Roux-en-Y (roo-en-why) gastric bypass (RYGB) is the most commonly performed weight loss procedure in the United States. It has been practiced for over 30 years and provides an excellent balance of weight loss and manageable side effects. The operation can be performed laparoscopically (small incisions to the abdomen), or robotically (computer-assisted surgery used to aid in surgical procedures).
RYGB promotes produces weight loss in two different ways:
Restriction: The surgeon separates the upper portion of the stomach from the lower portion. The upper portion or the “pouch” is then connected to a limb of small intestine called the “Rouxlimb”. The new stomach pouch restricts the amount of food you can eat. This makes you feel full after eating only a small amount of food.
Malabsorportion: Once the smaller pouch is created, the surgeon reroutes your digestive system to bypass the larger part of your stomach and part of your small intestine. The result of the bypass is that you absorb fewer calories and nutrients from the food you eat (malabsorportion).
- Average weight loss is greater than with other procedures, such as the adjustable gastric band and sleeve gastrectomy.
- Co-morbidities (conditions related to excess weight – such as type 2 diabetes and hypertension) may begin to improve even before you lose much weight.
- Less post-operative visits are needed.
- Adjustments after surgery are not needed.
- Weight loss is more rapid than the lap band if you follow dietary guidelines.
- RYGB doesn’t require any devices to stay inside you.
- Post-operative healing: surgery is more extensive because the digestive organs are rerouted. There is more pain and it takes longer to heal from this procedure than from laparoscopic adjustable band.
- The procedure reduces your ability to absorb nutrients as well as calories; you will need to take supplements for the rest of your life.
- Your intake of sugars and starches will need to be monitored very closely, or you may have uncomfortable physical consequences, including vomiting and diarrhea.
- This procedure is not reversible.
- Complications include the possibility of leaks, bleeding, blood clots, infection and blockages.
The sleeve gastrectomy, also known gastric sleeve, restricts the amount of food you eat by reducing the size of the stomach. The minimally invasive procedure removes a portion of the stomach, making the stomach roughly the size and shape of a banana.
Patients who have a sleeve gastrectomy feel full after eating much less. In addition, the surgery removes the portion of the stomach that produces a hormone that can make you feel hungry, so you won’t want to eat as much.
This procedure can be an excellent alternative to gastric bypass. Sleeve gastrectomy is a simpler operation than the gastric bypass procedure because it doesn’t involve rerouting or reconnecting the intestines. Also, the sleeve gastrectomy doesn’t require implanting a banding device around a portion of the stomach.
For certain patients, in particular those with a body mass index greater than 60, the sleeve gastrectomy may be the first part of a 2-stage operation. In the staged approach, the operation is broken down into two simpler and safer operations. In the first stage, a sleeve gastrectomy is performed. This allows patients to lose 80 to 100 pounds or more, making the second part of the operation substantially safer. Some people lose enough weight that they do not need any more surgery. For those who continue to the next stage, the second procedure is usually performed eight to twelve months after the first. The “sleeve” stomach is converted into a lap band or gastric bypass.
- Weight loss generally is faster with the sleeve than with gastric banding.
- There is no implantable band device, so slippage and erosion are not a risk.
- Quicker recovery time No device that needs adjustment is inserted, so the follow-up regimen is not as intense as it is with gastric banding.
- Sleeve gastrectomy is not adjustable or reversible.
- Complication risks are slightly higher than with the band.
- Hospital stay averages 48 hours
- Most patients return to normal activity within two weeks
- Full surgical recovery usually occurs within three weeks
The laparoscopic adjustable band (e.g. LAP Band, Realize) is a small adjustable band made of silicone rubber which is wrapped around the upper portion of the stomach. The band decreases the functional size of the stomach, which means after eating only a small amount of food you will feel full. It works by turning the stomach into an hourglass shape – the food you eat quickly fills the pouch, then empties very slowly through the constriction created by the band, just like sand passing through and hourglass. The band is adjustable and can be personally sized to patient needs.
