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Bariatric Surgery Procedures
Bariatric surgery is a treatment option for people living with morbid obesity - especially for those who have not experienced long-term weight loss success through other means including diet and exercise. Often referred to as weight loss surgery, bariatric surgery has transformed the health and lives of hundreds of thousands of people in the past decade. It is well know that surgery has proven to be the only efficacious modality in reducing and maintaining the weight in morbidly obese patients.
Health Benefits of Bariatric Surgery
Morbid obesity has been found to affect the quality of health and significantly reduce the length of life. It has been linked to several serious and life-threatening diseases such as diabetes type 2, heart disease, high blood pressure, acid reflux/GERD, and cancer. In each case, a prospective patient may want to compare bariatric surgery’s high resolution rates to the long term effects of the following co-morbid conditions:
Type 2 Diabetes: Type 2 diabetes is an increasingly widespread health issue and has serious long-term consequences. People with diabetes type-2 are at risk for developing heart, kidney disease leading to kidney dialysis, strokes, and poor circulation. Nerve damage, foot problems and eye complications can also occur.
Heart Disease and High Blood Pressure: High blood pressure indicates that your heart is straining to pump blood throughout your circulatory system and can lead to health disorders such as heart disease. People living with morbid obesity are at risk for developing high blood pressure, heart disease such as congestive heart disease.
High Cholesterol: High cholesterol can be harmful and is associated with serious health condition. People with high cholesterol are at risk for developing heart disease including hardening of the arteries (atherosclerosis), leading to heart attacks, and strokes.
Obstructive Sleep Apnea: Obstructive sleep apnea is a sleep disorder with symptoms of loud snoring and long pauses in breathing. Obstructive sleep apnea is linked to several serious conditions and experiences. People with obstructive sleep apnea are at risk for heart disease, and high blood pressure due to low oxygen levels in blood.
Quality of Life
Although the medical problems, by themselves will significantly deteriorate the quality of life, the daily activities are also commonly affected. Simple things such as walking, flying in airplanes, buying clothes, enjoying amusement parks, playing with kids, trimming your toe nails, and several other things can be difficult or impossible.
Most bariatric patients, who experience significant weight loss, will improve overall quality of life. They will experience improved physical functioning and appearance, and improvement of social and economic opportunities.
Gastric Banding
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Gastric banding is a restrictive surgical procedure. During the surgery, two medical devices are implanted in the patient: a silicone band and an injection port. The silicone band is placed around the upper part of the stomach and molds the stomach into two connected chambers. The superior part of the stomach, known as "pouch", when distended will promote satiety. The sensation of been satisfied, not hungry, will facilitate weight loss. Patients will enjoy early sensation of not being hungry, and the satiety will last for hours. The injection port is attached to the abdominal wall, underneath the skin. The port is connected to the band with a soft, thin tubing. The port will allow adjustments, if needed. This way the device can be properly optimized to maintain a sense of satiety that will greatly facilitate patients in regaining control of the constant hunger.
Dr. Baptista is one of the few bariatric surgeons in the United States to perform most gastric band surgeries through a single incision – at the belly button. A special trocar, which serves as passageway for the surgical instruments, is placed into the incision. The surgical instruments are placed through the trocar into the abdominal cavity.
In preparation for the band, a tunnel is created behind the stomach. The gastric band is introduced to the abdomen through the trocar. The band is positioned around the upper portion of the stomach then secured using the locking mechanism. A wrap of stomach is created over the band to prevent the band migration or slippage.
A tube attached to the band will be connected to the injection port. The port is used to adjust the band tightness after surgery. The injection port is placed beneath the skin, over the muscle in the abdomen.
The band does not alter your digestive function. Food consumed passes through the digestive tract in the normal route. Approximately four weeks after surgery, you will visit us and begin a series of periodic procedures to adjust your band. Adjustments are made by Dr. Baptista using a needle to inject saline solution into your band through the port. The needle is inserted over your scar located in your umbilicus. Since your scar is essentially numb, the procedure is practically painless. Adding saline increases the amount of restriction provided by the band, helping patients feel satisfied sooner and not feeling hungry for hours.
