About the Procedures Bariatric surgery is a treatment option for people living with morbid obesity—especially for those who have not experienced long-term weight loss success through other means. Often referred to as weight loss surgery, bariatric surgery has transformed the health and lives of more than 800,000 people in the past six years. How Does Bariatric Surgery Work? Bariatric surgery is the clinical term for several different procedures. The procedures use one or both of two approaches to help patients lose weight and improve or resolve co-morbid conditions.

Restrictive Procedures
During these procedures, the surgeon creates a small stomach pouch, that limits the amount of food patients can eat. The smaller stomach pouch fills quickly, which helps patients feel satisfied with less food.

Malabsorptive Procedures
During these procedures, the surgeon reroutes the small intestine so that food skips a portion of it. The small intestine absorbs calories and nutrients from food, and avoiding part of it means that many calories and nutrients are not absorbed. Surgeons rarely perform strictly malabsorptive procedures. Most procedures that use malabsorption also use restriction.

Combination Procedures
Certain procedures use both restriction and malabsorption. For example, Roux-en-Y gastric bypass surgery uses a combination of restriction and malabsorption. During the procedure, the surgeon creates a small pouch. The surgeon then attaches a Y-shaped section of the small intestine directly to the stomach pouch. This allows food to bypass a large portion of the small intestine, which absorbs calories and nutrients. The smaller stomach pouch causes patients to feel fuller sooner and eat less food; bypassing a portion of the small intestine means the patient’s body absorbs fewer calories.

These different methods work to help patients lose excess weight, lower their BMI, and transform their health by resolving or improving co-morbid conditions. Bariatric surgery has many benefits that can lead to a healthier, higher quality of life. It also has certain risks.

Gastric Bypass

Our bariatric surgeon performs surgical procedure called Roux-en-Y Gastric Bypass, which combines restrictive and malabsorptive procedures. This procedure restricts both food intake and the amount of calories and nutrients the body absorbs. In addition to creating a smaller stomach pouch, the surgery disrupts the body’s normal digestive process.  As a result, food bypasses a large part of the stomach and most of the small intestine.

During the Roux-en-Y procedure, stapling is used to create a small, upper-stomach pouch that restricts the amount of food able to be consumed. A portion of the small bowel is bypassed, thus delaying food from mixing with digestive juices to avoid complete calorie absorption. In most cases, patients report an early sense of fullness, combined with a sense of satisfaction, which reduces the desire to eat.

Life After Gastric Bypass

Excess Weight Loss
Gastric bypass patients typically lost 61.6 percent of their excess weight.

Health Benefits
Studies found that gastric bypass:

• Resolved type 2 diabetes in 83.8% of patients and often resolved the disease within days of surgery.
• Resolved high blood pressure in 75.4% of patients.
• Improved high cholesterol in 95% of patients.

For more information about the effect of gastric bypass on weight-related co-morbid conditions, visit Health Benefits.

Quality of Life
One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss:

• Overall quality of life improved greatly.
• They experienced improved physical functioning and appearance.
• They experienced improved social and economic opportunities.

Recovery
Most gastric bypass patients are able to:

• Leave the hospital after two days
• Return to work after 21 days

           
Potential Concerns of Gastric Bypass

• A condition known as dumping syndrome can occur from eating high-fat, high-sugar foods. While it isn’t considered a health risk, the results can be very unpleasant and may include vomiting, nausea, weakness, sweating, faintness, and diarrhea.
• Patients must supplement their diet with a daily multivitamin and calcium. Some patients must take vitamin B12 and/or iron.
• The stomach, duodenum, and parts of the small intestine cannot be seen easily using X-ray or endoscopy if there are problems after surgery such as ulcers, bleeding, or malignancy.
  

Gastric Banding

Our bariatric surgeon also performs a restrictive surgical procedure called Laparoscopic Adjustable Gastric Banding. In restrictive surgery, bands or staples are used to section off a part of the stomach, creating a pouch. Because the stomach pouch is so small, the amount of food one can eat is limited. Food continues to be digested through the normal digestive and absorption process.

In this procedure, a silicone band is placed around the uppermost part of the stomach, separating the stomach into one small and one large portion, slowing the emptying of food, and thus creating a feeling of fullness. In this procedure, the band can be adjusted to increase or decrease restriction, surgery can be reversed, and digestion and absorption are normal.

