If you’re thinking about weight-loss surgery, you probably have lots of questions about the different types of procedures. Let us be your guide. Fairview Park Hospital’s weight-loss team of bariatric surgeons, nurses and registered dietitians can help you choose the best path for weight-loss success and can answer your questions along the way.
Lap-Band® (Adjustable Gastric Banding)
In this type of surgery, the surgeon uses an inflatable band to squeeze the stomach into two sections: a smaller upper pouch and a larger lower section. The two sections are still connected by a very small channel, which slows down the emptying of the upper pouch. Most people can only eat a 1/2 to 1 cup of food before feeling too full. You can also get the band adjusted in a doctor's office.
During gastric sleeve surgery, the surgeon removes about 75% of the stomach though a minimally invasive, laproscopic procedure. What remains of the stomach is a narrow tube or sleeve, which connects to the intestines. For people who are very obese or sick, gastric sleeve is a simpler operation that gives them a lower-risk way to lose weight. If needed, once they've lost weight and their health has improved -- usually after 12 to 18 months -- they can have a second surgery, such as gastric bypass. Because the intestines aren't affected, gastric sleeve doesn't affect how your body absorbs food, so you're not likely to fall short on nutrients.
Gastric bypass is the most common type of weight loss surgery. It combines both restrictive and malabsorptive approaches. During the operation, the surgeon divides the stomach into two parts, sealing off the upper section from the lower -- then connects the upper stomach directly to the lower section of the small intestine. Essentially, the surgeon is creating a shortcut for the food, bypassing part of the stomach and the small intestine. Skipping these parts of the digestive tract means that the body absorbs fewer calories.
Weight loss tends to be swift and dramatic. About 50% of it happens in the first six months, and may continue for up to two years after the operation. Because of the rapid weight loss, conditions affected by obesity -- such as diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, and heartburn -- often get better quickly. Gastric bypass also has good long-term results. Studies have found that many people keep most of the weight off for 10 years or longer.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
This surgery combines restrictive and a malabsorptive techniques. The restrictive portion of the surgery involves removing approximately 70% of the stomach. The malabsorptive portion reroutes a lengthy portion of the small intestine, creating two separate pathways and one common channel. The shorter of the two pathways, the digestive loop, takes food from the stomach to the common channel. The much longer pathway, the biliopancreatic loop, carries bile from the liver to the common channel.
The common channel is the portion of small intestine, usually 75-150 centimeters long, in which the contents of the digestive path mix with the bile from the biliopancreatic loop before emptying into the large intestine. The objective of this arrangement is to reduce the amount of time the body has to capture calories from food in the small intestine and to selectively limit the absorption of fat. As a result, following surgery, these patients only absorb approximately 20% of the fat they intake.
The primary advantage of BPD/DS surgery is that its combination of moderate intake restriction with substantial calorie malabsorption results in a higher percentage of excess weight loss versus a purely restrictive gastric bypass for all individuals. And since the stomach pouch is larger than with other bariatric operations, you can eat larger portions than with the gastric bypass or LAP-BAND.