There are several types of Bariatric Surgeries to cure obesity:
First category is Restrictive, which surgically reduces the stomach size to reduce amount of food intake. This includes Vertical Banded Gastroplasty (referred to in 70s and 80s as stomach stapling), Laparoscopic Adjustable Gastric Banding and Laparoscopic Vertical Gastrectomy (Sleeve Resection).
The Second category is Malabsorption, which is surgical re-routing of the intestines leading to reduced absorption of the food consumed. This includes Jejuno-ileal Bypass (which is not done anymore) and Biliopancreatic Diversion (which is currently rarely done).
The Third category is a combination of Restrictive and Malbsorption procedures which reduces the size of the stomach in conjuction with bypassing some of the small intestine to create a weight loss surgery that works on both advantages. It includes Laparoscopic Gastric Bypass (Proximal RNY), Fobi Pouch, Distal RNY, Mini Gastric Bypass and Duodenal Switch.
Other procedures are Gastric pacemaker and Gastric Balloon, neither of which are FDA approved and are still in the investigative process.
In Vertical Gastric Banding the stomach is stapled with surgical staples to half of its capacity. A silastic ring is inserted in the stoma to help prevent the stomach opening from stretching in size and also to prevent stenosis or a stricture of scar tissue from closing this opening. It restricts food intake and creates a feeling of satiety. The VBG was very popular in 1970-1990 – but long term results were poor at best. Over time the stomach stretched back to the original capacity and the staple lines eroded causing patients to regain all if not more of their weight.
Gastric banding limits the quantity of food that can be contained in the stomach with the help of an inflatable silicon band. This removable band is placed around the upper part of the stomach creating a smaller pouch close to the barrio receptors that sense fullness. This method includes less surgical trauma, less pain, a lower rate of complications and smaller scar.
In Laparoscopic Vertical (Sleeve) Gastrectomy the stomach is reduced to the shape of a sleeve and essentially ¾ of the stomach removed. The reduced size causes weight loss because less food can be eaten without any bypass of the intestinal malabsorption. People lose 60% of their excess body weight within 6 months of this surgery. This surgery is only recently done as a standalone surgery; historically the Vertical Gastrectomy was used as a first stage surgery in the super obese because of its low risk factor. Once the patient had lost 50% of their excess weight, a Duodenal Switch could then be performed to insure continued weight loss without the inherent surgical risks of performing a two stage surgery in the same session.
Gastric Bypass or Roux-en-Y surgery is the most common form of laparoscopic surgery. This is recommended for morbid obese patients who are at least 100 pounds over their recommended weight. The surgery bypasses sections of the stomach and small intestine creating significant weight loss through both restricted portions and malabsorbtion. There are several variations of the Laparoscopic RNY – Distal, Proximal and Fobi Pouch.
The Laparoscopic Proximal RNY (up to 150 cm of bypassed intestine with the Y at 75 cm) is the most researched procedure to date and sometimes called the ‘Gold Standard’ of weight loss surgery.
In the Distal RNY procedure, the Y limb connection is created down further than the traditional 75 cm. This longer limb bypass shortens the intestine available for the absorption of nutrients aiding in weight loss. This Distal RNY should only be performed on patients that will without questions have the ability and commitment to secure proper follow-up and will require supplements the rest of their lives.
The Fobi Pouch is a variation of the Proximal RNY in which a silastic ring is placed in opening between the stomach and the intestinal connection to preserve the integrity of the connection over time.
The Duodenal Switch is a hybrid procedure and the most technically challenging and highest risk weight loss surgical procedure. While offering substantial permanent weight loss, the risks are high and the long term complications malnutrition, chronic frequent stools along with flatulence and unpleasant odor make this surgery difficult to live with.
Mini Gastric Bypass has been condemned by the world’s top bariatric surgeons. Do not let the word ‘mini’ fool you. This is basically a rename of the abandoned loop gastric bypass performed in 1970. This procedure while creating good weight loss also creates severe stomach irritation because the stomach is bathed in bile and pancreatic enzymes. Long term effects of this procedure are stomach ulcers and esophageal cancers requiring surgical reversal.
The Intragastric Balloon (BIB) System does not involve surgery. Under the supervision of medical experts an intragastric balloon consisting of a soft silicon balloon is placed in the stomach and filled with sterile saline. The balloon induces a feeling of satiety and the person does not feel hungry. The balloon is removed after six months. This procedure seems to have many complications and is NOT FDA approved and still investigational.
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