Four to six weeks after surgery you will return to have your band inflated. The band is inflated by injecting saline, better known as salt water, through an access port located underneath the skin on your stomach. If your band is ever to tight or too loose, all you have to do is come back to the Surgery Clinic for an adjustment (adding or removing saline). Laparoscopic adjustable band surgery is performed laparoscopically, which means surgeons will make 5-6 very small incisions in the abdominal wall.
Lower risk: Because this is a relatively simple operations, it provides the lowest risk of all bariatric surgeries. No cutting or stapling of the stomach is required.
Adjustability: The restriction of the band can be tailored to your personal needs.
Reversible: The laparoscopic adjustable band can be removed, whereas other types of surgeries are permanent.
Short hospital stay: Most patients go home the same day or after a brief overnight stay in the hospital.
Foreign body: The laparoscopic adjustable band is a foreign body, which could lead to infection or erosion.
Multiple adjustments: Everyone requires at least 3 or 4 band adjustments. Sometimes it is hard to find the perfect adjustment where the band is tight enough for good weight loss but not so tight that it causes vomiting.
Gradual weight loss: Weight loss is more gradual, however long-term weight loss is similar to weight loss seen with gastric bypass.
UI Hospital is one of the few centers in the country offering weight loss surgical treatment to older adolescents, and has been involved in studying the efficacy of this treatment in adolescents for the past four years. The center offers surgical treatments to adolescents from the ages of 15 – 19 years, and has a multidisciplinary pediatric support team.
Childhood obesity is a complex condition that dramatically increases a child’s risk for serious health problems, including diabetes, heart disease, depression, and disabilities. When other methods for weight loss are exhausted, bariatric surgery is a surgical intervention that can enable teens to reach a healthier weight.
The UI Health Adolescent and Pediatric Weight Management Program aims to help children and adolescents who are morbidly obese. Bariatric surgery is still a relatively new procedure in adolescents, and it is important that the surgery is performed by a pediatric team who understands the special needs of young patients – the physical and physiological differences as well as behavioral and psychological factors that influence health.
Our team is comprised of specialists from pediatric surgery, adolescent medicine, nutrition, psychiatry, plastic surgery, and other pediatric subspecialties are available as needed. Our adolescent specialist, surgeon and nutritionist follow patients closely on a monthly basis preoperatively. After surgery patients are seen monthly for at least the first six months, then follow-up is tailored to their specific needs.
For some patient, the rapid loss of weight can leave patients with excess skin that can be cosmetically unappealing, and can also cause further medical complications. The team at UI Hospital is led by of one of the nation’s leading practitioners in body contouring.
The Biliopancreatic Diversion – Duodenal Switch (BPD-DS)
The biliopancreatic diversion with duodenal switch goes by many names. Some refer to it by the initials BPD-DS. Many call it the “duodenal switch” or just “the switch” for short. This surgery is only done in people who are severely obese and who haven’t been able to lose weight any other way. Severe obesity means that you have a BMI (body mass index) of 50 or higher. The surgery has also help reduce obesity and related illnesses, including heart disease, high blood pressure, and especially type 2 diabetes.
In the BPD-DS, roughly one half of the stomach is permanently removed. The stomach goes from the shape of a small pineapple to the size and shape of a banana. It is a complex procedure that tackles weight loss in three different ways:
- First, the surgery takes out a large portion of the stomach to stop you from overeating. With less stomach to fill, you will feel full more quickly and eat less food and fewer calories.
- The second part of the procedure reroutes food away from the upper part of the small intestine, which is the natural path of digestion. This cuts back on how many calories and nutrients your body is able to absorb.
- The third part of the BPD-DS procedure changes the normal way that bile and digestive juices break down food. This cuts back on how many calories you absorb, causing still more weight loss. It allows food to bypass part of the small intestine so that you absorb fewer calories.
Benefits of the Procedure
The BPD-DS can cause drastic, significant weight loss, because it restricts how much food you can eat and reduces how many calories you can absorb.
