Fit-N-Wise Bariatric Solutions

Gastric Bypass
LAP-BAND®

EXPLANATION OF THE OPERATIONS

GASTRIC BYPASS
Gastric bypass surgery (also called BYPASS, Roux-Y, RNY, GBP) is the gold standard for weight loss surgery. It is the one surgery of which medical science has the most information regarding success, results and complications. To clarify misconceptions, urban myths and rumors, gastric bypass surgery has the best success for meaningful and sustained weight loss. Backed by medical science in the United States, no other weight loss surgery has had the success that gastric bypass surgery has provided to hundreds of thousands of patients. What this means is that gastric bypass patients are more successful than any other type of weight loss surgery patient to lose significant weight (more than 100 pounds if that is what is needed, or to drop below a BMI of 35). They are also able to keep the meaningful weight lost off over a long period of time. If they gain weight back, they are able to lose it again.

Gastric bypass surgery divides the stomach in to two, separate pouches. A small upper pouch (also called the proximal pouch) and a larger lower pouch (also called the distal pouch, non-functional pouch). These are separated so that the lower stomach never sees food again. This lower stomach does not die, shrink or fall off. It remains as a living organ. It is connected to the upper pouch by nerves and blood supply and still reacts to the upper pouch receiving food and responds to medication that a person may take. The upper pouch is built to hold about 1/4 to 1/3 of a cup. The pouch being this size makes a person full quickly when they eat (early satiety). Eating more than this amount produces severe fullness, bloating, pain and vomiting.

The upper pouch must be connected to an outlet, so that is where the bypass comes in. Small bowel (also called gut or small intestine) is brought up to the upper pouch to give food an outlet and to be absorbed by the body. This bypasses the digestive juices of the lower stomach, liver (bile) and pancreas. This part of small intestine is what makes sure that folks will not cheat their diet after surgery. This portion of bowel is not  to receiving undigested food, particularly if it is high in sugar, synthetic chemicals and fat. If someone cheats and eats those types of items, they will suffer pain, bloating, nausea, vomiting and diarrhea. This is called a “Dumping Syndrome”. This can last for 1 to 6 hours, with all of the events happening one at a time or all at once. Most bypass patient have a saying that goes, “dump once, never dump again!”.

Gastric bypass surgery can be performed with an open incision (cut) on the belly wall, or it can be done laparoscopically (minimally invasive), with ports that allows the surgeon to do the operation through tiny incisions. Some patient depending on their body and prior operations may need a combination of the two called Hand Assisted Laparoscopic surgery (HALS). This allows the surgeon to use the small incisions of laparoscopic surgery and a slightly larger incision to insert one hand to perform the surgery. Your surgeon can tell you which one may be best for you. Some patients go home the day after surgery, some may spend two or three nights in the hospital. How long you are in the hospital will depend on what type of surgery you have, medical conditions that go along with your obesity and if you have had prior belly operations.

Because of the small gastric pouch and the bypass, the bypass patient must eat small meals very frequently. They eat a diet which is described as high protein, medium fat, low carbohydrate. They eat 5 to 6 small meals a day and sip fluids constantly. This helps keep them nourished and hydrated. The surgery and the diet described above starts the weight loss process. Taking away cheating keeps the weight coming off. Combined with a daily progressive exercise program, the surgery produces weight loss.

LAP-BAND®
LAP-BAND® is the shortened version for laparoscopically inserted adjustable gastric band. It is a new approach to an old idea. The LAP-BAND® is very similar to the old stomach stapling surgery (also called the vertical banded gastroplasty or VBG). This made a person full quickly when they eat. Unfortunately folks with the old stomach stapling learned how to cheat the operation, thus it did not produce the results they wished for. The LAP-BAND® takes the same idea a step further by making the band adjustable.

The LAP-BAND® is a belt placed around the top of the stomach. When inflated or adjusted it produces to stomach pouches, a smaller top one and a larger bottom one, connected by a narrow waist through the middle of the band. When the band is inflated (also called adjusted) this narrows the waist and produces a sensation of becoming full quickly when a person eats (early satiety). The band is placed with laparoscopic surgery, making it minimally invasive (sometimes called band-aid surgery).  To inflate the band, at the surgery when the band is being inserted, an inflation port (reservoir) is placed beneath the skin, attached to the belly wall. After the patient has recuperated from surgery, when an adjustment is needed, a needle is placed through the skin of the belly in to the inflation port. Salt water is injected in to the band to tighten it and produce the sensation of early satiety. A local anesthetic is placed and the area above the port cleaned with an anti-septic before inserting the needle. Many surgeons will order x-ray dye studies where the patient swallows dye to see if the band is in the correct position and to check for blockage.

Because of the laparoscopic nature of the LAP-BAND®, many patients leave the hospital the same day of their surgery, other may choose to spend one night in the hospital. This is a choice you should discuss with your surgeon.

TheLAP-BAND® is a different operation than gastric bypass. It has different results and different effects that gastric bypass surgery. That does not mean it is a lesser operation or less effective. Fancy advertising would have you believe that it is a better and safer operation that then gastric bypass and the advertisers would have you believe that it has the same results as gastric bypass surgery. This is not true. The LAP-BAND® is a good but different operation. All weight loss surgeries are not the same and all of them have different results and effects.