Bariatric Surgery Procedure FAQs

What is a Vertical Banded Gastroplasty (VBG)?

This is a procedure where a smaller gastric reservoir is made with a stapler and the outlet of the smaller pouch of stomach is kept tight by a band. Most refer to this procedure as a stomach stapling.

This was the most popular operation for many years. However over the last decade, most bariatric surgery specialists have moved away from performing this operation. This is a trend that will most likely carry on with the development of the adjustable gastric band. A VBG is a gastric restrictive operation and functions by making the patient get full after eating less food. Although, drinking high calorie liquids and continuing to make unhealthy food choices can disrupt the success of your operation. Also, several investigators have reported a moderate weight return several years.

A benefit of this approach is that absorption is normal. Therefore anemia, calcium deficiency and other micro nutrient deficiencies are less common than after bypass procedures.

Average weight loss with a VBG is around 60% of excess weight.

What is a Gastric Bypass or Roux en Y Gastric Bypass (RYGB)?

Some patients may decide gastric bypass surgery is the best procedure for them. This combines making a smaller gastric reservoir with staples, with a bypass of the first portion of the small intestine. As a result, eating behavior is altered for several reasons. Since the storage capacity of the stomach has been reduced, and the outlet is restricted, a person becomes full fast as with VBG. Also food enters the small bowel without mixing with the digestive juices from the liver and pancreas. As a result food high in sugar and fat is not efficiently digested or absorbed and some of the calories are not absorbed.

For these reasons, rather than just gastric restriction, weight loss with a bypass is better than a VBG and average weight loss is approximately 70% of excess weight.

Most surgeons who specialize in bariatric surgery have shifted to a gastric bypass. However, the increased weight loss comes at a cost. Some disadvantages include an increased risk of nutrient deficiency and occasional malnutrition.

It is important to understand that there is no perfect operation, and an experienced obesity surgeon tries to maximize weight loss without risking malnutrition and vitamin and mineral deficiency.

After a bypass all patients must take a daily multi vitamin and calcium. Most, especially menstruating women, require iron supplementation.

Following surgery, it is recommended that you meet with a dietician to discuss short-term and long-term nutritional needs.

What is laparoscopic adjustable gastric band?

With the introduction of gastric banding patients now have an alternative to gastric bypass surgery. Some bariatric surgeons offer laparoscopic gastric banding. Adjustable Gastric Banding is a new device that is now FDA approved for the treatment of morbid obesity. It is a silicone band that is placed around the top portion of the stomach and when the band is tightened, the gastric reservoir is made smaller and the patient gets full after eating less food. As with a VBG this is a gastric restrictive procedure but offers several new features. The band is attached to a port which is implanted beneath your skin. The port can be used to change the tightness of the band. If you require more control the band can simple be tightened. If for some reason you are having difficulties or need to eat more, the band can be loosened.

The adjustable nature of the band offers numerous advantages. For example, your anatomy stays in its normal position. Malabsorption and vitamin deficiency is not a concern. Weight loss is not as fast as with bypass, however the band is inserted through a small incision with the aid of laparoscopy and the chance of intestinal leakage and infection is reduced. Also, if you do not do well, band placement does not rule out future bypass.

What is Biliopancreatic Diversion with or without Duodenal Switch ?

This is a procedure in which a considerable amount of the intestines are bypassed. Instead of relying on getting full faster, these procedures rely on creating malabsorption. Part of the stomach is removed in these operations, and food is redirected to bypass a large amount of the intestines. These procedures cause marked weight loss but protein supplementation is mandatory because malnutrition is a concern.

Compared to the surgical procedures described above, malabsorption operations have the potential for more nutritional deficiencies and should be reserved for those who are massively obese or have failed more conservative surgical options.

It is important to realize that most obesity health problems go away after 10 to 20% of body weight is lost. Therefore, operations that risk your health to maximize weight loss should be done with caution.

What about the size of my incision?

Most practices to do procedures safely with as minimally invasive an approach as possible. Gastric bypass surgery is performed with 4 to 5 inch mini incisions or via the laparoscopic method where 5-6 tiny incisions are made in the abdomen and surgical instruments are inserted through ports. The adjustable gastric band can also be placed via the laparoscopic method.

Incisions vary by patient size, health and whether the patient has had previous abdominal operations. For select patients a minimally invasive approach is not possible. However, even when incisions are slightly larger, most are able to be discharged from the hospital in a few days and require minimal pain medication.

What are the benefits of laparoscopy?

With laparoscopy, the surgeon is able to see the operative field using a television monitor. Some benefits include a reduction in potential wound complications, hernias and a faster return to full activity. For gastric bypass patients, this approach is ideal for appropriate candidates. It is important to emphasize that even when surgery is done through small incisions, it is still a major operation. While more operations are done in this minimally invasive manner, time in the hospital, as well as immediate post-operative pain appear similar. In addtion, since the procedure is the same with the exception of the size and number of abdominal incisions, and substantial part of the recovery is adjustment to new diet, there is little difference in return to work.

Currently it takes longer to perform a laparoscopic gastric bypass than an open procedure. As a result, those with considerable medical problems are not ideal candidates.

What procedure and approach are best for me?

Each procedure has advantages and disadvantages. For example, weight loss on average is better with a bypass than with a band. On the other hand, iron and calcium absorption are much easier following a band. A band is adjustable. Thus, it is important during your consultation you and your doctor discuss your health problems, concerns and expectations. If you want the operation that gives you the best chance to lose the most weight, a bypass is preferred. If you want to try something that probably will work and not change your anatomy, you may want to consider the band. Laparoscopy may be ideal for certain individuals and not others. An experience bariatric surgeon can help outline a strategy that works best for you.

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