BPD-DS has short-term and long-term risks, including:
- Dumping syndrome. This causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms get worse if you eat highly refined, high-calorie foods (like sweets). Sometimes you may become so weak that you have to lie down until the symptoms pass.
- A higher risk of osteoporosis. This happens because your body can’t absorb nutrients as well as it used to.
- Poor nutrition. Eating less and less absorption may mean that you are not getting enough nutrients, which can cause health problems. You will have to take vitamin and protein supplements for the rest of your life.
In addition, like any surgery, the BPD-DS procedure carries certain risks:
- Internal bleeding
- Potentially fatal blood clots that can move to the lungs or heart
Living with the BPD-DS
It is necessary to take a number of nutritional supplements after the operation than after gastric bypass. These include:
- Multivitamins (usually twice per day)
- Iron supplements (usually twice per day)
- Calcium (usually twice per day)
- ADEKs (fat-soluble vitamins) usually 3 times per day
Your physician will discuss these with you and set up a supplement plan to follow.
Revision & Correction Surgery
Patients who have had complications or ill effects as a result of weight loss surgery may require other procedures to correct the original operation. These types of operations are called revisional weight loss surgical procedures.
The UI Health Bariatric Surgery Center is one of the few hospitals in the country with bariatric surgeons experienced to perform these corrective procedures.
The Goal of the Revisional Weight Loss Surgery is to:
- Correct the problem that brings a patient under our care. It is common for our patients to have received their first bariatric operation from a different operating surgeon.
- Make the revisional weight loss surgery a definitive procedure. This will be discussed further with each type of procedure that we revise.
- Accomplish the primary goal of the weight loss surgical procedure: maintain a weight that is in a favorable range and resolve a patient’s comorbid conditions.
Of the reasons to have revision bariatric surgery, inadequate weight loss and/or weight regain is the number one reason.
Other Reasons for Revisional Weight Loss Surgery:
A specific bariatric surgery did not address the metabolic needs of a patient.
Bariatric surgery can metabolically and/or mechanically fail the patient. Mechanical failures are caused when the anatomical changes made during the original bariatric surgery, are not maintained.
Examples of these changes are as follows:
- The pouch may stretch and become larger
- The outlet of a gastric pouch may increase in diameter
- A gastro-gastric fistula may form between the gastric pouch and the bypassed stomach
- The intestine may increase its absorptive abilities beyond what was expected
- Restriction may decrease as a result of a band slippage
Unsatisfactory resolution of co-morbidities after bariatric surgery.
These are generally related to the factors causing metabolic failure, as co-morbidities are strongly associated with your metabolism. Cases involving unsatisfactory resolution of co-morbidities, require a similar approach as cases of metabolic failure, usually requiring conversion of the failed bariatric procedure, to a more metabolically active bariatric surgery type.
Other conditions that will lead to revision bariatric surgery.
- Band failure
- Pouch enlargement
- Sleeve failure
- Gastrogastric fistula
- Weight regain
If you’re considering revisional bariatric surgery, we can help you get started.
Weight Gain after Gastric Bypass Surgery
Patients Who Regain Weight After Initial Gastric Bypass Now Have Options
Have you started to regain weight after initial success from gastric bypass surgery? Overtime, for many gastric bypass patients, the small stomach pouch and the outlet that connects it to the small intestine stretch out. As a result, patients begin to eat more food before they feel full.
We offer qualified patients a safe and effective endoscopic procedure to repair your enlarged pouch and outlet to return them to their original post-gastric bypass proportions. This procedure is performed using a small flexible endoscope and specialized devices that allows real sutures to be placed through the endoscope. The scope and suturing devices are inserted through the mouth into the stomach pouch the same way as a standard endoscopy. Sutures are then placed around the outlet to reduce the diameter, typically about 10 mm. The same technique may then be used to place additional sutures in the stomach pouch to reduce its volume capacity. This is an outpatient procedure that takes about 45 minutes.
The Bariatric Surgery Program at the University of Illinois Hospital & Health Sciences System is one of the few centers in the country offering this procedure.