Surgical Procedures Information
Northwest Medical Center (NMC) and surgeons Dr. Chiasson and Dr. Burpee offer patients several surgical weight loss options. All are performed laparoscopically which means minimal incisions and faster healing than with traditional "open" surgeries. The Surgical Weight Loss Program at Northwest follows the guidelines set forth by the National Institutes of Health. Our patient-focused approach is designed to meet the individual needs of each patient.
What is the ideal weight loss operation? One that is safe to perform with minimal risk of death, has low short-term and long-term complication risks, and provides weight loss equal to or better than non-surgical options.
Surgical Weight Loss Options
Vertical "Sleeve" Gastrectomy
The laparoscopic vertical "sleeve" gastrectomy is the newest of the weight loss procedures. At present, it is performed by a very limited number of surgeons in the United States. We initially began offering the procedure as part of a two-stage surgical approach to our super-obese patients (BMI > 60). However, because our patients are experienced excellent weight loss results, we have expanded this procedure to our general weight loss patients.
Surgical Technique
The laparoscopic vertical "sleeve" gastrectomy procedure involves removing the lateral aspect (or side) of the stomach. We cut the stomach to create a long thin gastric tube which will hold less food than the normal stomach. The operation preserves the pyloric region of the stomach and the nerves that supply it. Consequently, food empties normally into the duodenum (small intestine).
The sleeve gastrectomy is less difficult to perform than the gastric bypass because it does not involve any organ rearranging. It has a low risk profile at the time of surgery and is associated with very minimal long-term risks.
How does the operation work?
The laparoscopic vertical "sleeve" gastrectomy works by limiting or restricting the amount of food that you can eat. In addition, it is believed that by removing the part of the stomach that produces the Grehlin hormone, that patients lose their appetite. It has very predictable results and our patients can expect to lose 60 - 80% of their excess body weight in the first year after surgery.
Risks
Short-term risks include staple line bleeding or leakage. Long-term risks are unknown.
Summary
The vertical sleeve gastrectomy is a simple operation with low mortality risk (1/1000) and with results comparable to the gastric bypass procedure.
Laparoscopic Gastric Bypass
The gastric bypass is presently the most common operation in the United States. This operation was initially developed using an open technique (making an incision where tissues and organs are fully exposed). However, since the mid-1990s, this procedure has been performed using a minimally invasive laparoscopic technique in which the surgery is performed through a series of small incisions. In the last 10 years there have been many modifications made to the procedure as new technologies have evolved.
Surgical Technique
This operation involves two steps. First, the stomach is divided into two parts. A small stomach pouch is created that receives food from the esophagus. This becomes the patient's new stomach. The larger remaining stomach is left behind and drains normally into the small bowel. Secondly, the small bowel is divided downstream. The cut end of the small bowel is then brought up and attached to the new stomach so that it may empty. This is the so-called "Roux Limb." The small bowel is also reconnected downstream to allow for drainage of the unused stomach and proximal small bowel.
How does this operation work?
The gastric bypass operation works for three reasons. First, because the new stomach is very small, it limits or restricts the amount of food that you can eat. Secondly, there is a hormone called Grehlin that is produced in the unused part of the stomach that affects appetite. Because this stomach is not used, the hormone level falls very low and patients generally lose their appetite for a period of 9-12 months. Finally, patients who have this surgery get "dumping syndrome" when they eat sweets. Dumping syndrome occurs when the undigested contents of your stomach enter your small intestine too quickly resulting in abdominal cramps and nausea. Consequently, as a form of aversion therapy, this operation helps patients make better food choices. It has very predictable results and one can expect to lose 60-80% of their excess body weight over the first year after surgery.
Risks
Short-term risks include anastomotic (at the site of the bypass connection) complications. Long-term risks include anastomotic strictures, ulcers, fistulas and internal hernias.
Summary
The laparoscopic gastric bypass is a difficult operation with significant short and long-term complications and a mortality rate of about 1/1000. It does result in considerable weight loss.
Adjustable Gastric Band
The laparoscopic adjustable gastric band procedure is a relatively new weight loss procedure. This procedure was developed in Europe and Australia in the 1990s. In 2001, the FDA gave its approval to the use of this implant for weight loss surgery in the United States.
Surgical Technique
This technique involves placing a band around the upper aspect of the stomach to create a small pouch. The band has an inner tube that can be adjusted by injecting fluid into a port that sits underneath the skin. Therefore, the diameter of the band can be adjusted to slow the transfer of food from the upper small stomach pouch to the remaining stomach. The Lap Band procedure is less difficult to perform, there is no organ re-arranging, and it carries less risk of death or infection to the patient at the time of surgery. Finally, the Lap Band is removable if the patient develops complications related to it.
How does this operation work?
This operation works by limiting or restricting the amount of food that a person can eat leading to weight loss. However, there are some issues with the band that differentiate it from gastric bypass and vertical sleeve gastrectomy. First, Grehlin hormone levels are not affected by this surgery so patients do not lose their appetite to the same degree as with gastric bypass. Consequently, the weight loss associated with the adjustable gastric band is generally slower and less predictable. Patients will generally lose 40-50 % of their excess body weight over the first three years after the surgery.
Risks
Short-term risk includes gastric perforation, obstruction and band misplacement. Long-term risks include esophageal dilatation, band slippage, band erosion or port problems. There are unknown risks associated with having a foreign body implant.
Summary
The adjustable gastric band has a re-operation rate of 10-40% but a low mortality rate (1/2000).
We recommend attending a free weight loss seminar where each of these choices is covered in detail. Then, you can make the choice about which option is best for you.
