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How Bariatric Surgery Works
How Bariatric Surgery Works
Calories still count. The underlying principle of bariatric surgery is that by dramatically reducing the size of your stomach, you’ll limit the amount of food you can comfortably eat at a meal. You’ll feel “full” much more quickly and ingest fewer calories.
The decision to undergo bariatric surgery involves a dramatic lifestyle change – a commitment to exercise and careful diet habits to keep the weight off and make your program successful.
The PRH program utilizes several approaches to weight-loss surgery. Which one is right for you depends on your health, your goals and your preferences.
Gastric bypass was the first bariatric technique to be adopted for general use. With a high success rate, it remains the “gold standard” of bariatric procedures. It enables the greatest amount of weight to be lost in the shortest time – an average of 70 to 80 percent of excess weight. A patient 100 pounds overweight can anticipate a loss of 70 to 80 pounds.
It’s performed by dividing the stomach into two sections. One section becomes a new, smaller stomach that holds about one-and-a-half ounces of food. The bulk of the stomach, with a volume of about quart, remains in place without the capacity for receiving food – “bypassed” in the gastric process.
During the procedure, a segment of small intestine called the “Roux limb” is connected directly to the new, smaller stomach, so that the stomach’s contents are channeled on to the intestinal tract. Since the Roux limb contains no enzymes to digest the food, digestion doesn’t begin until the food is farther down the gastric tract. The arrangement both limits the amount of food you take in before feeling full and reduces the amount of nutrients being absorbed from it, intensifying the calorie-limiting effect.
Performed with thin, fiberoptic laparoscopic instruments inserted through six dime-size incisions, the procedure takes two to three hours and requires two to three days of hospitalization. Most patients go back to work in about four weeks, although some return as early as two weeks.
Lap Band Surgery
Lap band surgery involves placement of a restrictive silicone band (or ring) around the upper stomach to reduce the amount of food that can be accommodate at any one time. The band can subsequently be adjusted, as appropriate, by means of a balloon within the structure. It’s connected by a tube to a disk implanted just under the skin, which your surgeon can access to inflate (or deflate) the balloon to tighten (or loosen) the band. Most patients require three to six of these “adjustments” in the year following surgery.
With no division of the stomach and intestine, lap band surgery is relatively easy and without significant risks. Performed with laparoscopic instruments inserted through dime-sized incisions, the procedure takes about an hour and most patients are able to return home the same day. They’re usually able to return to work in two weeks.
Benefits and Disadvantages
While the procedure is the easiest of the three techniques to perform, it also generally brings about the lowest amount of weight loss and does so over a longer period – patients on average lose 50 to 60 percent of excess weight, and do so more slowly than gastric bypass.
Unlike gastric bypass, lap band surgery relies strictly on limiting the amount of food that can be consumed at any one time. If adjusted correctly, the patient doesn’t feel hungry most of the time. When he or she does, a small amount of food will quickly fill the reduced stomach up. Patients who have a band have to learn to eat slowly, to not eat when they are not hungry, and to stop eating when they “fill up.”
Additionally, it is relatively easy to “defeat” a lap band if the patient doesn’t maintain self-discipline – there are no restrictions on ice cream, shakes or other high-calories liquids. The lap band procedure is the only one of the three that can be reversed, but removal is not recommended – the patient almost always gains he weight back.
Sleeve gastrectomy is the newest of the bariatric surgery techniques performed at Portsmouth Regional Hospital. In the procedure, about 80 percent of the stomach is removed, changing it from a water-bottle shape to a tube shape. The section of stomach removed is the area that produces ghrelin, a hormone that acts on the brain to produce hunger. As a result, the patient’s sense of feeling hungry is reduced.
Sleeve gastrectomy is easier to perform than gastric bypass and more difficult than lap band surgery. Performed lapaoscopically, the procedure itself takes about two hours in the operating room and a day of hospitalization. Most patients are able to return to work in two to three weeks.
Sleeve gastrectomy relies solely on restricting food intake. Overall weight loss is better than with lap band surgery but not as good as with gastric bypass. Although it’s not reversible, like lap band it can be defeated by consuming high-calorie liquids.