Bariatric Surgery

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Bariatric surgery encompasses a range of surgical procedures designed to promote significant weight loss in individuals struggling with obesity. As obesity rates continue to rise globally, these surgical interventions have emerged as effective options for those who have not achieved lasting weight loss through traditional methods such as diet and exercise. Bariatric surgery not only helps patients shed excess weight but also addresses wide range of health issues, including diabetes, hypertension, cardiac disease, sleep apnea, acid reflux, joint pain, cancer and depression. By altering the digestive system, these procedures can lead to profound changes in metabolism and appetite regulation, offering individuals a renewed opportunity for healthier living and improved quality of life.

Two common weight loss surgeries are sleeve gastrectomy and gastric bypass. 

Sleeve Gastrectomy

How It Works

  1. Reduced Stomach Size: By removing 75-80% of stomach, the procedure limits the amount of food that can be consumed at one time, leading to early satiety or feeling fuller faster. 
  2. Hormonal Changes: The surgery also affects hunger-regulating hormones, particularly ghrelin, which is primarily produced in the stomach. Lower levels of ghrelin can lead to decreased appetite and cravings.
  3. Nutrient Absorption: Unlike some other bariatric procedures, sleeve gastrectomy does not involve rerouting the intestines, so it preserves the normal digestive process. However, patients still need to be mindful of their nutrient intake post-surgery.

Results

Patients can expect to lose around 50-70% of their excess weight within the first 12-18 months. Many also experience improvements in obesity-related conditions, such as hypertension, diabetes, high cholesterol, sleep apnea, arthritis, etc.

Click here for more information about Sleeve Gastrectomy.

Roux-en-Y gastric bypass

How It Works

1. Division of the Stomach

The stomach is divided into a small upper pouch and a larger lower pouch. The upper pouch is created by stapling off a portion of the stomach, which significantly reduces its size and limits food intake.

2. Division of the Intestine

A portion of your small intestine is divided and attached to the upper stomach pouch, resulting in a “Y” shape configuration.  This “Y” shape is where the name “Roux-en-Y” comes from.  Food passes from the pouch into the lower part of your small intestine. The bypassed portion of the lower stomach pouch and proximal intestine reduces the absorption of calories and nutrients, which contributes to effective weight loss.

3. Hormonal Changes:

RYGB reduces the amount of ghrelin, or “hunger hormone”, that your stomach secretes. 

4. Increased feelings of fullness

RYGB increases the levels of glucagon-like peptide 1 (GLP-1) and peptide YY (PYY), which increase feelings of fullness. 

Results

Patients can expect to lose around 60-80% of their excess weight within the first 12 -18 months. Due to significant amount of weight loss, many patients with gastric bypass experience more prominent improvements in obesity-related conditions compared to ones with sleeve gastrectomy, specially in resolving type 2 diabetes and acid reflux diseases.

Click here for more information about Roux-en-Y gastric bypass.

Revisional Bariatric Surgery

Revisional bariatric surgery is a procedure performed to modify or correct a previous bariatric surgery when a patient experiences weight regain or complications like reflux (gastroesophageal reflux disease, GERD). This is typically done if the initial surgery did not produce the expected results, or if the patient encounters new health issues that impact their quality of life or weight loss outcomes.

Reasons for Revisional Bariatric Surgery:

1. Weight Regain:

  • Failure to maintain weight loss: Some patients may regain weight after an initial bariatric procedure due to a variety of reasons, such as changes in the digestive system, stretching of the stomach, or failure to adhere to post-surgery lifestyle and dietary changes.
  • Dilatation or stretching of the pouch: For example, in gastric bypass or sleeve gastrectomy, the stomach pouch may stretch over time, leading to an increase in the amount of food the patient can eat, resulting in weight regain.

2. Gastroesophageal Reflux Disease (GERD):

  • New or worsening reflux symptoms: Some patients may develop GERD after a bariatric procedure, especially after a sleeve gastrectomy, due to the altered anatomy or the shape of the stomach. This can lead to heartburn, regurgitation, chest pain, or trouble swallowing.
  • Gastric banding complications: In some cases, the adjustable gastric band (Lap-Band) may cause or worsen GERD symptoms due to its restrictive nature and pressure on the stomach.

3. Complications or Other Issues:

  • Band slippage or erosion: If a gastric band (Lap-Band) has slipped or eroded into the stomach wall, it can cause discomfort, vomiting, and difficulty eating.
  • Nutritional deficiencies: Long-term deficiencies in vitamins or minerals may require revisional surgery to address an ongoing problem or to modify the initial procedure.

Types of Revisional Bariatric Surgery:

Revisional procedures are tailored to the specific issue and the original surgery performed. Some common options include:

1. Conversion from Gastric Banding to Gastric Bypass or Sleeve Gastrectomy:

2. Sleeve Gastrectomy Revision:

3. Gastric Bypass Revision:

How Are Surgeries Performed

Laparoscopic and robotic weight loss surgery are minimally invasive surgical techniques which involve making small incisions and using specialized instruments to perform the surgery.  For the Robotic surgery, the surgeon operates robotic arms via a console, controlling the instruments with greater precision and visualization.

Here’s a breakdown of the process and recovery process:

  • Both surgeries are performed under general anesthesia
  • Both operations use small incisions, usually between 0.5 to 1 cm, to insert a camera (laparoscope) and instruments to perform the surgery on the abdomen.  Typically 4-5 incisions are required
  • The operation generally takes 1 to 2 hours.
intuitive-da-vinci-xi-patient-cart

Recovery

  • Hospital stay: Typically requires an overnight stay in the hospital.
  • Pain and discomfort: Minimal due to the small incisions, but patients may experience gas pain and bloating.
  • Diet: Clear liquids for the first 2 days, transitioning to full liquid then puree diet at home.
  • Activity: Most patients can return to light activities within 1-2 weeks and normal activities within 4-6 weeks.  No lifting greater than 10 pounds for 6 weeks. 
  • Follow-up: Regular follow-up visits with the surgeon and/or dietitian to monitor progress, diet, physical activity and nutritional needs.