Life After Gastric Banding
Excess Weight Loss
Gastric banding patients typically lose 1 to 2 pounds per week. Some patients will experience even further weight loss. Obesity is a chronic disease. It will take anywhere from 1 year to 2 years to lose your excess weight.
Recovery
Generally gastric banding requires no overnight hospital stay and you may return to work and resume normal activities within 3 to 7 days in most cases.
What Patients Should Know:
Gastric banding can help you feel satisfied sooner, but it won’t eliminate the desire to eat. You will need to follow your specific diet and exercise guidelines provided by our office to achieve success. We all incorporated bad eating habits in our lives. We will be guiding you in how to regain good eating habits that will prevent the weight regain.
Gastric banding requires follow-up care. This is mostly because we need to continue guiding you on how to replace a lifestyle of an obese person with the lifestyle of a healthy, fit person. Also the band may require an adjustment, so keep in mind that even after reaching and maintaining your success weight, you may still need to see us for further adjustments. In general the later follow ups are not as frequent as the initial visits.
Gastric Bypass Surgery
Roux-en-Y gastric bypass surgery uses a combination of restriction and malabsorption. During the procedure, the surgeon creates a smaller stomach pouch by firing staples that will permanently divide and separates the upper and lower portion of the stomach. The surgeon then attaches a Y-shaped section of the small intestine directly to the pouch. This allows food to bypass a large portion of the small intestine, which absorbs calories and nutrients. Having the smaller stomach pouch causes patients to feel fuller sooner and eat less food; bypassing a portion of the small intestine means the patient’s body absorbs fewer calories.
Life After Gastric Bypass
Excess Weight Loss
Gastric bypass patients may lose 1 to 2 pounds per week. Similar to the gastric band, the weight is variable depending on the patient willingness to follow recommendations. The malabsorption component of the surgery in general allows significant more weight loss in the first 1 to 2 years. The body tends to compensate later, and some weight regain may be seen in some patients. Although the follow up is generally not as intense as the gastric band, patients should be seen so recommended guidelines can be emphasized.
Recovery
Gastric bypass patients may be able to leave the hospital after two days and return to work after three weeks.
What Patients Should Know:
A condition known as dumping syndrome can occur from eating high-fat, high-sugar foods. While it isn’t considered a health risk, the results can be very unpleasant and may include vomiting, nausea, weakness, sweating, faintness, and diarrhea.
Patients must supplement their diet with a daily multivitamin, calcium, B12 and iron.
The stomach, duodenum, and parts of the small intestine cannot be seen easily using usual exam such as endoscopy. Problems after surgery such as ulcers, bleeding, or malignancy may be difficult to diagnose.
Sleeve Gastrectomy
Sleeve gastrectomy is a restrictive bariatric surgery used in the past as the first step in a two-part treatment of other bariatric surgeries. Recently, the Sleeve gastrectomy has been used as a bariatric procedure by itself. During this procedure, the surgeon creates a small, sleeve-shaped stomach. It is larger than the stomach pouch created during Roux-en-Y bypass—and is about the size of a banana. Sleeve gastrectomy is typically considered as a treatment option for bariatric surgery patients with a BMI of 60 or higher. Recently, it has been offered to morbid obese patients with a lower BMI.
Biliopancreatic Diversion with Duodenal Switch
Biliopancreatic diversion with duodenal switch (BPD/DS) is very similar to gastric bypass. Instead of a small stomach pouch, the surgeon creates a sleeve-shaped stomach. The surgeon then attaches the final section of the small intestine to the stomach sleeve. The small intestine absorbs calories and nutrients. So, bypassing all but the last section of the small intestine ensures that far fewer calories are absorbed.
Life After BPD/DS Surgery
Excess Weight Loss:
Patients may lose more weight that other surgical procedures, however there is a significant higher incidence of complications.
Recovery
BPD/DS patients may be able to leave the hospital after 3 to 5 days and return to work after three weeks.
What Patients Should Know:
Abdominal bloating and foul-smelling stool or gas may occur.
Patients also need to supplement with daily multivitamins, calcium, B12, and iron prescribed by their healthcare professional.
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