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Obesity is a complex, clinical disorder with many contributing causes and factors. The condition is often associated with a wide range of medical problems, including high blood pressure, heart problems, diabetes, sleep apnoea, depression, and arthritis. For many patients who are severely overweight, surgical treatment is the only proven method that will help them achieve the long-term weight control required to improve their overall health and enable them to perform normal activities.
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Restriction Operations  |
| These procedures are least commonly performed. They encourage weight loss in two ways: |
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Reduce the amount of food you can eat. We shrink your stomach by creating a small pouch at the top of the stomach where food enters from the oesophagus. This makes it impossible for you to eat much. At first, the pouch only holds about one ounce of food. It expands to hold 2-3 ounces over time. |
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Slow the speed of how the food empties from your stomach. The lower outlet of the pouch is only about 1/4 inch in diameter. Because it's so small, food empties slowly and you feel full longer. |
| There are two types of laparoscopic restrictive operations: |
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Gastric banding: A band of special material (Siliastic band) is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach. |
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Sleeve gastrectomy: In this surgery approximately 80 percent of the stomach is removed laparoscopically with the help of staplers so that the stomach takes the shape of a tube or "sleeve". |
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Laparoscopic Gastric Bypass Operations  |
Gastric bypass procedures are combination operations i.e. they combine both restrictive and malabsorptive techniques.
This is the most common bariatric procedure. First, we create a small stomach pouch with staples or a vertical band. This restricts food intake. Then, we attach a Y-shaped section of the small intestine to the pouch to allow food to bypass the first and second segments of the small intestine. This reduces your body's ability to absorb nutrients and calories. |
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| Comparing the Procedures |
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Patients generally have more success with gastric bypass operations than restrictive procedures. |
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Risks are similar for both restrictive and gastric bypass procedures. The risk of nutritional deficiencies for iron, calcium, and Vitamin B12 are higher in patients who undergo gastric bypass operations. Also, there is risk of intestinal leaking. |
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Gastric bypass operations also may cause "dumping syndrome". This is when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness, and sometimes diarrhoea. |
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In sleeve gastrectomy there is no intestinal bypass malabsorption i.e. vitamin and protein deficiency is minimal. |
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No intestinal obstruction with sleeve and band as no bypass of intestine done. |
| Open vs. Laparoscopic Surgery |
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Open and laparoscopic refer to how the abdominal cavity is entered and not the type of surgery being performed. So each type of weight loss surgery may be performed as either an open or a laparoscopic procedure.
When performing open surgery, surgeons create a single incision to open the abdomen for the operation. Typically, for women it is 4 1/2 to 6 inches, and for men, it is 5 1/2 to 7 inches.
With laparoscopic surgery, multiple, small incisions are made in the abdominal wall to accommodate a small video camera and surgical instruments. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them a better view and access to key structures. |
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| Recent studies show patients, who have had laparoscopic weight loss surgery experience, |
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less pain after surgery |
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easier breathing and lung function |
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fewer wound complications such as infection or hernia |
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quicker return to pre-surgical levels of activity |
| We offer the less invasive laparoscopic procedure whenever possible. Speak with your surgeon to find out if you are a good candidate for laparoscopic surgery. Laparoscopic surgery uses all the same techniques as open surgery and has similar results in terms of excess weight loss. |
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| Laparoscopic Sleeve Gastrectomy |
| Sleeve gastrectomy is a technique that offers the same results as the gastric bypass but with less risk. |
| The Gastric Sleeve is a new procedure that induces weight loss by restricting food intake (a restrictive procedure); the patient is going to eat a smaller amount of food. |
| With this procedure, the surgeon removes approximately 80 percent of the stomach laparoscopically with the help of staplers so that the stomach takes the shape of a tube or "sleeve". In addition of being restrictive, this procedure has seen that the hormone that regulates the appetite, the ghrelina, diminishes, causing the patient to avoid excess desire to eat. |
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| Highlights |
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Performed laparoscopically with 5 small incisions (most less than 5 mm to 12 mm ) |
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Endostapler used to divide stomach |
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Takes about 1 to 2 hours to complete |
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Stay in hospital for 2-3 days |
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Begin drinking on the second day |
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Liquid diet for 2 weeks after the operation |
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Return to work in 1 to 2 weeks |
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Resume strenuous activity in one month |
| Advantages |
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It is performed laparoscopically |
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It does not require disconnecting or reconnecting the intestines, as in bypass |
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No implant and adjustment required as in band surgery |
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Food is absorbed normally |
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No vitamin and protein deficiency |
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It is a technically simpler operation than the gastric bypass |
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Weight loss surgery for high risk patients, specially anaemia, severe asthma, for patients on steroids, inflammatory bowel disease |
| Disadvantages |
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Remaining stomach may stretch out |
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May require follow -up weight loss surgery for super-obese |
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Not reversible |
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| Laparoscopic Adjustable Gastric Banding (LAGB) |
In this procedure, a silicon band lined with an inflatable balloon is placed laparoscopically around the stomach near its upper end creating a small pouch (15 to 30 cc vol.) and a narrow passage into the larger remainder of the stomach.
When you eat, satiety or fullness of stomach comes early and thus you would start eating less, which in turn leads to significant weight loss.
This balloon is connected to a small reservoir that is placed under the skin of the abdomen through which the diameter of the band can be adjusted by injecting fluid into it as an outpatient procedure. |
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| Highlights |
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Performed laparoscopically with 5 small incisions (most less than 5 mm and one 15 mm) |
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Adjustable silastic gastric band used |
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Operative time approximately one hour |
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Short hospital stay, 1 to 2 days |
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Oral intake of liquids on first post operative day |
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Quick recovery, one week to work |
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Resume strenuous activity in 2 weeks |
| Advantages of LAGB |
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Eliminates feeling of being hungry |
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Food is absorbed normally |
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No vitamin and protein deficiency |
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No cutting or stapling of the stomach |
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Adjustable without additional surgery |
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Fully reversible: Stomach returns to normal if the band is removed |
| Disadvantages of LAGB |
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Band complication: Leak, infection, slippage and migration |
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Office adjustments |
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| Laparoscopic Gastric Bypass Surgery (LGBS) |
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In a laparoscopic gastric bypass, the stomach is made smaller by creating a small pouch (30 ml) at the top of the stomach using surgical staples. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum). The small stomach makes you feel full more quickly and part of the small intestine bypass causes reduced calories and nutrient absorption, which ultimately leads to weight loss. |
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| Highlights |
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Performed laparoscopically by 5-6 small 5 mm incisions, one 15 mm |
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Hospital stay 3 to 5 days |
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Begin drinking on the second day |
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Liquid diet for two weeks after the operation |
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Return to work in 2 to 4 weeks |
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Normal activities in 2 weeks |
| Advantages |
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Eliminates feeling of being always hungry |
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You eat small amount of normal food |
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Diabetes and other co-morbidities are usually resolved early |
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No need for adjustments |
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Lose 65-80% excess weight usually in 1-2 years |
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Sustainable long term weight control |
| Disadvantages |
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This operation is more risky than the band or the sleeve gastrectomy |
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Usually not reversible |
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Long term supplements of vitamins and minerals required |
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