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Bariatric

WEIGHT-LOSS AND METABOLIC SURGERIES

  1. Laparoscopic Adjustable Gastric Banding
  2. Laparoscopic Roux-en-Y Gastric Bypass
  3. Laparoscopic Biliopancreatic Diversion (BPD) / With Duodenal Switch (BPD-DS)
  4. Laparoscopic Gastric Sleeve Restriction
  5. Reoperative Bariatric Surgery
  6. Metabolic Surgery (for Diabetes)

 1.  Laparoscopic Adjustable Gastric Banding

It is a minimally invasive surgery that involves surgically inserting an inflatable band (the LAP-BAND) around the uppermost part of the stomach - creating a small gastric pouch.  By creating a smaller gastric pouch, the lap-band limits the amount of food that the stomach will hold at any time. The inflatable ring controls the flow of food from this smaller pouch to the rest of the digestive tract. The patient will feel comfortably full with a small amount of food. And because of the slow emptying, the patient will continue to feel full for several hours reducing the urge to eat between meals

This less traumatic reversible procedure does not include cutting or stapling the stomach and there is no bypassing of the intestines.

Procedure

After performing a series of small incisions, your surgeon would use a small camera, called a laparoscope, to visualize placement of the Lap-Band. The Lap-Band is placed around the top of the stomach and secured in place with sutures. The port is then placed underneath the skin on the top part of the abdomen. Surgery should take only about an hour, and an overnight stay in the hospital may or may not be required.
Following surgery, you should be able to return to work within a week, with minimal discomfort. You will need to follow a nutrition plan prescribed by your surgeon. The nutrition plan will likely include a liquid diet for a few weeks, until you can tolerate soft foods, and later solid foods. A specific exercise program, as well as behavioral-modification therapy, may also be recommended. Patients typically lose 50% to 60% of their excess body weight within two years after the procedure.

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2.  Laparoscopic Roux-en-Y Gastric Bypass

The Roux-en-Y bypass is the most frequently performed bariatric procedure, and is considered to be the gold standard in weight loss surgery. The Roux-en-Y surgery closes off most of the stomach, through stapling, to decrease the amount of food a patient can eat, and also rearranges the small intestine to reduce the amount of calories that a patient's body can absorb.

 The laparoscopic Roux-en-Y gastric bypass uses multiple smaller incisions (instead of one long incision) - a laparoscopic tool is inserted, which offers a visual guide to the inside of the abdomen during the procedure. The laparoscopic Roux-en-Y produces less scarring and lets you recover faster than the traditional Roux-en-Y gastric bypass.

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3.  Laparoscopic Biliopancreatic Diversion (BPD) / With Duodenal Switch      (BPD-DS)
A biliopancreatic diversion changes the normal process of digestion by making the stomach smaller and allowing food to bypass part of the small intestine so that you absorb fewer calories.

You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also means that you will absorb fewer calories. This leads to weight loss.

There are two biliopancreatic diversion surgeries: a biliopancreatic diversion and a biliopancreatic diversion with duodenal switch.

In a biliopancreatic diversion, a portion of the stomach is removed. The remaining portion of the stomach is connected to the lower portion of the small intestine.

In a biliopancreatic diversion with duodenal switch, a smaller portion of the stomach is removed, but the remaining stomach remains attached to the duodenum (the upper part of the small intestine). The duodenum is connected to the lower part of the small intestine.

These procedures can be done by making a small incision and using small instruments and a camera to guide the surgery.

After Surgery

Surgery for obesity usually involves a 2- to 3-day hospital stay. Most people can return to their normal activities within 3 to 5 weeks.

A biliopancreatic diversion may cause dumping syndrome. This occurs when food moves too quickly through the stomach and intestines. It causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms are made worse by eating highly refined, high-calorie foods (like sweets). In some cases you may become so weak that you have to lie down until the symptoms pass. Dumping syndrome does not occur in a biliopancreatic diversion with duodenal switch.

Risks

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop problems related to poor nutrition, such as anemia or osteoporosis.

Biliopancreatic diversion surgeries result in reduced absorption of protein, fat, calcium, iron, and vitamins B12, A, D, E, and K. You may have frequent, bad-smelling stools and a higher risk for developing osteoporosis.

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4.  Laparoscopic Gastric Sleeve Restriction

Sleeve gastrectomy is a new procedure that induces weight loss by restricting food intake. With this procedure, the surgeon removes approximately 60 percent of the stomach laparoscopically so that the stomach takes the shape of a tube or "sleeve." This procedure is usually performed on super obese or high risk patients with the intention of performing another surgery at a later time. The second procedure can either be a gastric bypass or duodenal switch.

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5.  Reoperative Bariatric Surgery

In patients who have undergone bariatric surgery, 10% to 25% will require a revision, either for unsatisfactory weight loss or for complications. These depend greatly on the individual nature of the previous surgery and the ongoing problem. The reoperation may be done laparoscopically or via the open operative method.

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6.  Metabolic Surgery (Diabetes)

A gastrointestinal operation can be performed to directly treat diabetes - not just as a byproduct of weight-loss surgery.  Sort of a surgical diet, the procedure is specifically designed to treat type 2 diabetes. The rerouting of the intestine is so that you do not absorb the stomach contents. Instead of shrinking the stomach like most approaches to weight-loss surgery, the metabolic surgery approach reroutes the small intestine, leaving the stomach intact.

Gastric bypass procedure is recommended in nonmorbidly obese patients with diabetes because of the lower complication rate and because the procedure can be performed laparoscopically.  Bypassing of the duodenum and proximal jejunum decreases production of a hormone or neuronal signal secondary to the passage of food that is responsible for the impaired action or secretion of insulin that occurs in type 2 diabetes. This outcome is not related to a decrease in food intake or a drop in weight.

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