How does Weight-Loss Surgery Work?We once thought it purely mechanical – a smaller stomach so you eat less, or a shorter intestine so you absorb less. We now believe that our bariatric procedures work through a complex change in the hormonal response to food. This appears to be the same mechanism by which diabetes and other metabolic problems respond so quickly to surgery before weight-loss occurs. The exciting part of this research is that one day we may be able to make surgery for this problem obsolete, once we identify the reason why bariatric surgery works so well.
Roux-en-Y Gastric Bypass – This is one of the oldest and most common type of weight-loss or bariatric surgery. This procedure has been performed for nearly 50 years, and has been refined over time in order to limit side effects and optimize performance.
There are many variations of gastric bypass procedures; older operations may be completely different from the state of the art procedures performed by most surgeons today. Here's what the procedure entails:
1. Surgeons operate through ½-inch incisions. Specialized instruments are guided through these tiny incisions by high definition cameras. This minimally invasive approach is known as laparoscopic surgery. By eliminating the large incision associated with traditional surgery, patients often experience shorter recovery times and are less susceptible to infection. Also, the operation is safer and more precise with the proper training and expertise.
2. A small pouch is created from your original stomach using surgical staples. This pouch becomes your new stomach. The rest of the stomach is left in place and remains healthy because the blood supply and nerves are left intact.
3. This new, smaller stomach is connected directly to the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. None of these bypassed organs are harmed or removed.
This technique is a proven way for patients to achieve and sustain weight-loss. Patients will often continue losing weight at a steady rate up to two or more years after surgery or until they have reached a healthier weight.
This operation can be reversed or modified, laparoscopically, depending on the needs of the patient.
Adjustable Gastric Band – The adjustable gastric band is a device that is placed on the upper portion of the stomach. Like gastric bypass, the gastric band procedure is done laparoscopically with minimal incisions. The gastric band creates a feeling of fullness with less food. Additionally, the adjustable band does not require stapling or the removal of the stomach or intestine.
The adjustable gastric band has been shown to be effective and safe, especially for lower body mass index (BMI) patients. However, long-term studies have shown a higher re-operation rate occurring over time. Removing or replacing a band, although a laparoscopic procedure is higher risk than the original procedure; therefore although the adjustable gastric band is one of our safest operations when first put in, the long-term risks can be higher than some of the more complex procedures.
Sleeve Gastrectomy – The sleeve gastrectomy requires removal of 85% of your stomach.
However, the intestine is not bypassed, so vitamin and most nutrient absorption is not affected as much as in the bypass procedures. Risks are similar to the gastric bypass and long-term data (>10 years) is not available. The sleeve gastrectomy appears to be a very good operation for some patients and can be converted to a gastric bypass or duodenal switch if necessary.
Biliopancreatic diversion – This is a form of gastric bypass and has confused many patients and physicians alike. This procedure requires removal of ½ of your stomach and bypass of over 50% of your small intestine. The side effects are pronounced and include smelly bowel movements, gas and a high degree of diarrhea. The 
malabsorptive nature of this operation makes vitamin, mineral and protein replacement critical for long-term health. However, it is one of our most powerful operations for sustained weight loss and control of metabolic disorders such as diabetes and high cholesterol.
Duodenal switch – Biliopancreatic diversion with duodenal switch (BPD/DS) is a modification of the biliopancreatic diversion that has many of the attributes with less side effects. This procedure combines the sleeve gastrectomy with a longer bypass of the intestine than the gastric bypass, so that it maintains the metabolic power of the biliopancreatic diversion with less diarrhea and gas issues. Unfortunately, the complexity of the operation makes it one of our most risky procedures and is usually done in two stages, the first being a sleeve gastrectomy, followed by the intestinal bypass six months to a year later.
Revisionary Procedures – You might be interested in a revisionary procedure for several reasons – failing to lose as much weight as you would like or need to, or maybe gaining weight back again. As the disease of obesity is incurable, it would be unreasonable to expect one intervention to solve this problem for all patients. Likewise, if the disease is 
only partially treated, then you may be a candidate for further intervention depending on your risks compared to the benefits.
You might also need a revision if you are experiencing complications of the primary operation such as diarrhea, malnutrition, unexplained abdominal pain or ulcers. Many times, with the proper treatment and follow-up, we can avoid another operation. But if it’s necessary, we can perform revisionary procedures laparoscopically, even if your first operation was done open, with a large incision.
Revisionary procedures are complex and highly individualized. The risks are much greater than a primary operation, but the benefits could be much greater as well. Not every bariatric surgeon feels comfortable or has the experience to perform revisionary surgery. Certainly, the average general surgeon should not attempt revisionary bariatric surgery, except in an emergency. Our surgeons teach revision surgery internationally to other surgeons.
Endoscopic / Endoluminal / Single-incision / Incisionless / NOTES
There are many bariatric procedures in development, experimental or investigational, that have caught the interest of surgeons and patients. Because of our dedication to bring forth the most effective and safest treatment options available and our reputation for quality, we are approached and have access to many devices and techniques not available to the general public. However, our ethics will not allow for human experimentation, or advising ineffectual treatment just for financial gain. There is a difference between state-of-the-art and trendy. The test for us is: “Is that what you would advise a member of your own family?”
Learn more about these surgical options and others that may be newly available by attending one of our free seminars.
