amount of calories consumed.
- Malabsorption – because of the rerouting of the bowel, you do not absorb as much of the fat, calories and nutrients from food as you once did.
- Hormonal Changes – Because of the rerouting of the bowel, there are changes in hormones which help you typically not feel as hungry and help you feel full faster.
During surgery, the stomach is divided into a small egg-sized pouch; this is what limits the amount of food you can eat after surgery. The bowel is rerouted and there are two new connections made. One connection is made between the stomach and bowel, the other new connection is made between two pieces of bowel.
This creates two new channels. One of the channels allows food to travel downstream from your new stomach pouch without being absorbed. The other channel allows digestive juices and enzymes to travel downstream from the other portion of your stomach and liver.
These two channels eventually meet up; this is when digestion and absorption begin.
Advantages of the bypass
- Weight loss of 60%-80% of excess body weight, with average weight maintenance of >50% of weight lost
- 80 percent remission of Type II diabetes
- Changes in hormones typically decrease hunger and help you feel full faster
Disadvantages of the bypass
- Technically more complex, therefore has a higher risk for postoperative complications compared to Sleeve Gastrectomy
- Lifelong vitamin and supplementation compliance is extremely important, because you do not absorb the nutrients from food like you once did
Learn if Roux-en-Y Gastric Bypass is right for you.
Laparoscopic Sleeve Gastrectomy
The sleeve gastrectomy is a newer procedure than the bypass. It is a non-reversible procedure in which a portion of your stomach is removed from the body. Studies show weight loss of >50 percent excess body weight, with average weight maintenance of >50 percent of weight lost. For example, if you were 100 pounds overweight we would anticipate you losing at least 50 pounds after weight loss surgery. The Sleeve works in two ways:
- Restriction – About 80% of your stomach is removed at the time of surgery. This leaves you with a tube shaped or banana shaped stomach. This limits the amount of food you are able to eat and limits the amount of calories consumed.
- Hormonal Changes – There are changes in the hormones which control hunger. Most patients will experience a time period where they do not feel hungry. This is an added benefit as you are making the necessary diet and behavior changes. This is not permanent, usually those hunger cravings will return.
During surgery, the stomach is divided. About 80% is completely removed, leaving your stomach size about 20 percent of what it once was. There is NO rerouting of the bowel.
Advantages of the Sleeve Gastrectomy
- Greater than 50% excess body weight loss with weight maintenance of >50 percent
- Changes in gut hormones that decrease hungry and help you feel fuller faster
- Less technically complex than the gastric bypass, therefore lower risk of postoperative complications when compared to the bypass
Disadvantages to the Sleeve Gastrectomy
- This surgery cannot be reversed
- Potential for increase in gastric reflux.
