Part 1 - What is Weight Loss Surgery?

What types of surgery are available to me?

The type of surgery available to you will likely vary depending on where you live and on the surgeons that practice in your area.

The idea behind weight loss surgery is to restrict the amount of food that can be taken in at any given time and/or to affect absorption of the food that is consumed.

The most common type of surgery performed in the U.S. does both; however, other popular ways of doing bariatric surgery generally only reduce the amount of food consumed at any given time.

Banding Procedures

There are two types of procedures performed that affect the amount of food the stomach can hold.

1. The first is called adjustable gastric banding procedure. In this procedure, a hollow band is placed around the top part of the stomach and is attached like a wristwatch.
   
   The band is filled with saline (salt) solution and can be filled more or less through a port placed just under the skin of the abdomen. In a sense, it makes for a much smaller stomach receptacle, leaving the rest of the stomach as simply a conduit like the remainder of the intestinal tract.
   
   The individual feels fuller faster and cannot eat large amounts of solid food without experiencing nausea and/or vomiting.
   
   This procedure can be done by means of an open surgery, with an incision that can be up to 6 inches long....
   
   Or by means of a laparoscope, a slender metal tube with a camera on the end that is inserted into the abdomen through several small incisions. The surgeon manipulates the tissues through the device. It’s sort of like a remote-controlled operation. Actually, all of the weight loss surgeries can be performed via an open or laparoscopic technique.
   
   
2. A vertical banding procedure is similar to the adjustable band procedure with the exception that a portion of the stomach is stapled together at the top that allows a band to grab around the unstapled part, creating a small pouch for a stomach and a narrow passage into the last part of the stomach.
   
   The bulk of the stomach is stapled off and does not receive food directly. Like the adjustable banding procedure, this procedure allows for food restriction; however, the absorption of food remains the same.

Bypass Procedures

The type of surgery that most people think of when they think “gastric bypass” is actually called a Roux-en-Y gastric bypass. While banding procedures are more common in Europe, the Roux-en-Y gastric bypass is the most common type of weight loss surgery performed in the U.S. This procedure is more complicated to perform than banding procedures but carries the advantage of generating a greater average weight loss. It can also be performed by means of a laparoscope.

The Roux-en-Y gastric bypass begins when the surgeon staples across the entire upper stomach, leaving a small blind pouch at the top of what was the stomach. A cut is made in the small intestine—somewhere in the middle of the jejunum. The lower part of the cut intestine is sewn into a hole created in the new stomach pouch. The upper end of the cut intestine is sewn back onto the lower part of the intestine, but is sewn further down the line. The end result is an intestinal tract that is in the shape of a Y.

The Roux-en-Y procedure allows food to enter the small stomach pouch and travel into the lower end of the intestinal tract, where it is not absorbed as well as it would be if it were allowed to travel the entire length of the small intestine. The lower stomach, the duodenum and the first half of the small intestinal tract—the places where food is absorbed the most—are left out of the picture entirely.

This is why there is nearly always a need for vitamin supplementation after surgery because the absorption of vitamins and other nutrients are diminished. Like the banding procedures, the stomach pouch created by this procedure is small so that large amounts of food can not be consumed.

The procedure that is perhaps the most extensive is called the biliopancreatic diversion. It is the most complicated weight loss procedure and is rarely performed in the United States.

It involves partial removal of the stomach, the creation of a small pouch out of the first part of the stomach and attachment of the pouch to the far segment of the small intestine.

The duodenum and the first part of the intestine are left as blind pouches so that no chance of absorption can happen in these segments. While the weight loss is often extensive, the risk for nutritional deficiencies is extremely high and there is an absolute need for closer follow-up of one’s nutritional status indefinitely.

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