Our Surgery Methods
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| BMI Surgical
Team During Weight Loss Operation |
At BMI Surgery, our doctors routinely
perform a wide variety of surgeries, including:
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The doctors, nurses, and staff at BMI Surgery work closely with each of our patients to determine the right type of weight loss surgery for them, depending on their specific needs.
Weight Loss Surgery Procedures
In recent years, a better understanding has been developing about restrictive and malabsorptive approaches to weight loss surgery. This has increased the choices available for thousands of patients and their doctors.
The table below provides a quick reference to the most common weight loss surgery methods and procedures. Click the tabs below for more details, including animations of each of the three main procedures.
Basic Methods |
Common Procedures |
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- Gastric Bypass
- Gastric Banding
- Gastric Band FAQs
- Vertical Sleeve
Gastric Bypass (Roux-en-Y )
Overview
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| (click to view animation) |
The Gastric Bypass (Roux-en-Y) procedure is the current gold standard procedure for weight loss surgery.1 It is one of the most frequently performed weight loss procedures in the United States.
The Roux-en-Y Gastric Bypass is a combined restrictive & malabsorptive surgical procedure. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients.
The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
Procedure
Briefly, the procedure involves the following steps:
- Stapling creates a small (15 to 20cc) stomach pouch.
- The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch.
- The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch.
- The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name.
- The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
Advantages
- The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
- One year after surgery, weight loss can average 77% of excess body weight.
- Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
- A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.
Risks
- Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
- Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
- A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
- A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
- In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
- The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.
footnote(s):
- The American Society for Bariatric Surgery and the National Institutes of Health have called Roux-en-Y gastric bypass the current "gold standard procedure" for weight loss surgery.
Gastric Banding
Overview
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| (click to view animation) |
The gastric banding procedure uses an adjustable gastric band which is designed to help you lose excess body weight, improve weight-related health conditions and enhance quality of life. It reduces the stomach capacity and restricts the amount of food that can be consumed at one time. The gastric banding procedure does not require stomach cutting and stapling or gastrointestinal re-routing to bypass normal digestion. The gastric banding procedure is the only adjustable and reversible weight-loss surgery available in the United States and the only weight-loss surgery approved for use by the Food and Drug Administration (FDA).
The gastric banding procedure is a silicone ring designed to be placed around the upper part of the stomach and filled with saline on its inner surface. This creates a new, smaller stomach pouch that can hold only a small amount of food, so the food storage area in the stomach is reduced. The band also controls the stoma (stomach outlet) between the new upper pouch and the lower part of the stomach. When the stomach is smaller, you feel full faster, while the food moves more slowly between your upper and lower stomach as it is digested. As a result, you eat less and lose weight.
A Minimally Invasive Procedure
During the procedure, surgeons usually use laparoscopic techniques (making tiny incisions rather than a large incision and inserting long-shafted instruments through “ports,” to wrap the gastric band around the patient's stomach. A narrow camera is passed through a port so the surgeon can view the operative site on a nearby video monitor. Like a wristwatch, the band is fastened around the upper stomach to create the new stomach pouch that limits and controls the amount of food you eat. The band is then locked securely in a ring around the stomach.
Since there is no stomach cutting, stapling, or gastrointestinal re-routing involved in the gastric banding procedure, it is considered the safest, least invasive, and least traumatic of all weight-loss surgeries. The laparoscopic approach to the surgery also has the advantages of reduced post-operative pain, shortened hospital stay, and quicker recovery. If for any reason the gastric band needs to be removed, the stomach generally returns to its original form.
Adjustable Weight Loss
Once placed around the stomach, tubing connects the gastric band to an access port fixed beneath the skin of your abdomen. This allows the surgeon to change the stoma (stomach outlet) size by adding or subtracting saline, or salt water, inside the inner balloon through the access port. This adjustment process helps determine the rate of weight loss. If the band is too loose and weight loss is inadequate, adding more saline can reduce the size of the stoma to further restrict the amount of food that can move through it. If the band is too tight, the surgeon will remove some saline to loosen the band and reduce the amount of restriction.
The diameter of the band can be modified to meet your individual needs, which can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing fetus, while patients who aren't experiencing significant weight loss can have their bands tightened.
The gastric banding procedure is also the only adjustable weight-loss surgery available in the United States to help maintain restriction and keep the weight off long-term.
