The American Society for Bariatric Surgery describes two basic
approaches that weight loss surgery takes to achieve change:
Follow the links below to learn more about the different types
of restrictive and malabsorptive procedures:
Combined Restrictive & Malabsorptive
Procedure - Gastric Bypass Roux-en-Y
In recent years, better clinical understanding of procedures
combining restrictive and malabsorptive approaches has increased
the choices of effective weight loss surgery for thousands of
patients. By adding malabsorption, food is delayed in mixing with
bile and pancreatic juices that aid in the absorption of nutrients.
The result is an early sense of fullness, combined with a sense of
satisfaction that reduces the desire to eat.
According to the American Society for Bariatric Surgery and the
National Institutes of Health, Roux-en-Y gastric bypass is the
current gold standard procedure for weight loss surgery. It is one
of the most frequently performed weight loss procedures in the
United States. In this procedure, stapling creates a small (15 to
20cc) stomach pouch. The remainder of the stomach is not removed,
but is completely stapled shut and divided from the stomach pouch.
The outlet from this newly formed pouch empties directly into the
lower portion of the jejunum, thus bypassing calorie absorption.
This is done by dividing the small intestine just beyond the
duodenum for the purpose of bringing it up and constructing a
connection with the newly formed stomach pouch. The other end is
connected into the side of the Roux limb of the intestine creating
the "Y" shape that gives the technique its name. The length of
either segment of the intestine can be increased to produce lower
or higher levels of malabsorption.
The average excess weight loss after the Roux-en-Y procedure is
generally higher in a compliant patient than with purely
One year after surgery, weight loss can average 77% of excess
Studies show that after 10 to 14 years, 50-60% of excess body
weight loss has been maintained by some patients.
A 2000 study of 500 patients showed that 96% of certain
associated health conditions studied (back pain, sleep apnea, high
blood pressure, diabetes and depression) were improved or
Because the duodenum is bypassed, poor absorption of iron and
calcium can result in the lowering of total body iron and a
predisposition to iron deficiency anemia. This is a particular
concern for patients who experience chronic blood loss during
excessive menstrual flow or bleeding hemorrhoids. Women, already at
risk for osteoporosis that can occur after menopause, should be
aware of the potential for heightened bone calcium loss.
Bypassing the duodenum has caused metabolic bone disease in some
patients, resulting in bone pain, loss of height, humped back and
fractures of the ribs and hip bones. All of the deficiencies
mentioned above, however, can be managed through proper diet and
A chronic anemia due to vitamin B12 deficiency may occur. The
problem can usually be managed with vitamin B12 pills or
A condition known as "dumping syndrome " can occur as the result
of rapid emptying of stomach contents into the small intestine.
This is sometimes triggered when too much sugar or large amounts of
food are consumed. While generally not considered to be a serious
risk to your health, the results can be extremely unpleasant and
can include nausea, weakness, sweating, faintness and, on occasion,
diarrhea after eating. Some patients are unable to eat any form of
sweets after surgery.
In some cases, the effectiveness of the procedure may be reduced
if the stomach pouch is stretched and/or if it is initially left
larger than 15-30cc.
The bypassed portion of the stomach, duodenum and segments of
the small intestine cannot be easily visualized using X-ray or
endoscopy if problems such as ulcers, bleeding or malignancy should
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Laparoscopic or Minimally Invasive
For the last decade, laparoscopic procedures have been used in a
variety of general surgeries. Many people mistakenly believe that
these techniques are still "experimental." In fact, laparoscopy has
become the predominant technique in some areas of surgery and has
been used for weight loss surgery for several years. Although few
bariatric surgeons perform laparoscopic weight loss surgeries, more
are offering patients this less invasive surgical option whenever
When a laparoscopic operation is performed, a small video camera
is inserted into the abdomen. The surgeon views the procedure on a
separate video monitor. Most laparoscopic surgeons believe this
gives them better visualization and access to key anatomical
The camera and surgical instruments are inserted through small
incisions made in the abdominal wall. This approach is considered
less invasive because it replaces the need for one long incision to
open the abdomen. A recent study shows that patients having had
laparoscopic weight loss surgery experience less pain after surgery
resulting in easier breathing and lung function and higher overall
oxygen levels. Other realized benefits with laparoscopy have been
fewer wound complications such as infection or hernia and patients
returning more quickly to pre-surgical levels of activity.
Laparoscopic procedures for weight loss surgery employ the same
principles as their "open" counterparts and produce similar excess
weight loss. Not all patients are candidates for this approach,
just as all bariatric surgeons are not trained in the advanced
techniques required to perform this less invasive method. The
American Society for Bariatric Surgery recommends that laparoscopic
weight loss surgery should only be performed by surgeons who are
experienced in both laparoscopic and open bariatric procedures.
Adjusted Gastric Band
More Information coming soon...
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