Procedures
Roux-en-Y Gastric Bypass Surgery | Laprascropic Adjustable Gastric Band
Roux-en-Y Gastric Bypass Surgery 
The purpose of the operation is to reduce the size of the stomach to roughly two ounces, as opposed to its former size of about two quarts. This drastic reduction limits the stomach’s ability to hold food, making the patient feel full and satisfied after eating only a small amount. Bypassing most of the stomach reduces hormones that induce hunger so patients may not have the cravings for food. Additionally, because most of the stomach and some of the small intestine has been bypassed, some of the nutrients and calories in your foods will not be absorbed. However, most of the effect of this surgery is in helping with volume control.
For the surgery to be successful, it requires lifelong dietary and behavior modifications of their eating habits and exercise. Average weight loss of patients undergoing a Roux-en-Y gastric bypass is 65% of their excess body weight over a 12 month period.
Step One
The stomach is stapled just below the esophagus, forming a 20 to 30cc (1 ounce) stomach pouch above the staples, severely restricting the amount and kind of food or liquid that can be consumed at one time.
Step Two
The small bowel is divided about four feet below the stomach (points A and B). Then a new 1.5 centimeter opening (stoma) is created in the stomach pouch (Point C).
Step Three
The open end of the small bowel at Point B is attached to the new opening at Point C. Food and fluids can now pass from the stomach pouch into the small bowel. The remaining end of the small bowel (Point A) is attached at Point D, creating a "Y-shaped" intestinal junction. An opening is made at Point D to allow digestive juices from the bypassed part of the stomach to flow into the small bowel.
Adapted from Bray, G.A., Gray, D.S. Obesity, Part I. Pathogenesis. West J. Med. 1988: 149:429-41.
Laprascopic Adjustable Gastric Band
Laparoscopic adjustable gastric banding is a restrictive weight loss surgery. The gastric band is an inflatable silicone prosthetic device which is placed around the top portion of the stomach creating a small pouch. On eating, food is now stored in the upper part of the stomach giving the sensation of fullness with a small amounts. The band can be adjusted (tightened or loosened) via a small access port placed under the skin. Most of the effect of this operation is with volume control.
For the surgery to be successful, it requires lifelong dietary and behavior modifications of their eating habits and exercise. Average weight loss of patients undergoing a laparoscopic adjustable band is 40% of their excess body weight over a 12 month period.
How does the Lap-Band promote weight loss?
The Lap-Band restricts the amount of food your stomach can hold and extends the feeling of being full and satisfied after eating a small amount of solid food. The success of this procedure, however, depends on how motivated you are to change your eating behaviors. Patients must eat three small meals daily of solid low-fat food with no snacking. Eating too fast or too much can cause vomiting. No fluid should be taken with meals because it will cause the stomach to empty quickly. High-calorie beverages such as non-diet sodas, fruit juice, milkshakes, and smoothies must be avoided because they will impair weight loss. The same is true of high-calorie snack foods such as candy, ice cream and chocolate.
How does the surgery differ from gastric bypass
The Lap-Band procedure requires no stapling or cutting of the stomach and no surgery on the intestine. No intestinal bypass is done, so there is no change in the amount of calories and nutrients absorbed in the intestine. Lap-Band patients do not experience dumping syndrome after consuming high-sugar foods or beverages. The tightness of the Lap-Band is adjusted to suit your individual situation and it can be removed if necessary. If done laparoscopically, which is the case for most patients, the Lap-Band procedure takes about one hour in the operating room and usually one night in the hospital. In 5% of cases, the Lap-Band placement cannot be completed laparoscopically. This would extend the hospital stay. Gastric bypass is a longer, more complex surgery that usually requires a stay of two or more nights.
How much weight can I expect to lose with the Lap-Band?
A weight loss of 2-3 pounds a week is possible during the first year, but this depends on the patient's commitment to new eating habits and regular exercise.
Weight loss is usually at a slower rate than weight loss after gastric bypass surgery. Studies show the average weight loss after Lap-Band surgery is about 15 points on the body mass index scale within 18-24 months after the surgery.
The average weight loss in the Lap-Band U.S. clinical trials was approximately 40% of excess weight, but some patients were able to lose much more. The majority of Lap-Band patients do not reach their ideal weight range; however, they enjoy a tremendous improvement in their health, appearance, energy level and ability to enjoy physical activities.
What are the risks?
Lap-Band surgery carries the same risks as other laparoscopic surgical procedures and much less risk than gastric bypass surgery. Only 1-3% of patients experience bleeding, infection inside the abdomen, blood clots in the leg that can travel to the lungs, perforation of the stomach or esophagus during surgery, spleen or liver damage and death (less than 1%). There also are possible complications related specifically to the Lap-Band. Over time, it is possible for the band to slip out of position, block the outlet from the stomach or erode into the lining of the stomach, which would require an additional surgery to repair.
If the band needs to be removed or replaced, it would require an additional surgery. Problems that can occur after Lap-Band placement include nausea, vomiting, acid reflux, heartburn, stomach ulcer, gastritis, gas bloat, trouble swallowing, dehydration, diarrhea, constipation and weight regain. The band may deflate if a leak occurs in the tubing, port or the band itself. In the first Lap-Band study in the U.S., 25% of the patients had the band removed for a variety of reasons. Since that time, surgical techniques have been improved to reduce the risk of complications.