Weight Loss Surgery: An Overview
Weight loss surgery is not a type of cosmetic surgery and does not surgically remove fat from the body. Weight loss surgery reduces the size of the stomach to restrict the amount of food that is eaten, re-routes the digestive system to change the way that food is absorbed, or both. Following weight reduction surgery, a commitment to lifelong healthy eating and exercise is required. Depending on the type of weight loss surgery, rates of 40% to 85% of excess weight loss may be achieved. It is possible for health problems to resolve or become more manageable after weight loss is achieved.
• Body Mass Index of 35 or more and a serious medical condition that might improve with weight reduction, such as type 2 diabetes, heart disease, high blood pressure, arthritis, or sleep apnea.
A ring of muscles is located at the bottom of the esophagus. It is called the lower esophageal sphincter (LES). The LES opens to allow food to enter the stomach. The LES closes tightly after the food enters. This prevents stomach contents and acids from backing up into the esophagus. The esophagus does not secrete mucus that protects it from stomach acids.
The stomach secretes mucus to protect the lining of the stomach from the acids. Your stomach produces acids to break down food for digestion. Your stomach processes the food you eat into a liquid form. The processed liquid travels from your stomach through the pyloric valve to your small intestine.
The small intestine is a tube that is about 20-22 feet long and 1 ½ to 2 inches around. The duodenum is the first part of the small intestine. It is a short C-shaped structure that extends off the stomach. The jejunum and the ileum are the middle and final sections of the small intestine.
Your gallbladder works with your liver and pancreas to send bile and digestive enzymes to the first part of your small intestine. Your small intestine uses these digestive products to break down the liquid from your stomach even further so your body can absorb the nutrients from the food that you ate. The remaining waste products from the small intestine travel to the large intestine.
Laparoscopic gastric banding reduces the size of the stomach. Individuals lose weight because laparoscopic gastric banding restricts the amount of food that they eat. Some types of bands are adjustable and can change the stomach size after surgery.
There are a few types of gastric banding procedures, but for many, laparoscopic surgery methods are preferred over open surgeries. A laparoscope is a thin viewing instrument that guides the surgeon during surgery. During surgery, the surgeon inserts the laparoscope and thin surgical instruments through several small incisions.
Advantages Laparoscopic Gastric Banding
• The laparoscopic ring is adjustable and removable
• Laparoscopic surgery is associated with a fast recovery time. People typically return to work in a week.
• 40% to 60% loss of excess weight over the first three years
Laparoscopic Gastric Bypass Surgery
Laparoscopic Gastric Bypass Surgery, also referred to as Roux-en-Y, is one of the most effective and commonly performed weight loss surgeries. Laparoscopic gastric bypass surgery creates a 95% smaller stomach. The smaller stomach size causes people to eat less food. The small intestine is rerouted so food bypasses the first two sections, which prevents the absorption of calories and nutrients. People lose weight because they eat less and the body absorbs less of the food. Laparoscopic Gastric Bypass surgery is both a restrictive and malabsorptive type of weight loss surgery.
Following surgery, individuals consume a liquid diet and progress to eating small amounts of table food. People typically lose 50% to 66%, and some up to 75%, of their excess weight within the first few years. About a 10% weight gain may occur between years two and five, if the small pouch increases in size.
• Small portions of table food can be eaten
• Greater amounts of weight can be lost with laparoscopic gastric bypass surgery than with restrictive weight loss surgeries.
• Laparoscopic gastric bypass surgery is more effective in reversing health problems associated with severe obesity than restrictive weight loss surgeries.
Biliopancreatic Diversion (BPD)
Biliopancreatic diversion (BPD) surgery creates a smaller stomach size and reroutes the path of food directly to the last part of the small intestine. People lose weight with biliopancreatic diversion because they eat less, feel fuller, and the body only absorbs a limited amount of calories and nutrients.
Biliopancreatic diversion surgery is an open surgery using a large incision or laparoscopic surgery using small incisions. The surgeon removes a large portion of the stomach to decrease its size. The surgeon connects the new small stomach to the last part of the small intestine (ileum). Now, food bypasses the first sections of the small intestine (duodenum & jejunum).
Most people lose as much as 75% to 80% of their excess weight and remain at their new weight. People with biliopancreatic diversion are at risk for anemia, vitamin deficiencies, and dumping syndrome. When food moves too quickly through the stomach and intestines too fast, the body "dumps" it causing nausea, diarrhea, sweating, and fainting soon after eating.
Advantages of biliopancreatic diversion (BPD)
• Maintenance of weight loss
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Biliopancreatic Diversion with Duodenal Switch is performed as an open surgery or laparoscopically. The surgeon reduces the size of the stomach, but a larger part of the stomach remains than with a biliopancreatic diversion. Unlike some other types of weight loss surgery, the pyloric valve and a small section of the first part of the small intestine (duodenum) remain. The surgeon connects the first part of the small intestine (duodenum) to the last part of the small intestine (ileum). Now, food will not pass through the middle part of the small intestine (jejunum). Because food is separated from digestive fluids and bile, the body absorbs a limited amount of calories and nutrients.
Advantages of biliopancreatic diversion (BPD) with duodenal switch
• Unlike Biliopancreatic Diversion (BPD) the valve (pyloric valve) between the stomach and small intestine is intact and eliminates such complications as dumping syndrome, ulcers, and blockages.
• Allows for more absorption of nutrients than other weight loss procedures
• Larger amounts of food can be eaten than with gastric bypass surgery
• Research studies demonstrate that sleeve gastrectomy, followed by a second type of weight loss procedure has been successful for people with a BMI greater than 50 or those at high-risk for weight loss surgery.
• With laparoscopic sleeve gastrectomy, individuals usually can resume regular activities in 2 weeks and are fully recovered in 3 weeks.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.