PROCEDURES
WHAT IS BARIATRIC SURGERY?
Bariatric surgery is a generic term to describe some surgical procedures used in the treatment of obesity, which seek to control the absorption of fats, carbohydrates and sugars in the body by reducing the size of the stomach and modifying the gastrointestinal tract.
These procedures involve the use of a laparoscope and are generally considered minimally invasive, since they do not require large incisions in the patient’s body as with conventional surgical methods. Therefore, procedures that require the surgical removal of body fat, such as liposuction, are not included in the bariatric surgery category.
All those people who have not been successful in their fight against obesity through diets and exercise programs, can achieve their goal through bariatric surgery.
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RESTRICTIVE PROCEDURES
Restrictive weight reduction surgery works by reducing the amount of food eaten at one time. However, it does not interfere with the normal absorption (or digestion) of food. It is extremely important to know that, in a restrictive procedure, the surgeon creates a smaller gastric pouch in the upper part of the stomach. The pouch, which has a capacity of approximately 1/2 to 1 ounce (15 to 30 ml), is attached to the rest of the stomach through an outlet known as a <<stoma>>. If the patient manages to follow his or her treatment to the letter, making changes in their routine together with the reduced stomach capacity, a systematically low calorie intake and equally systematic weight reduction can be achieved.
The procedure works by creating a sense of fullness in the body and thus decreasing the sensation of hunger, resulting in the person eating the right amount of food.
GASTRIC BALLOON
The Intragastric Balloon is a procedure offered as an option to lose weight in a short period of time. It consists in placing a deflated balloon endoscopically through the mouth, attached to a hose with a unidirectional valve. It is filled with approximately 500 cc to 700 cc of colored water. The objective is to occupy space inside the gastric chamber in order to force a smaller intake and to achieve diet discipline throughout the weight loss process. The advantages are that it is a non-surgical procedure with very low risk. However, it is temporary and the balloon can only be kept for six months to a year.. For this reason, the results are unpredictable since the success depends on the patient’s collaboration.
Why get an Intragastric Balloon?
Generally, this weight loss procedure is done for two reasons. One is a situation in which the patient may not qualify for another type of procedure, but does have obesity-related health problems. The other is for a severely obese patient for whom the procedure can help reduce weight before undergoing a permanent weight loss surgery, and reduce the risk factors for the latter.
Recovery
As with all weight loss procedures, after the Intragastric balloon has been inserted, the patient will have to change his or her diet and eating habits. General discomfort is normal for a few days after insertion until the stomach gets used to its new shape. Symptoms such as nausea, bloating and mild abdominal pain are to be expected, but these side effects are manageable and short lasting.
Risks associated with the Intragastric Balloon Procedure
Generally, the risks of an Intragastric Balloon procedure are minimal, but as with all surgical options, complications can occur and are very rare. Be sure to speak with one of our medical professionals to fully understand the risks.
Am I a candidate for an Intragastric balloon?
Our medical professionals will be happy to answer your questions and determine if you qualify for this procedure or if there are other more appropriate weight loss options. Each case requires an evaluation by medical experts. Contact us today to determine which weight loss options are best suited to help you reach your goals.
Contact our expert weight loss team to discuss whether restrictive bariatric surgery is right for you.
GASTRIC SLEEVE
Technically called Vertical Sleeve Gastrectomy, it is a surgery in which a longitudinal cut is made in the stomach resecting a large part of its left portion. The result is a stomach reduced by approximately 60% to 70% of its normal capacity, thus limiting food intake.
How does the Gastric Sleeve Surgery work?
It is a definitive and non-reversible surgery due to the percentage of stomach resected. Since the patient can eat only small portions, he/she will lose weight, especially if he/she follows a low-fat and low-carbohydrate diet. Due to the reduction of stomach size, the patient feels fullness and satiety for prolonged periods of time. As with all our procedures, it is performed laparoscopically in approximately 45 minutes to 1 hour, and the hospital stay is 1 day. It is recommended for patients with a low Body Mass Index (BMI) and those who do not have a clear metabolic syndrome, as an alternative to the gastric balloon. If weight loss is insufficient, this procedure can be easily modified to another type of bariatric surgery. Contact our expert weight loss team to discuss whether restrictive bariatric surgery is right for your particular case.
MALABSORPTION PROCEDURES
It is fair to say that some of the restrictive methods discussed above have not always achieved the weight reduction anticipated by both surgeons and patients. For this reason, procedures to alter digestion, known as malabsorptive procedures, were developed to work in conjunction with the restrictive methods. Some of these techniques involve bypassing the small intestine in order to limit caloric absorption. Ultimately, malabsorptive and/or restrictive procedures have resulted in an overall improvement in weight reduction. Generally, the risk of complications and side effects increase if the small bowel bypass procedure becomes longer. You and your surgeon should determine the risks and benefits to your daily life depending on the type of weight loss surgery you choose.
GASTRIC BYPASS
Gastric bypass surgery is among the most popular laparoscopic weight loss surgical options. Under this category of procedures, the most common gastric bypass is the Roux-en-Y Gastric Bypass. Hundreds of thousands of these surgeries are performed every year, allowing more patients to benefit from the results of the weight-loss in a long-term period. Since its approval in 1993, the Roux-en-Y Gastric Bypass has resulted in patients spending less time in the hospital, shorter recovery times and less scarring from these procedures.
