Treatments

Gastric Bypass Surgery

Gastric bypass, also known as Roux-en-Y gastric bypass, is a bariatric or weight loss surgery for obese patients who have not been successful losing weight through dieting, exercise and medication.

The surgery uses a combination of restrictive and malabsorptive techniques to achieve a successful outcome. Staples are used to create a smaller stomach to limit the amount of food intake, and a large portion of the small intestine is bypassed to limit the nutrients and calories absorbed.

The goal of the surgery is to make you feel full quicker so you don't overeat, and absorb fewer calories by the modifications made in the small intestine.

Gastric bypass surgery has been shown to help reduce obesity and related illnesses, including heart disease, high blood pressure, and especially type 2 diabetes.

It can be performed laparoscopically through tiny incisions (minimally invasive technique) or through a large open incision (open technique).

Indications

Gastric Bypass surgery may be recommended when diet, exercise or medications have not helped in reducing your weight.

It is indicated for people with a BMI of 40 or more, and also in those whose BMI is 35 to 39 that are suffering from obesity associated health conditions such as:

• Type 2 diabetes
• Heart disease
• High blood pressure
• High cholesterol
• Sleep apnea
• Non-alcoholic fatty liver disease
• Cancer

Surgery

Gastric bypass surgery is performed under general anesthesia. Your surgeon makes several small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera on the end, is inserted through one of the incisions, allowing your surgeon to clearly view the internal organs on a monitor. Small surgical instruments are inserted through the other incisions to perform the surgery.

The first step is to reduce the size of the stomach so that it holds less food. The upper portion of the stomach near the esophagus is converted into a pouch by stapling.

The second step of the surgery involves the creation of a bypass for food to flow from the new stomach pouch. The small intestine is divided into upper and lower segments.

The lower section of intestine is attached to the opening in the stomach pouch creating what is referred to as the "roux limb". The upper section of the small intestine which carries digestive juices from the remaining portion of the stomach is attached at the distal end of the roux limb. The roux limb enables food to bypass the lower stomach, duodenum, and a portion of the small intestine. At the end of the procedure, the incisions are closed with sutures

Post-operative care:

After gastric bypass surgery, you will have to stay in the hospital for about 3 to 5 days.

Your doctor will prescribe pain relieving medications to keep you comfortable. You will be given instructions to follow regarding wound care, diet and activity such as:

• Keep the incision area clean and dry.
• Avoid strenuous exercises and lifting heavy weights
• You may not be able to eat food for the first 1 to 3 days, after which you will be put on a liquid diet followed by pureed or soft foods.
• Sip water throughout the day to prevent dehydration.
• Follow the diet regimen given to you by the dietician.
• Follow an exercise program per your surgeon's instructions to maintain the weight loss.

Advantages and Disadvantages

Gastric bypass surgery can help you lose about 10 to 20 pounds a month in the first year following surgery. You will gradually lose more weight by eating a healthy diet and participating in regular exercise. The surgery also helps you manage obesity-related health conditions.

Disadvantages:

• It is not possible to fully reverse the procedure due to partial removal of the stomach.
• Lifelong follow up with a physician is required for blood tests to ensure proper health and nutrition.

Risks and Complications:

As with any surgery there are potential risks and complications involved. Complications associated with Gastric Bypass include:

• Problems associated with anesthesia
• Bleeding
• Infection
• Bowel obstruction
• Leaks in your gastrointestinal tract
• Deep vein thrombosis (blood clot in the leg)
• Dumping syndrome leading to diarrhea and nausea
• Hernia
• Gallstones
• Malnutrition
• Ulcers

Sleeve Gastrectomy Surgery

Introduction

Sleeve gastrectomy, also referred to as vertical sleeve, gastric sleeve or tube gastrectomy, is a surgical procedure performed for the treatment of obesity. The procedure is a restrictive bariatric surgery to treat extremely obese patients with a high BMI of 40 and above. It encourages weight loss by restricting the stomach size so it holds only a limited amount of food. This helps patients to eat less without hampering the normal digestive process.

Sometimes sleeve gastrectomy is carried out as a first stage of a 2-stage operation in extremely obese patients with a BMI of 60 or more. This is done to achieve a considerable amount of weight loss so it is safer for the patient to undergo a second bariatric surgery if needed.

Disease Overview

Obesity is a chronic condition in which there is an excessive accumulation of fat in the body.

Obesity is defined as a Body Mass Index (BMI) of 30 to 34.9 and extreme or morbid obesity is a BMI of 40 or more.

Obesity is a global problem affecting people of almost all age groups, and is associated with increased risk of cardiac problems, diabetes, high blood pressure, breathing difficulties, and other diseases.

Indications:

Sleeve gastrectomy is indicated for people with a BMI of 40 and more, and also in those whose BMI is 35 to 40 and suffering from obesity associated conditions.

The surgery is recommended when diet, exercise or medication have not helped in reducing the patients weight.

Surgery:

The procedure is performed under general anesthesia. The surgeon makes 2 to 5small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera attached, is inserted through one incision, allowing your surgeon to clearly view the internal organs on a monitor.

Additional surgical instruments are inserted through the other incisions. Your surgeon will remove nearly 75-80% of the stomach. A thin sleeve shaped like a banana is created by stapling the remaining part of the stomach. At the end of the procedure, the incisions are closed with sutures. The entire procedure takes about 60 to 90 minutes to complete.

