Procedures
ADJUSTABLE GASTRIC BAND (AGB)
The Adjustable Gastric Bands were designed to help the severely
obese patient to lose weight. A major advantage of the system is that the diameter of
the band outlet is adjustable to meet individual needs, which can change as weight is lost.
Weight loss surgery is a major surgery and most patients enjoy an
improvement in obesity related health conditions. The goal of the
surgery is to live better, healthier, and longer.
Modern (early 1990’s to present) weight loss surgery is safer than the interventions used in the 60’s, 70’s, or 80’s. The inclusion of a MULTI-DISCIPLINE philosophy that utilizes the expertise of dietitians, psychologists, and internal medicine specialists in addition to the surgeon, provides the opportunity for a safer process and more desirable outcomes.
The adjustable gastric band is the least invasive way of using surgery to assist with weight loss. It is a purely “restrictive” procedure that limits (restricts) the amount of food that can be eaten. The pouch above the band can hold only a small amount of food and the band controls the flow rate between the two stomach parts. This allows the patient to “feel full” sooner AND that feeling lasts longer. The AGB has been in use since the 1980s (worldwide) and in the United States since 2002.
Of the surgeries used to treat severe obesity, the LAP-BAND® and REALIZE® systems are considered to cause the least amount of trauma to the patient. There is no cutting, stapling or re-routing of the intestines or stomach.
ROUX-EN-Y GASTRIC BYPASS (RNY)
The RNY gastric bypass weight
loss surgery (performed several different ways) is the most frequently performed weight loss
surgical procedure in the United States.
Weight loss surgery is a major surgery and most patients enjoy an improvement in obesity related health conditions. The goal of the surgery is to live better, healthier, and longer.
Modern (early 1990’s to present) weight loss surgery is safer than the interventions used in the 60’s, 70’s, or 80’s. The inclusion of a MULTI-DISCIPLINE philosophy that utilizes the expertise of dietitians, psychologists, and internal medicine specialists in addition to the surgeon, provides the opportunity for a safer process and more desirable outcomes.
The most basic way to describe the RNY gastric bypass is: (1) Create a small upper stomach pouch to limit (RESTRICT) food consumption. (2) Bypass a segment of small intestine to “alter” absorption of certain foods (MALABSORPTION).
“Pouch creation” can be accomplished be merely stapling across the upper stomach or by doing a “TRANSECT and DIVIDE” where the small pouch is separated from the rest of the stomach. We favor the transect and divide as a probable more accurate way to judge pouch size (approximately 20 – 30 ml).
The bypass segment can be short or long to produce lower or higher levels of malabsorption. Our typical is 90 cm in length and seems to function very well by providing very acceptable weight loss with an appropriate degree of treatable malabsorption. The anastamosis (connection between the new stomach pouch and small intestine) is a very critical part of the procedure. This connection can be performed by linear stapler and hand sewing over a predetermined tube diameter Circular stapler (EEA) and reinforced with hand sewing. We favor the circular stapler in order to provide a more consistent sized opening at the anastamosis and a more predictable restrictive element to the pouch function.
Therefore the “KEY TECHNICAL COMPONENTS” to the procedure performed by us:
- TRANSECT & DIVIDE the stomach pouch
- EEA CIRCULAR anastamosis between stomach pouch and small intestine
- LAPAROSCOPIC approach