How Gastric Bypass works
Gastric Bypass surgery consists in the creation of a small pouch at the stomach’s entrance. This reduction in the size of the stomach restricts the amount of food that can be ingested and therefore decreases the body’s caloric intake resulting in weight loss. The other part of the stomach is hermetically sealed, and although it is not used, it is not removed from the body.
After the stomach has been divided, an exact part of the small intestine is adapted to the new size of the stomach. The size of the small intestine that has been reshaped is determined by the patient’s weight and must be accurate in order to allow sufficient absorption of food and to ensure the patient’s health.
The small pouch at the entrance of the stomach is then connected to the gastrointestinal tract, bypassing most of the stomach. By reducing the amount of small intestine available, the body’s ability to absorb nutrients is reduced, and consequently a process of weight loss begins once the surgery is completed. This is why gastric bypass surgery is also considered a malabsorptive procedure.
Finally, the part of the small intestine that comes from the larger part of the stomach is reconnected to the small intestine to ensure proper drainage of the stomach. When the small intestine is reconnected, it forms a “Y”, which is why the procedure is known as Roux-en-Y Gastric Bypass.
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The main objective of this approach is to minimize the patient’s ability to consume food and to alter the intestinal tract in such a way as to decrease the absorption of fats and sugars in the body.
Other techniques in this class, in addition to the Gastric Bypass, are the Biliopancreatic Diversion and the Duodenal Switch.
Consult our experts to determine which is the most appropriate for your case.
Re-interventions IN BARIATRIC SURGERY
Weight regain is a common procedure in patients who do not meet their goals or regain weight several months or years after having undergone surgery. Some studies indicate that these patients usually present dilation of the anastomotic mouth (junction between the remnant of the stomach and small intestine) or dilation of the stomach reservoir, with the subsequent constant non-decrease or gain of weight. Some of the reasons for weight regain are:
- Weight gain
- Disturbing and/or disabling digestive symptoms
- Recurrence of metabolic disorders
Re-intervention Surgery
Our group of surgeons is the most experienced medical team in surgical reintervention due to weight regain, also known as revision bariatric surgery. Furthermore, our work has been published in reputable medical journals.
All surgical procedures involve a series of risks that could lead to not achieving the desired result or even worse, lead to serious side effects that affect the patient’s health. In these cases a surgical reintervention may be required. Normally when these problems occur, more complex procedures than the original ones are usually necessary and this is why the risk factors increase.
When any of these complications occur, the patient should choose only the most experienced medical team to perform the required re-intervention
Previous bariatric surgery: When the patient is presenting some type of complication as a consequence of the bariatric surgery previously performed, a reintervention procedure may be necessary.
Some of the most common complications of bariatric surgeries are:
- Failure of the Adjustable Gastric Band: With time, this procedure presents an important failure in weight loss. It can become displaced and behave as a foreign body, producing an important inflammatory reaction and even perforation of the stomach. In most cases it is necessary to remove the gastric band and submit the patient to a gastric bypass in a second operation.
- Late staple line disruption: This complication can occur in the vertical banded gastroplasty procedure (currently not widely used) and consists in the abnormal connection of the previously sectioned tissues, which would lead to a failure in the weight loss objective. For this reason, this intervention is not used anymore.
- Gastric Sleeve Failure: As a purely restrictive procedure, it is designed so that the patient cannot ingest large amounts of food. If the patient consumes small amounts of high-calorie food, the expected objective is lost. In these cases, conversion to laparoscopic gastric bypass should be considered.
- Gastric Bypass Failure: Although it is minimal, there is a possibility of a mild to moderate dilatation of the outlet orifice of the small stomach, and a partial loss of the intended malabsorption mechanism. In these cases, a reintervention to remodel the small stomach and rethink the length of the derived intestinal loop is considered. In cases of severe obesity, there is the option of conversion to a duodenal switch or a bilio-pancreatic diversion.
Reinterventions that must be performed following failures in the expected results of the previously performed bariatric surgery are considered high-risk procedures. Be sure to consult with your surgeon and make the right decision on a case-by-case basis. The Cirugía Para La Obesidad group has performed hundreds of corrective procedures to failed weight loss surgeries performed by other surgical groups. If you have any type of failure or problem as a result of previous weight loss surgery, contact one of our specialists to discuss how to help you.
Previous non-bariatric abdominal surgery: “There is no reason not to operate on a patient who has had other abdominal surgery”. The level of complexity of these cases varies depending on how severe the adhesive process may be and the nature of the previous procedure. The patient should be clear with the surgeon as to what previous procedures he/she has undergone and how these may affect the surgical approach to the weight loss procedure. In general, a thorough work-up by an experienced surgeon can lead to satisfactory results.
Additional risk factors: Generally, a candidate for bariatric surgery must meet a series of pre-established criteria. A properly conducted protocol guarantees patient safety and minimizes risks. In complex cases (high risk patients or with previous bariatric surgery), it is highly recommended that the procedure be performed in an outstanding bariatric surgery center by an experienced and qualified surgeon. For this type of procedure, our best presentation is our extensive experience in bariatric surgery and in reintervention of complex cases coming from other institutions and surgical groups.