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There is so much information about
all the different kinds of weight-loss surgery; it is hard to be
able to tell which one is best. The answer? There is none that one
can call the best. Because we are all different, the patient must
weigh the pros and cons for their particular situation. Just because
one surgery may work for one person, it may not be the best option
for another.
Below, you will find a chart listing
some of the advantages and disadvantages of some of the more commonly
performed bariatric surgery procedures. The most important thing
you can do for yourself is to research, in depth, all of the procedures.
Then you should discuss them with your surgeon before making a final
decision.
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The
Sapala-Wood Micropouch®
Roux-en-Y Gastric Bypass Operation
In the Sapala-Wood Micropouch® operation the very top of the
stomach is completely divided. It is not stapled. This division
results in the creation of a small "micropouch" completely
separate from the lower part of the stomach. This Sapala-Wood Micropouch®
is about the size of a grape (1-2 cc).The small intestine is divided
into two ends.
One end travels upward to be connected
to the Sapala-Wood Micropouch®.The other end is attached downward
to the side of the distal small intestine to complete the circuit.
Food travels down the esophagus, through the Sapala-Wood Micropouch®,
to the intestine It bypasses the stomach. The bottom of the stomach
no longer receives any food or liquids. But the stomach will still
function because its nerve and blood supply are intact.
Advantages/Disadvantages:
• Greatly controls food intake.
• Dumping syndrome - dumping conditions to control intake of sweets.
• Less susceptible to ulcers.
• Limits the total number of calories that can be absorbed by the gastrointestinal or GI tract.
• Narrowing/blockage of the stomach.
• Vomiting if food is not properly chewed or if food is eaten to quickly.
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Adjustable
Gastric Banding (AGB)
In this procedure, commonly known
as the LapBand®, a silicone elastomer band is placed around
the upper part of the stomach to create a small stomach pouch
which can hold only a small amount of food. The lower, larger
part of the stomach is below the band. These two parts are connected
by a small outlet created by the band. Foodwill pass through the
outlet ("stoma" in medical terms) from the upper stomach
pouch to the lower part more slowly, and one will feel full longer.
The diameter of the band outlet
is adjustable to meet individual needs, which can change as one
loses weight.On the inner lining of the band there is a longitudinal
balloon (like a bicycle tire). The band is left empty at time
of surgery but is thereafter gradually filled with fluid by injection
through the subcutaneous (just under the skin) port. It is thus
possible to vary the opening in the stomach after surgery. This
can be done in the surgeon's office.
Advantages/Disadvantages:
- Simple and relatively safe
- Short recovery period
- Major complication rate is low
- No opening or removal of any part of the stomach or intestines
- No altering of the natural anatomy
- Very short recovery period
About 5% failure rate because of:
- Balloon leakage
- Band erosion/migration
- Deep infection
- Identifying patients who will not "eat through" the operation is difficult
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Vertical
Banded Gastroplasty (VBG)
This, along with the RNY, is one
of the two major types of operations recognized by the NIH for
the treatment of clinically severe obesity. It is a purely restrictive
procedure with no malabsorptive effect. The goal of this procedure
is to severely restrict the patient's capacity to eat certain
foods.
Advantages/Disadvantages:
- Completely reversible
- Body anatomy is left intact
- No dumping syndrome
- No nutritional deficiencies
- Needs strict patient compliance to diet
- No malabsorption
- Vomiting if food is not properly chewed or if food is eaten too quickly
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Roux-en-Y
(RNY)
This operation is the most common
gastric bypass procedure. With this procedure a portion of the
stomach is sectioned off, creating a small pouch for reduced food
intake. The pouch will usually hold about one ounce of food or
less, which causes the feeling of fullness after just a few bites.
The size of the pouch varies with different doctors.
Advantages/Disadvantages:
- Greatly controls food intake
- Dumping syndrome - dumping conditions to control intake of sweets
- Reversible in an emergency - though this procedure should be thought of as a permanent
- Staple line failure
- Ulcers
- Narrowing/blockage of the stoma
- Vomiting if food is not properly chewed or if food is eaten to quickly
Biliopancreatic
Diversion (Scopinaro procedure) (BPD)
This procedure is less food restrictive
than the RNY. The stomach capacity is 4-5 ounces compared with
RNY of around an ounce. There is a significant malabsorptive component
which acts to maintain weight loss long term. The patient must
be closely monitored to guard against severe nutritional deficiencies.
Advantages/Disadvantages:
- Significant malabsorptive component
- Better chance of sustained weight loss
- Ability to eat larger quantities of food and still loose weight
- Greater chance of chronic diarrhea, stomach ulcers, more foul smelling stools and flatus
- Higher risk of nutritional deficiencies
- Higher chance of micronutrient deficiencies such as vitamins and calcium
Duodenal
Switch (DS)
An improvement of the BPD (it
is also referred to as "BPD/DS"). Here again, there
is a significant malabsorptive component which acts to maintain
weight loss long term. The patient must be closely monitored to
guard against severe nutritional deficiencies. This procedure,
unlike the BPD, keeps the pyloric valve intact. That is the main
difference between the BPD and the DS.
Advantages/Disadvantages:
- More "normal" absorption of many nutrients than with BPD, including calcium, iron and vitamin B12
- Better eating quality when compared to other WLS procedures
- Eliminates or greatly minimizes most negative side effects of the original BPD
- Essentially eliminates stomach ulcer and dumping syndrome
- Greater chance of chronic diarrhea
- Significant malabsorptive component
- More foul smelling stools and flatus, but less than with the BPD alone It is important to remember that there is risk with any surgery. There are some specific risks associated with Bariatric Surgery.
Surgery
Complications:
- 10-20% of patients who have weight-loss operations require follow-up operations to correct complications. Abdominal hernias are the most common complications requiring follow-up surgery. Less common complications include breakdown of the staple line and stretched stomach outlets.
- More than one-third of obese patients who have gastric bypass surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. During rapid or substantial weight loss a person's risk of developing gallstones is increased. Gallstones can be prevented with supplemental bile salts taken for the first 6 months after surgery. Many surgeons are opting to remove the gallbladder during the initial weight loss surgery.
- Nearly 30% of patients who have weight-loss surgery develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained.
- Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus. Women of childbearing potential should have a pregnancy test before having weight-loss surgery
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