Advantages and Disadvantages of sleeve gastrectomy:

Advantages:

• Reduced stomach size makes you feel full sooner.
• Normal functions of the stomach are retained.
• Simpler than other bariatric surgeries.
• Can be performed laparoscopically
• Shorter hospitalization stay
• Less operative time
• No implant used as in lap band surgery.
• Minimal post-operative pain and discomfort.
• Shorter recovery time

Disadvantages:

• Irreversible
• Need for second surgery in highly obese patients
• Exposure to surgical risks twice in the case of 2-stage procedures

Post-operative care:

Your doctor will prescribe pain relieving medications to keep you comfortable following the procedure.

• You will be advised to take medication to reduce the amount of acid produced by your stomach.
• Avoid strenuous exercises and lifting heavy weights until approved by your surgeon
• For the first month after the procedure, eat only small amounts of soft foods
• Sip water throughout the day to prevent dehydration.
• Eat a highly nutritious diet rich in proteins with a low-fat content.
• Your dietitian will tailor a new diet regimen for you to follow.

Risks and Complications:

As with any surgery there are potential risks and complications involved. The risks include blood loss, infections, problems associated with anesthesia, and deep vein thrombosis

The major complication following sleeve gastrectomy surgery is occasional leakage or breakdown of the gastric contents from the staple line that secures the divided stomach.

Bariatric Revision Surgery

Bariatric surgery is the surgical option for losing weight and improves the quality of life. However, in some cases the results may not last long, be unsuccessful, or cause certain complications. These individuals are the candidates for revisional bariatric surgery. Revisional bariatric surgery is the surgery performed in patients who had their bariatric surgeries earlier and was unsuccessful because of any of the following conditions:

• Post-surgical medical complications
• Unsatisfactory results
• Weight regain after achieving weight loss goals
• Unsuccessful resolution of co-morbidities such as diabetes and hypertension

May be not all the individuals with earlier, unsuccessful bariatric surgery will be candidates for revision surgery. Revision surgery is associated with more risks than the first-time surgery. Your surgeon considers the probable risks and benefits and suggests you the appropriate surgery.

Loop Duodenal Switch Surgery

Loop Duodenal Switch Info Video

Duodenal Switch surgery is a highly effective weight loss surgery with a proven record of long-term weight loss success. Duodenal Switch surgery helps those who are severely overweight or morbidly obese experience their maximum excess weight loss.

Bariatric Medicine Institute specializes in the Duodenal Switch procedure, so call us today to see if you qualify as a candidate for this life-altering procedure.

Duodenal Switch Procedure

The Duodenal Switch procedure combines both restrictive and malabsorptive components allowing patients to experience maximum weight loss results quickly and maintain them long-term:

Restrictive - In the first part of the DS surgery, the outer curvature of the stomach is removed while the remaining stomach is shaped into a long, slim sleeve also known as a vertical sleeve gastrectomy. Unlike other gastrectomies, the vertical sleeve gastrectomy leaves the pyloric valve in place in order to control food movement into the small intestine removing the patient’s risk of dumping syndrome and other complications such as blockages and stoma closure.

Malabsorptive - The malabsorptive component of the Duodenal Switch procedure involves rerouting portions of the small intestine in order to create two separate pathways from the duodenum to the lower portion of the small intestine. This technique reduces the amount of calories the patient’s body absorbs by limiting how long food can mix with digestive juices before being moved into the large intestine.

Duodenal Switch Benefits

Weight loss surgery in general can provide those who are severely overweight or morbidly obese with numerous improved health benefits. Losing weight as a result of Duodenal Switch surgery can help treat the following symptoms:

• Type 2 Diabetes
• Asthma
• Sleep Apnea
• Depression and Anxiety
• Heart Disease

Amongst other bariatric surgery options available today, the Duodenal Switch procedure has similar risks to other weight loss surgeries but the extent of the intestinal changes mean that DS has a higher risk of nutritional deficiencies developing over time without lifelong dietary follow up. Most recipients of the Duodenal Switch procedure experience 60 to 85 percent excess weight loss after 18-months which is usually higher than that seen in other weight loss surgeries. .

The Duodenal Switch procedure is also effective at treating Type 2 diabetes because of its ability to reduce the body’s need for insulin or oral hypoglycemic medicine post-surgery. According to some studies, duodenal switch surgery is effective in curing Type 2 Diabetes in 99% of cases.

Because the Duodenal Switch leaves patients with a larger stomach than gastric bypass, patients are able to enjoy more satisfying portion sizes, than is possible with other bariatric surgeries. Because of the larger stomach sleeve, Duodenal Switch patients also have a reduced risk of vomiting.

Duodenal Switch Risks and Complications

As with any bariatric surgery, the Duodenal Switch procedure does have certain risks and potential complications to consider before making the decision to undergo surgery. Our doctors can help you evaluate your individual risks with your potential benefits, but below is a condensed list of some of these complications.

Risks and Complications

Short-Term Risks:

• Bleeding during or after surgery
• Injury to liver or spleen
• Blood clots
• Infection
• Pneumonia
• Hernia
• Anemia
• Kidney Stones
• Diarrhea

Long-Term Risks

Some common concerns after Duodenal Switch are malnutrition, excess gas and diarrhea. Before scheduling your Duodenal Switch procedure talk with our doctors about these risks and any other concerns you may have.