Information on Bariatric Weight Loss Surgery

RESULTS from Bariatric Weight Loss Surgery:

Substantial weigh loss occurs in the great majority of patients after Roux En-Y (RNY) Gastric Bypass Surgery. Most patients are satisfied or very satisfied with the results of the surgery. Losing about 50% of one's excess weight is considered to be a satisfactory weight loss. After losing 50% of one's excess weight, patients usually feel physically and mentally better, and Diabetes, hypertension, stress incontinence, and other complications of obesity are often either improved or eliminated altogether. Roux-En-Y patients are required to take lifelong mineral supplements as directed and cannot eat high glycemic sugar and starches "the white foods" as they produce a "dumping" reaction, a physical response that may include heart palpitations, vomitting, sewatting, diarrhea and other painful sensations".

Information on Roux en - Y Gastric Bypass Surgery

Roux-en-Y Gastric Bypass (RNY):

This surgery involves creating a small (less than one ounce) vertically oriented stomach pouch, as well as a bypass of most of the stomach and a varying amount of small intestine (see figure). As a result, weight loss is accomplished both by restriction of food and by malabsorption of nutrients. Ingestion of concentrated sugar is also essentially prohibited because doing so results in "dumping." Dumping is a group of unpleasant symptoms that resembles food poisoning (nausea, vomiting, diarrhea, abdominal cramps, flushing, and palpitations) that occurs when simple sugars enter the small intestine without first being properly digested by the stomach. Many people also report diminished appetite after Roux-en-Y gastric bypass, as well as a change in the taste of food. These are additional ways the gastric bypass causes weight loss. Following RNY surgery, patients are at risk for developing anemia because of poor absorption of iron and vitamin B12. Therefore, dietary supplementation of these nutrients is required. Poor absorption of calcium may also occur. Thus, calcium supplements must also be taken postoperatively.

Since the staples at the top of the stomach completely block off the lower portion of the stomach and the upper small intestine, there is no easy way to evaluate these portions of the gastrointestinal tract should a problem -- such as ulcer, bile duct stones, or cancer -- arise at a future time. In fact, although this could be a very real problem, it seldom becomes as issue.

Weight loss commonly reaches 75% of a person's excess body weight. As in all weight loss surgery, however, the amount of weight loss is not guaranteed. In fact, there is no guarantee that the patient will lose any weight at all. The amount of weight a patient loses depends not only upon the surgery, but also upon what the patient does with the surgery. The surgery is not a cure for morbid obesity; it is merely a tool. Patients have been known to ingest large quantities of high caloric foods that can result in less than satisfactory weight loss. If a patient adheres to the dietary booklet that she or he receives as part of the New York Bariatrics Program, and if exercise becomes a part of the patient's regular routine, a substantial weight loss usually results. The Roux-en-Y gastric bypass routinely necessitates a stay of four or five days in the hospital.

As in any sort of major surgery, there is a certain amount of risk. It is important to consider these risks when deciding to have weight loss surgery. Operative risks are: death (0.5%), leaks or perforation causing internal infection and need for recuperation (0.6%), wound infection (2 %), and pulmonary embolism (0.1%).

Information on Adjustable Laparoscopic Gastric Banding (Lap Band):

This procedure is a close second in popularity to the gastric bypass procedure.  A silicone ring , or band, is placed on the upper portion of the stomach, creating a small pouch and a narrow passage into the larger remaining stomach.  The band has an inflatable area on it's inner surface that is filled with saline solution through a very thin tube, connected to a port that is placed in the abdomen.  This reduces the food storage area of the stomach and controls the size of the stoma (the stomach outlet) from the newly created pouch to the lower, larger stomach.  When the stoma is smaller in diameter, patients feel fuller faster and for a longer period of time.  Food will also empty more slowly from the upper area of the stomach to the lower portion.  Patients with the Lap Band will lose weight more gradually, usually 1-2 pounds per week on average the first 12 months following surgery.

Although bariatric surgeries have the same goals for patients, the lap band works differently than the gastric bypass for several reasons.The lap band is a restrictive mechanism only, there is no stomach stapling or intestinal bypass performed.  Lap band patients lose weight more gradually than gastric bypass patients overall; both surgeries will yield significant weight loss, the lap band taking more time than the gastric bypass to lose a comparable amount of weight.  Also unlike the gastric bypass, the lap band does not limit the types of foods one can comsume for the most part; it limits portion size and frequency of eating but generally does not produce any extreme physical discomfort, or "dumping" when sugars and carbohydrates are consumed.  This often requires a patient to be more vigilant and accountable regarding food choices and eating behaviors.  Maximum weight loss and health benefits can be experienced by lap band patients if they follow the post-operative aftercare recommendations including follow-up appointments with medical, nutritional and emotional support services avilable to them.

Laparoscopic Surgery for Weight Loss Procedure

Laparoscopic Roux-en-Y gastric bypass procedure (lap/RNY):

The New York Bariatrics Program performs the Laparoscopic Roux-en-Y gastric bypass (RNY) on selected patients - generally, those with BMI's less than 55 are considered potential candidates. Initially Laparoscopic RNY was reported to have been associated with a number of problems -- primarily related to the instrumentation required to perform surgery successfully on very overweight patients. This resulted in an unacceptably high complication rate. The development of new Laparoscopic instruments and techniques and their introduction into the New York Bariatrics Surgery Program has made Laparoscopic RNY a reasonable alternative to open RNY in some patients. The addition of Philip Weber, MD, a fully trained Laparoscopic surgeon, to the New York Bariatrics Surgery Program, has also expedited the introduction of this minimally invasive procedure.

Laparoscopic Roux-en-Y gastric bypass is identical to the traditional gastric bypass except that instead of being performed through an incision extending from the lowest aspect of the breastbone (xiphoid process) to the umbilicus (navel), it is performed through several smaller incisions each measuring about an inch or less in length. A laproscope connected to a video camera is inserted into the abdominal cavity and the surgical field, the inside of the abdominal cavity, is visualized by the surgeons on video monitors in the operating room. Long thin surgical instruments and especially designed staplers are inserted through additional small incisions; the surgeon performs the surgery by watching the video monitor.

The advantages to performing the Gastric Bypass Laproscopically are that it yields cosmetically superior results and the recovery is faster. Some long-term problems of open surgery, such as incisional hernias, may also occur less frequently. One disadvantage of laproscopy is that sometimes, because of difficulty in visualization, the operation must be converted to an open procedure in order to complete the operation safely. This decision, of course, is made during the course of the operation while the patient is under anesthesia, so the patient must be aware of this possibility before the surgery starts. Another disadvantage is that the incidence of leakage from the surgical staple lines may be more common in the postoperative period. Leakage from the staple line is a serious complication and often necessitates additional surgery, usually using a traditional incision, and prolonged hospitalization, and sometimes even death.

Nonetheless, the idea of avoiding a large surgical incision is compelling, because of the decreased amount of pain experienced and the shorter recovery time. The possibility of performing Laparoscopic RNY Gastric Bypass can be discussed at the initial meeting with New York Bariatrics.

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