BARIATRIC SURGERY
LAPAROSCOPIC GASTRIC BANDING:
This is a safe and effective way of assisting the patient to remove excess weight by restricting their food intake.
Using a keyhole (laparoscopic) technique, the band is placed around the upper part of the stomach to give a 30 ml reservoir to receive the food. It is the effect of this smaller reservoir that gives a feeling of fullness after eating a smaller quantity of food. The band also exerts a pressure effect at the site. An access port is placed in the fat under the skin connecting to the band through a small internal tubing. Fluid can be introduced or removed through this access port and tubing which inflates or deflates the balloon on the inside of the band, thus adjusting the internal diameter.
Having a band should be regarded as a life-long commitment to weight control and healthy eating. Generally patients who are motivated to lose weight and eat sensibly, have very good outcomes. Regular follow up with your surgeon for adjustments will assist in maintaining the weight loss.
Our qualified dietician can assist with advice on appropriate food choices for good nutritional value. Following the procedure, most patients are able to eat “normal meals” but in smaller amounts.
The risks of the procedure are those of any operation, which include but are not restricted to, bleeding, bruising, infection, and the risks associated with having a general anaesthetic. Some of these risks are increased by virtue of the patient’s increased weight. For those patients who have had their gall bladder removed, the risks are similar. A specific risk associated with banding is that the band can slip further up or down the stomach but this is less likely with the newer technique commonly in use.
The disadvantages of gastric banding are that initially weight loss is not as great as it is with bypass or sleeve procedures.
The advantages of gastric banding are that it is safer and less intrusive than bypass surgery. The continuity of the bowel is not interfered with. The differences in weight loss compared to gastric bypass or sleeve tends to even out after five years. The band procedure is reversible and if slippage occurs, further banding can be performed. The band can be adjusted to take account of events such as pregnancy.
GASTRIC SLEEVE:
This keyhole procedure is performed to reduce the volume of the stomach by about 90%. The sleeve is formed by inserting a long row of internal staples along one edge of the stomach and then removing the large remainder of the stomach.
The advantages of this procedure are that significant weight loss occurs and that the continuity of the bowel (gut) remains intact.
The disadvantages are that the sleeve can expand over time or, alternately, it can be too restrictive. The gastric sleeve has been associated with severe reflux (heartburn). Due to the loss of the greater part of the stomach, the procedure is permanent and not reversible. There have been no long term follow up studies at this time.
GASTRIC BYPASS:
In this procedure the size of the stomach is reduced to a 30 ml reservoir. Some distance from the stomach, the small bowel is bisected – the far end is then attached to the small reservoir of stomach and the near end is re-attached further down along the small bowel. This forms a route for the food to bypass the stomach and a variable amount of the upper part of the small bowel, significantly reducing the absorption of this food from a large section of the bowel.
The advantages are significant and rapid weight loss which can lead to the reversal of type II diabetes, high blood pressure and some other medical problems.
The disadvantages are that this is major surgery with the associated risks. The procedure can be reversed with difficulty.
MINI GASTRIC BYPASS:
This can be performed laparoscopically and is similar to the gastric bypass. A small gastric sleeve is made. The bypassed length of bowel is shorter. The bypassing bowel forms a loop that is joined directly to the gastric sleeve with an opening being formed between the sleeve and the bowel. The stomach sleeve contents then pass directly into the gut.
The disadvantages are the potential for the bowel to leak at the site where it is joined.
The advantages are that the weight loss experienced is comparable to that of the more advanced bypass and sleeve procedures, but with fewer problems. Assertions that reflux can be troublesome after this procedure have not been supported by studies. This can be an appropriate procedure for those patients for whom a gastric band is not suitable.
BILIARY PANCREATIC DIVERSION (BPD):
I would not recommend this procedure under most circumstances.