Laparoscopic Adjustable Gastric Band (Lap Band)
General Description
Lap band weight loss surgery is a restrictive Bariatric surgery procedure that limits the gastric capacity so the patient looses weight because of reduced food intake. All patients who undergo bariatric surgery must be aware of pre and post surgery requirements and be sure to fully understand them.
Benefits
Bariatric surgery in the form of laparoscopic weight loss banding, is for patients who have a body mass index (BMI) of 40 kg/m2 + or those with BMI of 35 + who suffer from obesity-related morbidity. The age range is from 14 to 65; nevertheless, there can be exceptions to this rule.
Advantages of adjustable gastric banding:
- Does not alter gastric anatomy much.
- It is reversible.
- Technically, it is the fastest option.
Some of its disadvantages are:
- Requires adjustment for proper functioning.
- There is no weight loss of more than 70% of excess weight.
Potential complications are:
- Slipping
- Gastric perforation
- Gastric erosion
- Vomiting
- Impossibility to produce restriction
- Impossibility for placing it
Technical description
Procedure – Weight loss surgery of this type (Laparoscopic adjustable gastric band) is a procedure to place a devise around the stomach, through laparoscopic surgery that has an adjustable band with a valve. In this way, the devise limits the amount of food intake and makes the person feel full sooner. Each time the patient eats more than is allowed, some discomfort will be experienced.
We at Clínica Bíblica Hospital use a Swedish gastric band (Obtech by Johnson & Johnson), the original devise for this technique.
Hospitalization – One night stay is usually required.
Time – Laparoscopic adjustable banding takes between 45 minutes and two hours.
Laparoscopic Roux-en-Y Gastric Bypass (Stomach Stapling)
General description
Laparoscopic Roux-en-Y Gastric Bypass (also known as stomach stapling) is a bariatric surgery procedure considered the golden rule by many. It has a restrictive and malabsortive side to it:
- Surgical stapling limits your gastric intake, so you will loose weight since you will be eating less.
- Intake of some nutrients is limited due to a surgical change in the biliar and pancreatic secretions and their union with food.
All patients who undergone bariatric surgery must be aware of all pre and post surgical requirements.
Benefits
Laparoscopic Roux-en-Y Gastric Bypass is a surgery for those who have a body mass index of 40 kg/m2 and higher, or those whose BMI is above 35 and who suffer from comorbidity associated to obesity. The age range is from 14 to 65, nevertheless, there can be exceptions to this rule.
Laparoscopic Roux-en-Y Gastric Bypass has the following advantages:
- It does not require readjustments, only periodical control.
- It is the most common bariatric surgery since weight loss is very successful (close to 80% of excess weight).
Disadvantages are:
- Possibility of surgical complications.
- Occasional vomiting.
- There might be the need for further surgical procedures.
- Irreversible alteration in the gastrointestinal anatomy.
- Needs vitamins after surgery.
Possible complications are:
- Trans and post surgery bleeding.
- "Anastomotic" leakage.
- Internal hernia.
- Intestinal obstruction.
- Pulmonary embolus.
- Obesity-related respiratory distress syndrome.
- Death.
Technical description
Procedure – Laparoscopic Roux-en-Y Gastric Bypass reduces the size of the stomach through surgical staling. This type of weight loss surgery cuts the stomach and leaves a reservoir of approximately 30ml. Then, the small intestine is divided to form a “y” and changes the course of biliopancreatic secretions and unite the “y” to the gastric reservoir so food follows a different course.
Weight loss surgery of this type performs gastrointestinal cuts and unions and could eventually cause “leaks”. This is a risk involved in this type of surgery.
After surgery, the patient must follow special diets and vitamin intake to loose weight properly.
Hospitalization – Laparoscopic Roux-en-Y Gastric Bypass requires 4 nights hospitalization.
Time – Between an hour and a half and four hours.
Biliopancreatic Deviation
General description
Biliopancreatic diversion is a malabsorsive bariatric surgery procedure: the absorption of some nutrients decreases because the passage of biliar and pancreatic secretions is altered. There could also be “duodenal change”.
Weight loss surgery patients must be aware of pre and post surgery requirements.
Benefits
Bariatric surgery of this type can be performed on patients who have body mass index (BMI) of 50 kg/m2 and above. The age range is from 14 to 65, nevertheless, there can be exceptions to this rule.
Biliopancreatic diversion offers the following advantages:
- This type of surgery is advisable for patients with extreme obesity and BMI of 50 kg/m2 +.
- Weight loss is over 90% of excess, nevertheless, the majority of patients suffer from frequent diarrhea.
Some of its disadvantages:
- Frequent diarrhea
- Flatulencies
- Some cases of malnutrition
Potential complications involved are:
- Trans and post surgery bleeding
- Anastomotic "leakage"
- Internal hernia
- Intestinal obstruction
- Pulmonary embolus
- Obesity-related respiratory distress syndrome
- Death
Technical description
Procedure – Biliopancreatic diversion reduces the stomach, but not as much as in bypass surgery. The small intestine is cut and put back together in a way to have food and secretions unite in a common one-meter handle before they reach the colon. Sometimes, poor nutrient intake can result, which in turn causes diarrhea and flatulency in some patients.
Hospitalization – Biliopancreatic diversion needs you to stay four nights at the hospital.
Time – Between two and a half and four and a half hours.
Intragastric Balloon
General description
Intragastric balloon as weight loss surgery offers a restrictive endoscopic procedure that uses a devise to limit gastric intake and so you will loose weight because you will be eating.
Weight loss surgery patients must be aware of pre and post surgery requirements.
Benefits
This weight loss option is for patients who have body mass index (BMI) of 40 kg/m2 or those with BMS of 35+ who suffer from obesity-related comorbidity. The age range is from 14 to 65, nevertheless, there can be exceptions to this rule. Gastric balloon can be performed on patients who suffer from extreme obesity so that later they can qualify for a bypass.
Gastric balloon offers the following advantages:
- It is used in patients whose BMI prevents them from having surgery and those who must first have a smaller BMI to minimize the risk or surgical complications.
- It is not a surgical procedure, it is endoscopic, and it does require cessation to place it and anesthesia to take it off.
Disadvantages are:
- Some patients show intolerance and vomits, so it is necessary to take the balloon out.
- It can only be inside the body for 6 months, and some patients regain weight after it is removed.
Potential complications are:
- Respiratory tract obstruction.
- Incoercible vomit.
- Esophageal perforation.
Technical description
Procedure – Weight loss treatment of this sort places, under endoscopic vision, a silicone balloon to make the patient feel full faster. In this way, food intake diminishes and the patient looses weight.
Hospitalization – Placing and removing the balloon is an ambulatory procedure.
Time – Between 30 minutes and an hour, both for placing and removing the balloon.
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