Bariatric Surgery Treatment Options

Bariatric surgery is an excellent and highly effective treatment option for patients unable to lose weight through diet and exercise. Bariatric surgery procedures help patients reduce weight through several processes, including restriction, malabsorption, and hormonal changes. Restriction reduces the amount of food the stomach is capable of holding by decreasing the size of the stomach, thereby limiting the amount of food you can eat. Malabsorption limits the absorption of nutrients through the intestines by rerouting the intestines so that the route of food through the gastrointestinal tract is changed, thereby decreasing the number of calories that are actually absorbed from the food you eat. Hormonal changes alter the levels of hormones in your body responsible for feeling hungry and feeling full, in favor of feeling full. All bariatric surgical procedures work by employing one or more of these processes.

BASS Medical Group offers patients four types of minimally invasive (laparoscopic) surgery options: laparoscopic adjustable gastric band, laparoscopic gastric bypass, laparoscopic gastric sleeve, and laparoscopic duodenal switch. Each procedure has its own advantages and disadvantages. Below is a guide to help you understand the different types of bariatric surgery treatments.


Laparoscopic vertical gastrectomy (sleeve gastrectomy)

In a sleeve gastrectomy (gastric sleeve), a majority of the stomach is separated and removed from the body. Unlike the gastric bypass procedure, in which nothing is removed from the body, the gastric sleeve involves removing a portion of the stomach. The remaining smaller section of the stomach is formed into a tube-like shape which resembles the shape of a shirtsleeve—hence the name “sleeve gastrectomy”. Reducing the size of the stomach as in the sleeve gastrectomy has a dual effect: it reduces hunger as the patient becomes full more quickly because of the reduction in the size of the stomach (restriction), and it produces less of the appetite-regulating hormone ghrelin (hormonal changes). Ghrelin is the hormone in your body that regulates hunger. The more ghrelin your body produces the more hunger you feel. In some patients struggling with weight gain due to hormonal effects, sleeve gastrostomy can be an excellent and very effection solution.


Laparoscopic roux-en-Y gastric bypass (gastric bypass)

In the roux-en-Y gastric bypass, the surgical team at BASS Medical Group partitions the stomach, creating a small upper pouch and a large lower pouch referred to as the gastric remnant. By partitioning the stomach, the surgeons effectively reduce the size and, therefore, the capacity of the small gastric pouch to hold food. It’s easy to imagine the effect–this greatly limits the amount that you can comfortably eat and drink at one time.

In addition to partitioning the stomach, your surgeon also cuts the small intestine, detaching it from the larger remnant pouch and connecting it to the small pouch. Food flows directly from the small pouch into the small intestine. The main part of the stomach or large pouch is still functional and serves an important role–it makes digestive juices that help break down food throughout the digestive process.

The gastric bypass employs all three methods for achieving weight loss: partitioning the stomach into a small and large pouch helps achieve weight loss by restriction, redirecting the flow of food through the small intestine helps achieve weight loss by malabsorption, and the hormonal changes seen after the gastric bypass help patients feel less hunger.


Laparoscopic adjustable (gastric band)

In the laparoscopic adjustable gastric banding procedure, commonly known as the lap-band, a rubber-like ring containing an inflatable balloon is placed around the upper part of the stomach and affixed in place. This creates a small stomach pouch similar to the small pouch created surgically in the gastric bypass procedure. The difference is two-fold: first, the band does not completely separate the small pouch from the large pouch and, second, the band can be tightened or loosened to achieve the desired effect.

Injecting or removing fluid regulates the size of the balloon attached to the band. The balloon in the band is connected by a tube to a port, or reservoir, that is easily accessible by the surgeon in your abdominal wall. The lap band helps you achieve weight loss through restriction, by restricting the amount of food that your stomach can hold.


Laparoscopic duodenal switch

This procedure begins with a sleeve gastrectomy. The valve that releases food to the small intestine is left, along with the first part of the small intestine, called the duodenum. The surgeon then closes off the middle section of the intestine and attaches the last part directly to the duodenum. This is the duodenal switch.

The separated section of the intestine isn’t removed from the body. Instead, it’s reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into this part of the intestine. This is the biliopancreatic diversion.

As a result of these changes, food bypasses most of the small intestine, limiting the absorption of calories and nutrients. This, together with the smaller size of the stomach, leads to significant weight loss.