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The gastric bypass is an operation in which we take the stomach and we cut off the upper portion of the stomach and create that as your new stomach pouch. So a patient's stomach goes from the size of a football to being the size of a large egg. We then cut the small intestine lower down and we bring that up and we connect it to the stomach pouch so that the food can go into the stomach pouch and directly into the small intestine. When you do that, you end up bypassing the old stomach and you bypass part of these beginnings of the small intestine. People lose weight for multiple reasons with the gastric bypass: 1. They have a small stomach so they can't eat very much fruit. 2. We are bypassing part of the old stomach and the small intestine and by doing that, patients absorb a little bit less food than they normally would. The third reason why they lose weight is that by causing the food to go directly into the small intestine, patients generally cannot tolerate eating sweets. By that I mean that they can't tolerate eating ice cream or cake in any large quantity. If they do, they experience something called Dumping Syndrome, which is a combination of symptoms that include a stomachache, diarrhea, cold sweats, and a racing heartbeat. Obviously, that doesn't sound very good and it is very uncomfortable, but it's quite effective in causing patients or restricting patients from eating sweets.
The gastric bypass is an operation in which we take the stomach and we cut off the upper portion of the stomach and create that as your new stomach pouch. So a patient's stomach goes from the size of a football to being the size of a large egg. We then cut the small intestine lower down and we bring that up and we connect it to the stomach pouch so that the food can go into the stomach pouch and directly into the small intestine. When you do that, you end up bypassing the old stomach and you bypass part of these beginnings of the small intestine. People lose weight for multiple reasons with the gastric bypass: 1. They have a small stomach so they can't eat very much fruit. 2. We are bypassing part of the old stomach and the small intestine and by doing that, patients absorb a little bit less food than they normally would. The third reason why they lose weight is that by causing the food to go directly into the small intestine, patients generally cannot tolerate eating sweets. By that I mean that they can't tolerate eating ice cream or cake in any large quantity. If they do, they experience something called Dumping Syndrome, which is a combination of symptoms that include a stomachache, diarrhea, cold sweats, and a racing heartbeat. Obviously, that doesn't sound very good and it is very uncomfortable, but it's quite effective in causing patients or restricting patients from eating sweets.
There are various types of weight loss operations. The most commonly performed weight loss operations in this country would be the gastric bypass, the sleeve gastrectomy, and the lap band. The gastric bypass has been around for over 50 years and is still considered to be the gold standard when it comes to weight loss operations. The sleeve gastrectomy is relatively new in that it has only been around for about 7-8 years but it has now become the most common (or the most popular) weight loss operation. The lap band (otherwise known as the adjustable gastric band) has been around for about 20 years and at one point was the most commonly performed weight loss operation in the United States and in other countries around the world. However, currently it only accounts for about 5% of all of the weight loss operations. Bariatric surgery is a term used to cover all different types of weight loss operations, and that typically includes the sleeve gastrectomy, the gastric bypass, and the lap band.
The sleeve gastrectomy is an operation in which we take the stomach (which is about the size of a football) and we remove about 85% of the stomach and take that out and discard it. What you're left with is a stomach that is in the shape of a tube which kind of looks like a banana. Because of that, patients are able to eat much less food and that in turn causes them to lose a significant amount of weight. This operation is permanent and is a lifelong change for the patient.
The newest procedure that is available to patients in the United States is the intragastric balloon. There are various types of balloons, but this is one of them. This is a saline filled balloon and the outside is made out of silicone. What we do is we place this inside of a patient's stomach when it's empty and we begin inflating it with fluid and once it's fully inflated, we pull on the tube (which gets disconnected from the balloon) and the balloon stays inside of the patient's stomach. The idea behind this device is that it takes up space within the stomach, so you can't eat a lot of food. It also has weight to it. 600 cc's of fluid does have some heft to it, so it also feels like you have eaten a large meal. Therefore most patients have a sense of fullness within their stomach and in the end, you end up eating less and losing weight.
After weight loss surgery, some patients do require plastic surgery or reconstructive surgery to remove some of the excess skin. This skin might be removed from the abdominal region or from the arms or the legs. However, there are some patients who never require any type of reconstructive surgery or plastic surgery after having their weight loss operation. Every individual is different and it's really impossible to predict whether or not somebody would need plastic surgery after having weight loss surgery.
One of the most common questions I get from patients is: "which operation should I have?" That is actually one of the tougher questions to answer. There's no one right answer for everybody, but there are guidelines that we go by and suggestions that we may give the patient. For instance, if somebody has fairly significant type 2 diabetes or they have horrendous heartburn and reflux, we may suggest the gastric bypass to them. Why? Because the gastric bypass is the most effective operation in treating type 2 diabetes and it is also an anti-reflux operation and usually cures an individual of their heartburn and reflux. On the other hand, if a patient has a strong family history of stomach cancer, let's say that their mother or their father or their brother or some other relative has had stomach cancer and they are at an increased risk of that, we may suggest performing a sleeve gastrectomy because we are removing 85% of that patient's stomach and that in turn reduces their risk of getting stomach cancer. It is also much easier to monitor a patient that has had a sleeve gastrectomy for screening with an upper endoscopy to check and see if they do have stomach cancer. With the lap band, that is generally a choice that the patient makes. Lap bands are the safest operation when it comes to the weight loss operations and it is also reversible. Because of that fact, patients often select the lap band because of those features. However, it's important to note that the lap band does result in the least amount of weight loss when compared to the sleeve gastrectomy and the gastric bypass. When considering weight loss surgery, it's important to have a lengthy discussion with your weight loss surgeon to decide which operation fits you best.
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