• 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. All types of weight-loss surgery are performed at Lahey Hospital & Medical Center—Roux-en-Y gastric bypass, sleeve gastrectomy, laparoscopic adjustable gastric band, duodenal switch and revisional surgery for failure after other procedures.

    Nearly all of the weight-loss surgeries performed at Lahey Hospital & Medical Center are performed laparoscopically. Laparoscopic surgery is performed through small incisions, as opposed to the large surgical opening used in traditional surgeries. Performing surgery this way cuts down on  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.

    Laparoscopic Gastric Bypass

    Roux-en-Y Gastric BypassThe most common weight-loss surgery performed at Lahey Hospital & Medical Center is the laparoscopic 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 portioned-off section of the stomach and about 150 centimeters of the small intestine.

    The gastric bypass works in several ways: First, it creates a much smaller receptacle for food, preventing you from overeating. Second, because it bypasses a section of intestine, it reduces the intestinal area that absorbs nutrients and calories. Third, this surgery alters the stomach and intestinal hormones, reducing hunger and helping to fix diabetes in many people. Based on current research, this is the best weight loss surgery option for people with diabetes.

    Weight loss is usually fairly rapid following a gastric bypass procedure; the average person loses about half of their excess body weight in the first six months. After that, weight loss slows down and finally reaches a plateau after about two years. Overall, patients lose an average of 60-70 percent of excess body weight. This means that if you are 100 pounds overweight, you can expect to lose about 60-70 pounds after gastric bypass and keep it off.

    Laparoscopic Sleeve Gastrectomy

    Laparoscopic Sleeve GastrectomyA very popular procedure at Lahey Hospital & Medical Center is the laparoscopic sleeve gastrectomy. Initial weight loss from the sleeve gastrectomy is a little less than the gastric bypass at one year.

    In this operation the outer part of the stomach is permanently removed. This decreases the amount of food that the stomach can hold by about 90%. 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, 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 and is less effective in curing diabetes compared to the bypass. In those patients, gastric bypass is usually advised.

    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.

    Gastric Band 

    This surgery is reversible, safer and less invasive than the other surgical options. However, it is also less effective for weight loss. Patients require more frequent office visits to “fill” the band and there is a 40% chance that you may need another surgery in the future for a complication or intolerance to this implanted device. About 50% of patients will not lose sufficient weight with this procedure.

    Laparoscopic Duodenal Switch

    The most powerful procedure to lose weight is the laparoscopic duodenal switch. This procedure is not commonly performed, and reserved for the most obese patients, typically those with a body mass index (BMI) of 50 or higher. It is also associated with a higher complication rate, so people that have a lot of medical problems are usually not good candidates. However, it is associated with 80% excess weight loss and the highest success with eliminating and preventing complications associated with obesity. In this operation, a sleeve gastrectomy is combined with an intestinal bypass to result in a combination of restriction and malabsorption. The overall hospital stay and recovery is the same as with the bypass and sleeve gastrectomy, but long term complications of diarrhea and vitamin and mineral deficiencies are higher.

    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

    Vertical Sleeve Gastrectomy 

    About half of the patients that have the Lap Band do not lose enough weight, or develop other problems such as reflux or difficulty swallowing. In these patients, the band can be laparoscopically removed, and a gastric bypass or a sleeve gastrectomy performed instead. The hospital stay and recovery is similar to non-revisional surgery. These operations are frequently performed at Lahey Hospital 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.

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