Life After Gastric Banding

Excess Weight Loss
Gastric banding patients typically lost 47% of their excess weight.

Health Benefits
Studies found that gastric banding:

• Resolved type 2 diabetes in 47.8 percent of patients and often resolved the disease within days of surgery
• Resolved high blood pressure in 38.4% of patients.
• Improved high cholesterol in 78.3% of patients.

For more information about the effect of gastric banding on weight-related co-morbid conditions, visit Health Benefits.

Quality of Life
One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss:

• Overall quality of life improved greatly
• They experienced improved physical functioning and appearance
• They experienced improved social and economic opportunities

Recovery
Your healthcare team will advise you when to return to work and when you are able to resume normal activities.
           
Potential Concerns of Gastric Banding

• Gastric banding can help you feel satisfied sooner and with less food, but it won’t eliminate the desire to eat. You will need to follow your specific diet and exercise guidelines provided by your surgeon to achieve success.
• Gastric banding requires more intensive follow-up care than most other bariatric surgeries. This is mostly because the band is adjustable. Keep in mind that even after reaching and maintaining your success weight, you may still need to see your healthcare professional for further adjustments.

Risks of Surgery

Indications
Bariatric surgery is intended for people who are 100 pounds or more overweight (with a Body Mass Index (BMI) of 40 or greater) and who have not had success with other, less risky weight loss therapies such as diet, exercise, and medications.] In some cases, a person with a BMI of 35 or greater and one or more co-morbid condition may be considered for bariatric surgery.

Important Considerations

Bariatric surgery should not be considered until you and your doctor have explored all other options. The best approach to bariatric surgery calls for a discussion of the following:

• Bariatric surgery is not cosmetic surgery. 
• Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
• Together, you and your doctor should discuss the benefits and risks.
• You must commit to long-term lifestyle changes, including diet and exercise, which are key to the success of bariatric surgery.
• Complications after surgery may require further operations.
• Patients who underwent bariatric surgery have significantly reduced rates of developing cancer, cardiovascular diseases, endocrinological disorders, infectious diseases, musculoskeletal disorders, psychiatric disorders, and pulmonary disorders.

Surgical Risks for Gastric Bypass and Gastric Banding
As with any surgery, there may be immediate and long-term complications and risks. Discuss the benefits and risks with your healthcare team.

Possible risks associated with abdominal surgery can include, but are not limited to:

• Bleeding
• Pain
• Shoulder pain
• Pneumonia
• Complications due to anesthesia and medications
• Deep vein thrombosis (clotting in the veins, commonly in the lower extremities or pelvis)
• Carbon dioxide embolism
• Injury to the stomach, esophagus, or surrounding organs
• Dehiscence (separation of areas that are stitched or stapled together)
• Infections
• Leaks from staple lines
• Marginal ulcers
• Pulmonary problems, pulmonary embolism
• Spleen injury (to control operative bleeding, removal of the spleen may be necessary)
• Stroke or heart attack
• Stenosis (narrowing of a passage, such as a valve)
• Death

Potential Risks and Complications After Gastric Bypass

According to the American Society for Metabolic and Bariatric Surgery 2004 Consensus Statement, the operative morbidity (complications) associated with Roux-en-Y gastric bypass in the hands of a skilled surgeon is approximately 5%, and the operative mortality (death) is approximately 0.5%.

For gastric banding, the same consensus statement reported that, in the hands of a skilled surgeon, the operative morbidity is approximately 5% and operative mortality is approximately 0.1%.

Compare Mortality Rates

Why Would I Have an Open Procedure?

In some patients, the laparoscopic or minimally invasive approach to surgery cannot be used. Here are reasons why you may have an open procedure, or that may lead your surgeon to switch during the procedure from laparoscopic to open:

• Prior abdominal surgery that has caused dense scar tissue
• Inability to see organs
• Bleeding problems during the operation

Based on patient safety, the decision to perform the open procedure is a judgment made by your surgeon either before or during the actual operation.

The health and medical information presented on this web site is for educational purposes only and is not intended as a substitute for medical care. If you have a medical question about any of this information, please consult your physician or a health care professional. Every reasonable effort has been made to ensure the accuracy and reliability of the information presented on this web site. Trinity Hospital of Augusta and Trinity Bariatric and Weight Loss Center make no guarantee or promise, express or implied, as to the accuracy or reliability of the information presented. This information is subject to change without notice and cannot be guaranteed to be current.