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Gastrointestinal (or bariatric) surgery may be considered for those with a Body Mass Index (BMI) of 40 or more (about 100 pounds overweight for men and 80 pounds overweight for women). Those with a BMI of 35 or more accompanied by other weight-related problems, such as diabetes or heart disease, may also be candidates for bariatric surgery.
An option for people who are severely obese and cannot lose weight by traditional means, bariatric surgery promotes weight loss by restricting food intake and, in some cases, interrupting the digestive process. If recommended, bariatric surgery is not a long-term solution. Bariatric procedures must be followed by lifestyle changes, including healthy eating behaviors and regular physical activity.
During laparoscopy, the surgeon makes one or more small incisions through which slender surgical instruments are passed. This technique eliminates the need for a large incision and creates less tissue damage. Patients who weigh more than 350 pounds or have had previous abdominal operations may not be good candidates for laparoscopy. Ultimately, Dr. Salimath will recommend whichever approach will offer the safest outcome.
Laparoscopic Adjustable Band Procedures
Also called the Lap Band, this is a restrictive procedure in which an inflatable band is placed around the upper part of the stomach. This then creates a smaller stomach pouch, which restricts the amount of food that can be consumed at one time and increases the time it takes for the stomach to empty. As a result, patients achieve sustained weight loss by limiting food intake, reducing appetite and slowing digestion.
Laparoscopic Gastric Bypass
A permanent, major operation, Gastric Bypass involves creating a small pouch in the stomach after bypassing the lower portion of the stomach. An opening is then created in the small pouch which connects to the lower end of the upper intestine. Food enters the small stomach, causing a sensation of fullness before it slowly empties into the intestine through the newly reconstructed opening. Close follow-up including blood work is recommended after this surgery.
Laparoscopic Sleeve Gastrectomy
An operation in which the left side of the stomach is surgically removed, the Sleeve Gastrectomy results in a new stomach that is about the size and shape of a banana. This operation does not involve any rerouting or reconnecting of the intestines, so it is a more simple operation than the Gastric Bypass. Unlike the Lap Band, the Sleeve Gastrectomy does not require implanting an artificial device inside the abdomen.
Management of Bariatric Surgical Complications
When problems arise from a previous operation – for example, when there are problems with a device or unsatisfactory weight loss or when one type of operation does not work for a patient and another type is recommended – Dr. Salimath can discuss the options available for revisional procedures, converting an “old” procedure to a more modern one. For example, stomach stapling was a very common procedure in the past (vertical banded gastroplasty or VGB) which left many patients with inadequate weight loss and sometimes excessive vomiting. This procedure may be converted to a gastric bypass. In addition, there may be problems that arise as the result of a surgical procedure that may require additional management. For example, vitamin B12 shots may be required, anemia may result, etc. Most complications can be avoided with ongoing follow-up after these procedures.
Open Gastric Bypass
Performed the same was as a Laparoscopic Gastric Bypass, the only difference with this procedure is that it is handled traditionally with a large incision that allows direct access to the abdominal organs. Open Gastric Bypasses have been performed for years successfully and offer the advantage of allowing the surgeon to directly handled the abdomen. If your BMI is very high or extensive scarring from a previous surgery is present, the traditional open approach may be preferred. However, the procedure that results in the safest outcome will be recommended.
Revisional Bariatric Operations
Performed to alter or repair a pre-existing operation for treatment of morbid obesity, revisional bariatric operations become more necessary as weight loss procedures increase. Not that uncommon, the two most currently popular procedures – the Gastric Bypass and the Lap Band, although successful, have required occasional revision. The revision rate for Lap Band is about 10 percent during the first two years for either device-related problems or unsatisfactory weight loss. Gastric Bypass revisions are roughly 5 to 10 percent over five years for troublesome complications, such as ulcers or unsatisfactory weight loss.
If you have any questions or concerns related to the above conditions or treatments, please contact Dr. Salimath or call 672-5975 for a professional consultation.
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