Gastric Band Advantages
Minimal Trauma- Least invasive surgical option
- No intestinal re-routing
- No cutting or stapling of the stomach wall or bowel
- Small incisions and minimal scarring
- Reduced patient pain, length of hospital stay and recovery period
- Significantly lower mortality risk compared to other weight-loss surgeries
- Low risk of nutritional deficiencies associated with gastric bypass
- Reduced risk of hair loss
- No “dumping syndrome” related to dietary intake restrictions
- Allows individualized degree of restriction for ideal rate of weight-loss
- Adjustments performed without additional surgery
- Supports pregnancy by allowing stomach outlet size to be opened to accommodate increased nutritional needs
- Only surgical option designed to help maintain long-term weight loss
- Removable at any time
- Stomach and other anatomy are generally restored to their original forms and functions
- More than 250,000 gastric banding procedures performed worldwide
- Standard of care for hundreds of surgeons around the world
- Academic publications with up to 10 years of follow-up.
Gastric Banding FAQs
(Frequently Asked Questions)
Weight-loss results vary from patient to patient, and the amount of weight you lose depends on several things. The gastric band needs to be in the right position, and you need to be committed to your new lifestyle and healthy eating habits.
Obesity surgery is not a miracle cure, and the pounds won't come off by themselves. It is very important to set achievable weight-loss goals from the beginning.
A weight loss of two to three pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too quickly creates a health risk and can lead to a number of problems.
The main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity.
Many surgeons have reported that gastric bypass patients lose weight faster in the first year. At five years, however, many gastric band patients have achieved weight loss comparable to that of gastric bypass patients.
Focus on long-term weight loss and remember that it is important to lose weight gradually while reducing obesity-related risks and improving your health.
Although the gastric band is not meant to be removed, it can be. Surgeons report that the stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight. You may also gain more.
The gastric band makes you eat less and feel full in two ways, first by reducing the capacity of your stomach and second by increasing the time it takes food to get through the digestive system.
After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that the gastric band is a tool to help you change your eating habits.
The gastric band does not hamper physical activity including aerobics, stretching and strenuous exercise.
It is important to choose a surgeon who is qualified to perform your procedure and who has a comprehensive program for post-operative follow-up.
Here are some suggested criteria to look for:
- Weight-loss (bariatric) surgery experience
- Board certification (The American Board of Surgery)
- Fellowships (The American College of Surgeons) and memberships (The American Society for Bariatric Surgery)
- A program with hospital facilities, supplies, and equipment specific to the needs of weight-loss surgery patients
- A comprehensive team of staff and procedures to address weight-related health conditions, dietary instruction, exercise training, nursing care, and psychological counseling (if necessary)
- A program that emphasizes long-term care and goals
If gastric band surgery is performed laparoscopicallyas it most frequently is, patients typically spend less than 24 hours in the hospital.
It takes most patients about a week before they can return to work and a month before they can resume strength training exercises. In the case of open surgery or if there are complications, recovery may take longer.
The gastric banding procedure limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well enough or that you are not following the diet rules properly.
However, it could also mean that there is a problem with the placement of the band, so contact your doctor if this problem persists. Vomiting should be avoided as much as possible as it can cause the small stomach pouch to stretch. It can also lead to slippage of part of the stomach through the band and thus reduce the success of the operation. In some cases, excessive vomiting can necessitate another operation.
Check-ups with your doctor are a normal and very important part of the gastric banding procedure follow-up. Patients are seen four to six weeks after surgery for their first adjustment. They are then seen approximately every six weeks for the 1st year after surgery for adjustments.
It is typical for follow-up visits to be scheduled every three to six months during the second and third year, depending on the individual case.
Adjustments are performed without surgery using a thin needle to inject or withdraw saline from the band via the access port. They can be done in an office setting or can be carried out in the X-ray department under flouroscopy. When X-rays are used, your reproductive organs should be shielded.
Most adjustments take 10 to 15 minutes and patients say they are nearly painless.
After a successful operation, you will not have any activity restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed the access port should not cause discomfort or limit any physical exercise.
The only sensation you may experience from the port occurs when you go in for adjustments. If you feel persistent discomfort in the port area, talk to your doctor.
That is not always the case. As a rule, plastic surgery should not be considered for at least a year or two after the operation since sometimes the skin will mold itself around the new body tissue. Give the skin the time it needs to adjust before you decide to have more surgery.
This is a fairly common feeling, especially for patients with bands that are tight to begin with to facilitate maximum weight loss, or for patients who have just had an adjustment. During the day the water content in the body changes, causing the band to feel tighter some of the time. Some women have also noticed that the gastric band feels tighter during menstruation.
