Surgical Weight Loss Options

• Surgically separates stomach into two sections using parallel rows of titanium staples.
• The small upper segment of the stomach connected to the esophagus continues to receive food much as it did prior to surgery, while the lower portion no longer comes in contact with food.
• A portion of the small intestine is disconnected, allowing the surgeon to re-route food directly from the newly-created small stomach pouch directly into the remaining intestine for digestion.
• The procedure can be performed laparoscopically, followed by a typical hospital stay of three days and two to four weeks of restricted activity.
• Several post-surgery appointments will be necessary to monitor healing and progress.
• Gastric bypass is a non-reversible procedure and leads to very rapid weight loss. Weight loss occurs more quickly following gastric bypass compared to the laparoscopic adjustable gastric banding procedure.

• The stomach is restricted by stapling and dividing it vertically. The portion of the stomach that receives food is shaped like a very slim banana (or sleeve).
• The nerves to the stomach and the valve leading from the stomach to the small intestine remain intact, thereby preserving the functions of the stomach while drastically reducing the volume. The small intestine remains intact.
• Sleeve gastrectomy is sometimes used as the first of two procedures for very high-risk patients. After several months of significant weight loss post-procedure (thereby reducing risk), a second bariatric procedure can be performed (see duodenal switch below).
• Typical hospital stay after the procedure is 2-3 days.
• Post-surgery appointments to monitor healing and progress will occur with the clinical team.

The duodenal jejunal bypass with sleeve gastrectomy, commonly known as DJB-S, is a type of bariatric procedure in which 80 percent of the stomach is removed and a portion of the small intestine is rerouted. The first part of the intestines, called the duodenum, remains connected to the new stomach sleeve. The valve at the outlet of the stomach remains in place and provides normal stomach-emptying. Further down the duodenum, the intestine is divided just before the area where bile and digestive juices from the pancreas enter the digestive tract. The lower end of the small intestines is also divided and then connected to the duodenum. This creates the “alimentary limb.”

• In a biliopancreatic diversion with duodenal switch, the surgeon will first perform a vertical sleeve gastrectomy procedure as stage 1.
• During stage 2, typically 12-18 months after stage 1 procedure, the biliopancreatic diversion with duodenal switch is performed where the remaining part of the stomach is connected to the lower portion of the small intestine resulting in significant malabsorption of calories and nutrients.
• This surgery is high-risk and can cause long-term health problems because your body has a harder time absorbing food and nutrients.
• People who have this surgery must take vitamin and mineral supplements for the rest of their lives, which can be expensive.
• Typical hospital stay after the procedure is three days.
• Long-term follow-up is absolutely essential following the duodenal switch, so patient selection is extremely important.

Memorial Bariatric Services offers revisional procedures meant to supplement, correct or maximize the effectiveness of a past surgery. If you have already undergone a bariatric procedure, your clinical team will assess whether revisional surgery is appropriate for you.

• This procedure involves surgical placement of a silicone elastic ring around the upper part of the stomach. The ring is then filled, or inflated, with saline solution.
• The ring is accessed by tubing connected to a port placed beneath the skin of the abdomen. The healthcare provider injects or withdraws saline until it reaches the ideal tightness around the opening from the upper stomach to the lower stomach.
• Tightening the band decreases hunger and allows the patient to eat less and still feel full.
• The ring is inserted laparoscopically, resulting in shorter hospital stays and faster recovery times compared to a traditional surgical incision.
• Laparoscopic adjustable gastric banding is often performed as an outpatient procedure.
• Following surgery, patients require monthly clinic visits during the first year to monitor results and the possible need for adjustment to the device. The frequency of adjustments decreases after the first year.
• Adjustments must be completed by a qualified, appropriately trained healthcare provider.
• This is a completely reversible procedure; however, it is intended to be a permanently implanted device. Removal would eliminate restriction and may lead to weight re-gain.
• An appropriate candidate for the laparoscopic adjustable gastric banding procedure typically has a lower BMI (under 40) and is relatively active. Of all the bariatric procedures, the laparoscopic adjustable gastric banding is the least effective at achieving and maintaining adequate weight loss. For this reason, patient selection is extremely important.