• Surgical Weight Loss Options

    Dmitry Nepomnayshy, MD (left), leads the surgical team during a laparoscopic bypass surgeryThe main goals of weight-loss surgery are to: 

    • Help the patient achieve a more normal weight
    • Reduce comorbidities and improve overall health
    • Extend life expectancy and quality of life
    • Improve the patient’s self-image and psychological health
    • Modify behavior

    Once it is determined that you are a potential candidate for surgical weight loss, and the appropriate tests have been performed, you and your surgeon will discuss surgical options. Three main types of weight-loss surgery are performed at Lahey Hospital & Medical Center—Roux-en-Y gastric bypass, sleeve gastrectomy and laparoscopic adjustable gastric band.

    Nearly all of the weight-loss surgeries performed at Lahey Hospital & Medical Center are done laparoscopically. Laparoscopic surgery is performed through a small incision, as opposed to the large surgical opening used in traditional surgeries. Performing surgery this way cuts down on possible complications and speeds up your recovery time. Sometimes, some patients are not candidates for laparoscopic surgery. For these people, the procedure is done through a traditional open surgery. 
     

    Roux-en-Y Gastric Bypass

    Roux-en-Y Gastric BypassThe most common weight-loss surgery performed at Lahey Hospital & Medical Center is the Roux-en-Y gastric bypass procedure. It involves surgically separating the stomach so that a small pouch is created at the top. The small bowel is connected to this pouch, completely bypassing the larger, portioned-off section of the stomach and about 150 centimeters of the small intestine. The pouch can hold 30 cubic centimeters of volume, which is the equivalent of about one ounce of food or liquid, or a serving the size of a golf ball.

    The Roux-en-Y surgery works in two ways: First, it creates a very small receptacle for food, preventing you from overeating. Second, it creates a small degree of malabsorption by reducing the intestinal area that absorbs nutrients and calories. Third, this surgery alters the stomach and intestinal hormones, reducing hunger and helping to fix diabetes. Based on current research, this is the best weight loss surgery option for treatment of diabetes.

    Weight loss is usually fairly rapid following a Roux-en-Y procedure; the average person loses about two-thirds of excess body weight in the first six months. After that, weight loss slows down until, after about two years, the person ends up losing an average of 75 percent of excess body weight.
     

    Laparoscopic Sleeve Gastrectomy

    Laparoscopic Sleeve GastrectomyThe newest weight loss procedure Lahey Hospital & Medical Center is performing is the laparoscopic sleeve gastrectomy. Initial weight loss from the sleeve gastrectomy is thought to be similar to that of gastric bypass at one year. It is extremely effective in curing health problems such as diabetes and sleep apnea.

    In this operation the outer part of the stomach is removed. This decreases the amount of food that the stomach can hold by about 90% by turning the stomach into a long narrow tube. The smaller amount of food that can be eaten passes more quickly into the intestine which is not surgically altered. Removing part of the stomach and speeding the delivery of food to the intestine changes intestinal hormones such as Grehlin and GLP-1, decreasing appetite and improving diabetes.

    The sleeve gastrectomy provides some advantages, namely no anastomoses (connections between the stomach and intestine), no need to divide or bypass the intestine, and avoiding adjustments as needed with the Lap Band.

    The sleeve gastrectomy can make heartburn or reflux worse in patients with hiatal hernias, and in those patients, gastric bypass is usually advised.

    If this operation is not fully effective in obtaining the desired weight loss or treating diabetes, it is still possible to convert it later to another weight loss operation such as the gastric bypass in a revisional operation. 

    Laparoscopic Adjustable Gastric Band

     Laparoscopic adjustable gastric band surgery involves an adjustable band placed around the upper stomach to help control portion size. Attached to the band is an access tube, which is laid across the abdominal wall under the skin and attached to a port.. The port is not visible, but is also attached to your abdominal muscle and deep under your skin. By injecting saline into this port—a process known as "filling" or “adjustment”—the band can be tightened and loosened depending on your weight-loss progress and portion control.

    Laparoscopic Adjustable Gastric BandThis surgery is reversible, safer and less invasive than the other surgical options. However, it, is also less effective for weight loss, as weight is lost more slowly (1-2 pounds per week), and over two years the average patient will lose 30-50% of their excess weight. Additionally, you require more frequent office visits to “fill” the band and there is a greater, 30% chance that you may need another surgery in the future for a complication from or intolerance to this implanted device. About 30% of patients will not lose sufficient weight with this procedure.

    Laparoscopic adjustable gastric band surgery is often better for someone who is of greater surgical risk, who may not tolerate a more invasive surgery. It is also better suited for an individual who does not have chronic joint pain or other comorbidities that make it harder to exercise at a moderate intensity and for those who have less than 100 pounds to lose. 

    Revisional Weight Loss Surgery

    Revisional surgery may be an option for patients who have already undergone a weight loss operation and have a problem that needs to be corrected, or if they have regained weight or have lost an insufficient amount of weight. The following are examples of revisional surgeries performed at Lahey Hospital & Medical Center.

    Revision from Lap Band to Gastric Bypass or Sleeve Gastrectomy

     About half of Lap Bands result in poor weight loss or regain, or other problems such as reflux or difficulty swallowing. In these patients, the band can be laparoscopically removed, and a gastric bypass can be performed. This operation is being done frequently at Lahey with excellent results.

    Revision of Vertical Banded Gastroplasty to Gastric Bypass

    This operation, commonly known as “stomach stapling,” was very popular in the 1980s. In about 50% of patients the staples failed, leading to poor weight loss, stomach ulcers and pain. This operation can be converted to a gastric bypass.

    Revision of Gastric Bypass

    This operation is necessary if there is a complication such as a fistula or connection between the bypassed stomach and stomach pouch. This can also lead to poor weight loss and ulcers. In other cases if the gastric pouch was much too large, weight loss will be inadequate and the pouch can be made smaller.