Your Surgical Weight Loss Options

The main goals of metabolic and weight-loss surgery are to:

  • Help the patient achieve a healthier weight
  • Reduce health conditions that are related to obesity and improve overall health. This happens because of weight loss and the impact of surgery on metabolic and hormonal pathways that are not working well in the body
  • Extend life expectancy and quality of life
  • Improve the patient’s self-image, confidence and psychological health
  • Support long term healthy behaviors

Dmitry Nepomnayshy, MD (left), leads the bariatric surgical team during a laparoscopic bypass surgery at Lahey Hospital & Medical CenterWe now offer metabolic and weight loss surgery at both Lahey Hospital & Medical Center and Beverly Hospital. All patients are supported through surgery with the same well trained outpatient multidisciplinary care team and cared for with the same high quality and well proven pre-operative, postoperative and surgical protocols, no matter which facility your surgery is completed. Location of your surgery will be dependent on your personal health history and surgical needs in order to help support your best outcomes.

Between our two facilities, we are able to offer you all types of metabolic and weight loss surgery.These includeRoux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch/single anastomosis duodenal switch and revisional surgery for weight regain, additional weight loss or complications from prior procedures. You will work with your surgeon and members of the multidisciplinary care team, to figure out what the best option is for you.

Nearly all of the weight-loss surgeries are performed laparoscopically or robotically. Laparoscopic and robotic surgery are completed through 5-6 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 or robotic surgery. For these people, the procedure is done through a traditional open surgery.

Roux-en-Y Gastric BypassGastric bypass is the surgery that has been around the longest for weight loss. It involves surgically separating the stomach so that a small pouch is created at the top. The small bowel is divided and 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.

The most common procedure we complete at our facilities 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) and no need to divide or bypass the intestine. This results in less risk of long term complications following this surgery compared to the gastric bypass.

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.

The most powerful procedure to lose weight is the laparoscopic duodenal switch. This procedure is not commonly performed, and reserved for individuals with obesity, 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 surgery may be an option for patients who have already undergone a weight loss operation and have a problem that needs to be corrected. This can also be an option if they have regained weight, have lost an insufficient amount of weight or have increased difficulty with controlling diabetes.

Cartoon illustration of Vertical Sleeve Gastrectomy (VSG)

About 90% of the patients that have the Lap Band do not lose enough weight, regain 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.

About 25% of patients can develop acid reflux after a sleeve gastrectomy procedure. Some patients may find this hard to control with medication or not want to remain on medication for the rest of their life. For these reasons, a patient may have revisional surgery and switch to a gastric bypass to improve acid reflux control.

Obesity is a disease caused by many factors. It is possible to regain weight after a sleeve gastrectomy surgery for many different reasons. Our team is here to help prevent this. However, if you have struggled with weight regain following a sleeve, you may be a candidate for a conversion to a duodenal switch/single anastomosis duodenal switch to help achieve greater weight loss. Some patients may also choose this type of surgery if they have poorly controlled diabetes or newly developed diabetes after a sleeve gastrectomy and would like to get better control with a surgery.

Intestines now Intestines after

Weight regain can occur after gastric bypass surgery. Studies have shown that 15-35% of patients who have had gastric bypass do not achieve the expected weight loss or experience significant weight regain in the years after their surgery.

The limb distalization procedure can be a surgery to help reverse weight regain after bypass. This is an option for some patients, but not all patients who have regained their weight.

When this surgery is completed the area of absorption of nutrients in your small intestine is made shorter, which helps you to lose more weight. In the picture below you can see that there is a shorter area of intestine with purple arrows, which is where food and digestive juices are mixing and your nutrients are being absorbed.

When undergoing this surgery, patients have experienced an average drop in BMI by 11 points or have lost 62% of the excess weight on their body (ex: 100 pounds overweight = 62 pounds of weight loss). This can also lead to improvement in diabetes.

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.

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.