Procedures
Adjustable Gastric Banding
Making the decision to break the never-ending cycle of yo-yo dieting to opt for weight loss surgery is one that we ask our patients here at North Florida Regional Medical Center to take very seriously. Getting all the facts about what options are available will enable you to take those next steps with the education and confidence necessary to understand the benefits, risks and lifestyle changes that go along with the procedure. Studies show that patients who use traditional weight loss programs often regain about two-thirds of it in a year and nearly all of it within five years. Adjustable gastric banding or as it’s most commonly referred to LAP-BAND (the trademark name for the original FDA-approved gastric banding device), can put an end to that.
Adjustable Gastric Banding is a minimally invasive procedure that involves fastening a silicone band around the upper stomach to reduce the size of the stomach’s food storage area and thereby controlling the amount of food you are able to eat. For the procedure, often performed on an outpatient basis in just an hour or two, no cutting, stapling or re-routing of the digestive process is required, making it one of the least traumatic or debilitating weight loss operations. Adjustable Gastric Banding is performed laparoscopically, meaning only a few small incisions are made in the stomach enabling the surgeon to operate through the use of a small camera and miniature surgical tools, so there is less scarring and reduced recovery time for the patient, who typically returns to regular routines within a week’s time.
Unlike other weight loss surgeries, the rate of weight loss with the Lap-Band can be customized to fit the individual’s goals since the actual band is adjusted over time. As the band, an inflatable doughnut-shaped balloon, is attached, it creates a gastric pouch with a capacity of about 15 to 30 cc’s. A tube is then inserted, connecting the band and an abdominal port beneath the skin, and after the initial four to six weeks, the diameter of the band is adjusted with the addition or removal of saline through the port, impacting how much restriction the patient will experience while eating. There are typically more adjustments during the first year with the Lap Band to optimize weight loss than with subsequent years.
For patients to be successful with this procedure, commitment and adherence to a new diet and fitness regimen are essential. A smaller stomach pouch simply holds less food and empties more slowly than a stomach of regular proportion, so smaller meals are required for the patient to feel full and he or she stays full for a longer period of time. Patients who undergo the Adjustable Gastric Banding procedure must incorporate a recommended vitamin regimen into their regular schedule to offset any potential nutritional deficiencies caused by consuming less. Once the patient has fully recovered from surgery, daily exercise and a balanced diet of healthy protein sources, fresh vegetables and fruit are a must to ensure success.
Gastric Bypass
Nationwide, statistics indicate the Gastric Bypass surgery is effective in 85 percent of all people who have the surgery. Success means the individual must lose at least 50 percent of their excess body weight and maintain that weight loss for more than five years. Bear in mind, this also means that 15 percent of all people who have had Gastric Bypass surgery did not lose weight, or they lost weight but gained it back within five years.
In Roux-en-Y gastric bypass the stomach is divided into two compartments. The upper, and much smaller component, is about 1-2 oz., or roughly the size of a thumb, which can hold approximately 30 cc (1/8 cup) from its original capacity of 2000-3000 cc. A new outlet, 1.0 cm in diameter (approximately the size of a dime), is created in this small portion of the stomach. The upper small intestine is then divided close to its beginning and the lower divided end brought up and joined to the new stomach opening. Food entering this new “small stomach” causes a sensation of fullness, and then slowly empties into the intestine through the “new” small outlet. This re-routing causes food to bypass the lower part of the stomach (hence the name “Gastric Bypass”). Digestive juices from the lower stomach and the duodenum still flow around to mix with food through a new hook-up further down, thus permitting digestion of the food.
To ensure that staple line failure does not occur, the stomach is no longer simply partitioned with a row of staples. It is now completely divided between two staple lines, each with double staple rows. Finally the staples are oversewn to reinforce the closure. Staple line failure is very uncommon with this technique. Eliminatation of staple line failure as a cause of weight gain should significantly improve the long term weight loss results of gastric bypass, especially when combined with a healthy diet and exercise. On average, successful patients will lose about one-third of their preoperative weight.