At the Heywood Center for Weight Loss and Bariatric Surgery, we perform two types of weight loss surgery. In most cases, bariatric surgery can be performed laparoscopically, using several small incisions in the abdomen. This minimally invasive procedure reduces recuperation time and offers less chance of infection than open surgery.
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.
There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.
The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into fewer calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is less absorption of calories and nutrients.
Most importantly, the re-routing of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
Gastric bypass produces significant long-term weight loss (60 to 80 percent of excess weight) by restricting the amount of food that can be consumed, and by limited the absorption of some calories and nutrients. It has been shown to result in favorable changes in gut hormones that reduce appetite and enhance satiety. Typically, patients of this procedure will maintain a 50 percent weight loss long term.
It is technically more complex than the Sleeve Gastrectomy and has the potential for greater complication rates. Due to the mal-absorptive element, it can cause long-term vitamin/mineral deficiencies, particularly deficits in vitamin B12, iron, calcium, and folate. This procedure requires strict adherence to dietary recommendations, life-long vitamin/mineral supplementation, and a commitment to follow-up compliance
The Laparoscopic Sleeve Gastrectomy – often called the Gastric Sleeve – is performed by removing approximately 70-80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.
This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety and blood sugar control.
Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggests the sleeve, similar to gastric bypass, is effective in improving type 2 diabetes independent of weight loss.
The Sleeve Gastrectomy restricts the amount of food the stomach can hold without the mal-absorptive element of the Gastric Bypass. It has been shown to induce rapid and significant weight loss comparable to Gastric Bypass. Weight loss results range in excess of 50 percent up to five years, with similar long term maintenance of 50 percent of weight loss. This procedure results in a relatively short hospital stay of approximately 2 days, and as with Gastric Bypass, causes favorable gut changes that suppress hunger hormones which reduce appetite and improve satiety.
As with Gastric Bypass, Sleeve Gastrectomy is a non-reversible procedure and holds the potential for long-term vitamin deficiencies, somewhat lessened by the non-mal-absorptive nature of the surgery.