Restrictive Weight Loss Surgery
This type of bariatric surgery involves closing off parts of the stomach to make it smaller, thus decreasing the amount of food that can be eaten. The LAP-BAND and Vertical Banded Gastroplasty procedures are restrictive types of bariatric surgery.
The Laparoscopic Adjustable Gastric Band procedure, more commonly known as LAP-BAND surgery, is growing in popularity. This restrictive procedure involves using a Silastic band to create a smaller stomach pouch, causing patients to become full after eating a minimal amount of food. To learn more about this procedure, please visit our LAP-BAND page.
Vertical Banded Gastroplasty (VBG)
The Vertical Banded Gastroplasty weight loss surgery procedure creates a smaller stomach pouch by stapling off a section of the stomach, then using a band to restrict the passage of food out of the pouch. After stomach stapling, the patient is unable to consume large amounts of food in one sitting. Once the food leaves the pouch, it goes through the normal digestive tract.
Malabsorptive Weight Loss Surgery
This weight loss surgery approach entails altering the digestive system to decrease the body’s ability to absorb calories. The Biliopancreatic Diversion and Extended (Distal) Roux-en-Y Gastric Bypass procedures are malabsorptive types of bariatric surgery.
Biliopancreatic Diversion (BPD)
Biliopancreatic Diversion involves first creating a reduced stomach pouch and then diverting the digestive juices in the small intestine. The first part of the small intestine, where most of the calories are normally absorbed, is bypassed. That section, which contains the bile and pancreatic juices, is reattached to the small intestine much further down. There is a variation of this procedure called Biliopancreatic Diversion with “Duodenal Switch.” This operation utilizes a larger stomach “sleeve” and leaves the beginning of the duodenum attached, but is otherwise very similar to standard BPD.
Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)
This weight loss surgery procedure is a variation of the Roux-en-Y Gastric Bypass operation. It differs in that a somewhat larger stomach pouch is created, but a significantly longer section of the small intestine is bypassed. There is less emphasis on restricting food intake quantity and more on inhibiting the body’s ability to absorb calories.
The Combined Approach – Restrictive and Malabsorptive Surgery
The Roux-en-Y gastric bypass procedure is a combination operation in which stomach restriction and a partial bypass of the small intestine work in tandem as one of the most effective treatments for severe obesity.
Roux-en-Y Gastric Bypass
The most commonly performed weight loss surgery in the United States is Roux-en-Y Gastric Bypass. This operation involves severely restricting the size of the stomach and altering the small intestine so that caloric absorption is inhibited. To learn more, visit our gastric bypass surgery page.
While laparoscopic bariatric surgery can be performed through several small incisions in the stomach area, open bariatric surgery requires one larger incision that begins directly below the patient’s breastbone and ends just above the navel. While both the open and laparoscopic procedures produce similar long term results, open bariatric surgery is associated with a longer recovery period.
Laparoscopic Bariatric Surgery
As opposed to open bariatric surgery, laparoscopic bariatric surgery involves making several small incisions and performing the operation by video camera. A laparoscope, the device used to capture the video, is inserted through an abdominal incision. This provides the bariatric surgeon a magnified view inside the abdomen, allowing the operation to be performed using special surgical instruments and a television monitor.
The long-term results for laparoscopic bariatric surgery and gastric bypass surgery should be similar to those for open procedures. The advantages of the laparoscopic approach include less post-operative pain, a shorter recovery period, and less extensive scarring.
Gastric banding limits the capacity of the stomach. This means that after eating a small amount of food, you feel full. Keyhole surgery is used to tie an inflatable band (sometimes called a lap band) around the top part of the stomach, creating a small pouch at the top. This limits the amount of food your stomach can hold. Food then slowly passes from the pouch into the lower part of your stomach and on into your digestive system.
The operation is quite simple to reverse but does require further surgery.
A gastric balloon is a silicone balloon that is inserted into the stomach via your mouth and filled with a sterile saline solution once it is in place. The gastric balloon will partially fill your stomach which results in you having a feeling of being full and prevent overeating.
The balloon will be removed after 6 months via the same method as it was inserted.
Gastric bypass is a complicated surgery that can last up to four hours. The most common type of gastric bypass is Roux-en-Y-gastric bypass, which is performed with one long incision. Using staples or a plastic band, a surgeon makes a small pouch at the top of the stomach. This smaller stomach is connected to the section of the small intestine called the jejunum. With this rearrangement, food bypasses the rest of the stomach. The patient feels full more quickly, so fewer calories are consumed and absorbed by the body.
The duodenal switch combines two surgical approaches. First, a surgeon removes about 85 percent of the stomach. What is left is shaped like a banana, about 6 ounces in size. Next, a large section of the small intestine, the section where most digestion occurs, is cut out and bypassed. With a smaller remaining section of the intestines involved in digestion, not as many nutrients and calories can be absorbed, so patients lose weight.
Gastric Sleeve Surgery
Gastric sleeve surgery is a newer type of weight-loss surgery. The laparoscopic procedure is typically used to kick-start weight loss for the extremely obese—people who are too overweight to withstand more invasive surgeries. During a gastric sleeve operation, a surgeon removes more than half of the patient’s stomach. What’s left takes a sleeve- or tube-like shape, and it is sealed with staples. When the patient has lost enough weight, he or she may then undergo gastric bypass or another type of weight-loss surgery.
Gastroplasty, also known as “stomach stapling,” was once a popular type of weight-loss surgery. The original gastroplasty debuted in the 1970s. It involved stapling the stomach into a smaller section, so only a small opening was left for food. Surgeons eventually began performing Vertical Banded Gastroplasty (VBG). In this type of surgery, both staples and a band are used to reshape the patient’s stomach into a small pouch. Like regular gastroplasty, only a small hole is left for food to travel into the rest of the stomach. Today, gastroplasty is not performed as often, as studies indicate many patients regain weight.