The Gastric Sleeve

The latest weight loss procedure, the Gastric Sleeve, or Vertical Sleeve Gastrectomy is an innovative procedure that is commonly selected among potential bariatric patients because it does not require any foreign objects placed inside the body and it typically has less long-term risks.  This procedure is also favorable for out-of-town patients due to the minimal follow-up care that is required. The sleeve procedure is rapidly becoming more popular as insurance plans covering this procedure for their members continues to increase.

The procedure
The Gastric Sleeve procedure is minimally invasive similar to the Gastric Band and Bypass procedures. It is a purely restrictive procedure in which the restriction is created by surgically decreasing the size of the stomach by greater than 90%, thereby creating a small tube or sleeve, without bypassing the intestines or causing any gastrointestinal malabsorption. There are no additions or re-routing of the anatomy of this procedure.

The recovery time includes an overnight stay at the hospital and you can typically return to work within one week of having surgery.

Results
Typically, patients who practice the principles of behavior change and who have had the gastric sleeve procedure can expect on average a 60-70% excess weight loss within two years of having surgery. In addition, patients tend to have less long-term risks such as ulcers, hernias and nutritional deficiencies.

Gastric Banding

Gastric banding was approved in the US by the FDA in June 2001.  Over 200,000 Band procedures have been performed throughout the world.  It is now the favorite weight control procedure performed internationally.  Here’s why:

Minimally Invasive
During the procedure, surgeons usually use laparoscopic techniques (using small incisions and long-shafted instruments) to in plant an inflatable silicone band into the patient’s abdomen.  Like a wristwatch, the band is fastened around the upper stomach to create a small outlet that slows the emptying process into the stomach and the intestines.  As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food.  In turn, this results in weight loss.

Safest Procedure
Since there is no cutting, stapling, or stomach re-routing involved in the Banding procedure, it is considered the safest and least tramautic compared to other weight-loss surgeries.  It also offers the advantages of reduced post-operative pain, shortened hospital stays, and quicker recoveries.

Adjustable Treatment
The Gastric Band is the only adjustable weight-loss surgery.  The diameter of the band is adjustable for a customized weight-loss rate.  To modify the size of the band, its inner surface can be inflated or deflated with a saline solution via an access port placed well below the skin during the surgery.  The saline is administered as needed through the skin using a fine needle.

Reversible
The Gastric band can be removed at any time for any reason.  Following removal, the stomach and other anatomy are generally restored to their original forms and functions.

Gastric Bypass

In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of your stomach and adds a bypass around a segment of your stomach and small intestine.

The surgeon staples your stomach across the top, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch.

This connection redirects the food, bypassing most of your stomach and the first section of your small intestine, the duodenum (doo-o-DEE-num). Food enters directly into the second section of your small intestine, the jejunum (jay-JOO-num), limiting your ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine.

Some surgeons perform this operation by using a laparoscope  a small, tubular instrument with a camera attached  through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside your abdomen.

Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens your hospital stay and leads to a quicker recovery. Fewer wound-related problems also occur. Not everyone is a candidate for laparoscopic gastric bypass, however. Talk to your doctor about whether this approach is appropriate for you.

Before gastric bypass, food (see arrows) enters your stomach and passes into the small intestine. After surgery, food is redirected so that it bypasses (see shaded areas) most of your stomach and the first section of your small intestine (duodenum). Food flows directly into the middle section of your small intestine (jejunum), limiting absorption of calories.