Procedures
Roux-en-Y Gastric Bypass Surgery
By reducing the size of the stomach, gastric bypass surgery severely restricts the amount of food you can consume. Mills-Peninsula offers the Roux-en-Y (roo-en-wy) Gastric Bypass Procedure, which also bypasses part of the small intestine, reducing calorie absorption. This surgery is not considered reversible.
Long-term success depends in large part on permanently following a restricted diet and making major life style changes.
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.
Lap-Band Procedure
The Lap-Band is an adjustable silicone band placed around the top part of the stomach during a laparoscopic surgical procedure. Laparoscopic surgery is less invasive than open incision surgery because it is performed by placing the instruments and a camera through several very small incisions in the abdomen. At the time of surgery, a small device called a port (or reservoir) is placed under the skin of the abdomen. It is connected by tubing to the Lap-Band, and allows the surgeon to adjust the tightness of the band periodically. This is done by injecting a small amount of saline water into the port. The Lap-Band may be adjusted several times in the first six months after surgery to promote maximum weight loss without side effects.
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.
Roux-en-Y Gastric Bypass
Lap-Band Procedure