One of the major advantages of the gastric band is that it can be adjusted. If your illness requires you to eat more, the band can be loosened by removing saline from it. When you have recovered from your illness and want to lose weight again, the band can be tightened by increasing the amount of saline. If the band cannot be loosened enough, it may have to be removed.
Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. If you need to eat more while you are pregnant, the band can be loosened. After pregnancy, the band may be made tighter again and you can resume losing weight.
You may eat most foods that don't cause you discomfort. However, because you can only eat a little at any given time, it is important to include foods rich in important vitamins and nutrients—foods such as those recommended by your surgeon and/or dietitian.
If you eat foods that contain lots of sugar and fat or drink liquids full of empty calories, such as milkshakes, the effect of the gastric band may be greatly reduced or even cancelled.
You may. It's possible to not get enough vitamins from three small meals a day. At your regular check-ups, your surgeon will evaluate whether you are getting enough vitamin B12, folic acid, and iron. Your surgeon may advise you to take supplements.
You should be able to take prescribed medication, though you may need to (1) use capsules or (2) break big tablets in half or dissolve them in water so they do not get stuck in the stoma and make you sick.
Always ask the doctor who prescribes the drugs about this. Your surgeon may tell you to avoid taking aspirin and other non-steroidal anti-inflammatory pain relievers because they may irritate the stomach. The problems these drugs may cause could result in band removal.
Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.
Alcohol has a high number of calories and breaks down vitamins so it is not recommended as a healthy food choice. However, an occasional glass of wine or other alcoholic beverage is not necessarily considered harmful to weight loss.
It is important to ask your surgeon all the questions you have about obesity surgery and the gastric band. It is also essential that you follow his or her advice.
Vertical Sleeve Gastrectomy
Overview
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| (click to view animation) |
A sleeve gastrectomy is a restrictive surgical weight loss procedure that limits the amount of food you can eat and helps you feel full sooner.
During this procedure, a thin vertical sleeve of stomach is created using a stapling device, and the rest of the stomach is removed.
The sleeve is about the size of a banana. It allows for normal digestion and absorption. Food consumed passes through the digestive tract in the usual order, allowing it to be fully absorbed in the body.
Sleeve Gastrectomy benefits
Significant weight loss: Studies have demonstrated that patients lost an average of 55% of their excess weight. A clinical study on sleeve gastrectomy showed the following health benefits.
Health improvements: As a result of the procedure, patients experienced resolution rates of type 2 diabetes, hypertension, hyperlipidemia, and sleep apnea that were comparable to other restrictive procedures. Post procedure studies provided evidence that patients lost 33 percent to 83 percent of their excess weight.
| Health Problem (Comorbidity) |
Result After Sleeve Gastrectomy Procedure | |
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| Resolved |
Improved |
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| Type 2 Diabetes | 14% |
86% |
| High Blood Pressure | 55% |
42% |
| High Cholesterol | 5% |
77% |
| Obstructive Sleep Apnea | 39% |
61% |
| Acid Reflux/GERD | 57% |
43% |
Shorter hospital stays, faster recovery: The majority of sleeve gastrectomy procedures are performed using a laparoscopic technique. Laparoscopic (minimally invasive) surgery results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures.
Cost savings over time: A recent study showed that expenses associated with bariatric surgery were recouped in about 2 years. One important reason is that weight loss surgery may help to improve or resolve conditions associated with obesity, such as type 2 diabetes and high cholesterol, so patients save money on related prescription drugs, doctor visits, and hospital visits. In addition, monthly savings associated with laparoscopic bariatric surgery reached more than $900 as early as 13 months following surgery.
A reduction in cravings for sweets: A clinical study showed that 50% of patients who had a sleeve gastrectomy procedure lost their craving for sweets after 1 year, and after 3 years 23% still experienced a loss of cravings for sweets.25 In addition, the level of a hormone called ghrelin, which has been described as a hunger-regulating hormone, was found to be significantly reduced after sleeve gastrectomy surgery.
Quality-of-life improvements: Clinical studies of laparoscopic bariatric surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities, and had more self-confidence than they did prior to surgery.
"Bariatric surgery is the only
proven method of achieving
weight control in the morbidly
obese."
Dr. Christopher Joyce
Walk in the shoes of a morbidly
obese person for one day and
you will understand their
suffering.