What is Bariatric Surgery?
Bariatric surgery is surgery on the stomach and/or intestine to help a person with extreme obesity lose weight. There are two major types of surgery offered, and many variations of those two types. Here’s a list to help you understand some of the most common procedures available today:
- Adjustable gastric banding
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This involves insertion of a band to restrict the size of the opening from the esophagus to the stomach. The surgeon can control the amount of restriction by the band, thereby reducing the amount of food that can be eaten and absorbed by the stomach. This procedure is considered reversible because the band can be removed at any time.
- Gastric bypass (also called roux-en-Y gastric bypass)
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This is a permanent reduction in the size of the stomach. The proximal (or nearest point of attachment to the esophagus) is used to create a golf-ball sized pouch that is connected to the intestine that bypasses about 2 feet of your normal intestine. The size of the pouch and the opening size between the pouch created and the intestine restrict the amount of food eaten.
There are two ways to perform bariatric surgery:
- Traditional open surgery
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A large midline incision is made and the operation is performed with the surgeon viewing the anatomical contents. Recovery time is longer than laparoscopic surgery.
- Laparoscopic surgery
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Also known as limited access surgery: several small incisions are made into the abdomen one of which allows a microscopic video camera that displays the operation on a video screen. The surgeon uses a small scope to obtain access and perform the surgery. The surgeon can convert to an "open surgery" at any time if needed. Recovery time is usually shorter, with less risk and pain involved than an open procedure.
Bariatric Procedure Definitions
| Procedure | Definition | Open Surgery or Laproscopic | Permanent or Temporary |
|---|---|---|---|
| Gastric By-Pass | Creation of a small, egg- sized pouch from the upper stomach, by-passing the remaining stomach. The G.I. tract is reconstructed to allow drainage of contents from both parts of the stomach outlet. See the following definitions for variations on this procedure | Both | Permanent |
| Gastric By-Pass Variation: roux-en-Y-proximal (upper) | Most common variation. The small bowel is divided about 18" below the lower stomach outlet, re-arranged into a Y shape to allow outflow of food from the new, small stomach. The proximal version the "Y" shape is made near the upper end of the small bowel so that most of it can be used for absorption of nutrients | Both | Permanent |
| Gastric Bypass-Variation: roux-en-Y-distal (lower) | The "Y" connection is formed closer to the lower (distal) end of the small bowel compared to the proximal bypass—this reduces the amount of nutrients the bowel can absorb. Bowel/G.I. upset is more common but more total weight loss is seen. | Both | Permanent |
| Loop Gastric Bypass or "Mini-gastric Bypass" | Uses a "loop" for reconstructing the small bowel, instead of the "Y". Easier to do laparoscopically | Both | Permanent |
| Adjustable Gastric Banding (AKA "the Roker Ring") | A hollow plastic band goes around the stomache. The band is connected via a tube to a small box located in the abdomen. The band restriction is controlled by filling the box with serum, forcing reduced intake. The serum can be either removed or added to with a needle via the doctor. | Usually laparoscopic | Can be Reversed |
| The Duodenal Switch Procedure | About 70% of the stomach is removed, a large part of the small intestine is re-routed which creates separate pathways to re-route food intake and decrease the amount of time the body has to absorb calories. Only 20% of fat consumed is absorbed. | Open | Permanent |
| The Sleeve Gastrectomy | Stomach is reduced to about 15% of its original size by surgical removal. The open edges are closed (usually with staples) and the remaining stomach is formed into a sleeve, or banana shape. | Laparoscopic | Permanent |
| Vertical Banded Gastroplasty (VBG) | Also commonly known as stomach stapling. A band and staples are used to create a small stomach pouch. The bottom of the pouch has a small opening (1 cm), through which the contents flow to the G.I. tract. | Open or Laparoscopic | Permanent |
| Jejunoileal Bypass | Procedure used in the 1950s through the '70s. All but 30 cm. of small bowel was detached and set to the side and left in the abdominal cavity. Many severe complications occurred following surgery--including anemia, liver failure and severe malnutrition, which essentially brought an end to this surgery. | Open | Permanent |