Surgery for Weight Loss
Surgery for weight loss, or bariatric surgery, is becoming increasingly popular in the United States. The different types of surgery available fall into three general categories: malabsorptive, restrictive and mixed. Malabsorptive procedures limit the amount of calories and nutrients that the body absorbs by shortening the digestive tract. Restrictive procedures reduce stomach size, reducing the amount of food that the patient can eat. Mixed procedures use a combination of both techniques. Many of these procedures can be performed laparoscopically, which requires only three to five small incisions in the abdomen.
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Gastric Bypass
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The most common form of bariatric surgery in the United States, gastric bypass is a mixed procedure that reroutes the digestive system. A small portion of the stomach is sectioned off and a segment of the small intestine is rearranged so that both portions of the stomach are connected to it. There are several different types of gastric bypass; the most commonly used procedure is known as Roux-en-Y, in which the small intestine is reformed into a "Y" shape.
Laparoscopic Adjustable Gastric Band (Lap-Band)
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This is a popular restrictive procedure in which a flexible silicone band is placed around the upper portion of the stomach. The small pouch created by the band causes food to drop more slowly into the lower portion of the stomach. Because the nerves that signal the brain when the stomach is full are located in the upper portion of the stomach, a person will feel full after eating just a small amount of food. The band is connected to a port that is placed under the skin. Saline solution is periodically injected into the port to inflate the band, further reducing the size of the pouch after stretching occurs.
Biliopancreatic Diversion
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Biliopancreatic Diversion, or BPD, is a malabsorptive procedure in which 70 percent of the lower stomach is removed. The remaining portion of the stomach is directly attached to the small intestine. After BPD, patients typically absorb only 25 percent of the fat they consume. The procedure has a high record of maintained weight loss, but patients may suffer from nutritional deficiencies and must be willing to follow a strict vitamin regime and diet.
Duodenal Switch
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Duodenal Switch is similar to Biliopancreatic Diversion in that it removes 70 to 80 percent of the lower stomach; however, this procedure leaves intact the pyloric valve, the muscle at the base of the stomach that allows food to pass into the duodenum. This helps prevent dumping syndrome, which occurs when food passes from the stomach into the small intestine too quickly. Dumping syndrome can cause bloating, nausea, fatigue and dizziness. In this procedure, the small intestine is rerouted to allow food to reach the large intestine more quickly, resulting in only 20 percent fat absorption.
Sleeve Gastrectomy with Duodenal Switch
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This is a mixed procedure that removes about 85 percent of the stomach, leaving a sleeve or cylindrical-shaped stomach. During the surgery, a thin cylinder called a bougie is inserted into the stomach to create the correct shape and size of the sleeve. The open side of the stomach is stapled shut and the unused portion of the stomach is removed. Sleeve gastrectomy may be used on patients who are too obese to qualify for gastric bypass or other forms of bariatric surgery. This procedure is generally the first step in a two-part surgical procedure; after the patient has lost a certain amount of weight a duodenal switch is performed to maintain the weight loss.
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