Surgical Solution.

At the Center For Severe Obesity, the operation we recommend as the safest and most effective procedure, with the best long-term results, is the Roux-en-Y gastric bypass surgery. There have been many modifications of this procedure over the years and it has been found that the best results are obtained if certain important principles are followed: The "pouch" into which swallowed food enters must be very small (less than 30 ml. or ½ ounce). It is constructed from the uppermost part of the stomach on the right side because this is the thickest and least distensible part of the stomach.

In addition, the pouch must be totally separated from the remaining or "excluded" stomach. There is a tendency for the opening from the pouch to the small intestine to stretch over time. To prevent this, a ring made of soft plastic (silastic), which is visible on x-ray, is placed around the pouch. Because this opening can no longer enlarge, the amount of food that can be eaten at one time remains small and this helps to maintain weight loss.

If an individual is very heavy, it is possible to make the small intestine leading from the pouch longer, before digestive juices enter the intestine and mix with the food. This too, helps with weight loss, by increasing the "malabsorbtion," or the amount of food not absorbed.

Psychological and dietary evaluation and one on one discussion with your surgeon are an important part of our program, before and during hospitalization, and monthly, after surgery.

Plastic Closure Roux-en-Y Gastric Bypass Surgery/Silastic Ring Gastroplasty.

This is the operation as described above and is performed through a midline incision below the breastbone and towards the navel. The incision is closed with a stitch beneath the skin that dissolves, (no skin staples or clips) hence the name.

As there is a 1 in 3 risk of forming gallstones after massive weight loss, we will remove the gallbladder at the same time (unless previously removed).

Laparoscopic Gastric Bypass Surgery.

Roux-en-Y gastric bypass surgery can be performed laparoscopically. The only advantage is a lower risk of hernia after this technique, although it can still occur. In our hands there is no quicker recovery and there may actually be more pain when done laparoscopically.

In addition, no silastic ring is placed, and internal hernia and bowel obstruction can occur later. The gallbladder is usually not removed routinely unless gallstones are present.

If you prefer the laparoscopic approach, we also are able to offer this.

Laparoscopic Silicone Adjustable Gastric Band/Lap Band.

The laparoscopic silicone adjustable gastric band or Lap Band is another surgical option. This surgical approach involves a band being placed around the uppermost portion of the stomach that restricts the amount of food eaten. Within the band, there is a balloon that can be inflated through a reservoir under the skin. This reduces the capacity of the stomach more as fluid inflates the balloon. The procedure is attractive because it can be done laparoscopically, that is through minimal small punctures and hospital stay is reduced usually to just overnight. Unfortunately, the weight loss results for this procedure are inferior to the Roux-en-Y gastric bypass surgery.

Typical Results.

Patients who have obesity surgery typically lose most of the weight in the first year provided they follow the recommendations they are given for diet and behavior. (Actual weight loss varies from person to person, depending on several factors including age and weight at the time of surgery. More obese people generally lose more weight than less obese people.)

With Roux-en-Y gastric bypass surgery (RGBP), weight loss is approximately 70% of the excess weight. There may be some late weight gain without a band. The combination procedure of RGBP/VBG where a band or ring is placed around the lower end of the gastric pouch produces the best weight loss, averaging more than 80% of the excess weight, and this weight loss tends to be better maintained.

During the first 6 weeks, weight loss can be as much as 5or 6 pounds per week. Then, it should continue at 2 or 4 pounds per week for several months. Over the first year, the rate of weight loss gradually decreases and most patients eventually achieve a stable weight somewhat above their normal weight. As with anyone else, a surgery "graduate" can lose additional weight by making a more concerted effort.

Patients who lose excess weight as a result of successful surgery and the follow-up program often find that their quality of life improves as well. Among the reported benefits are greater self-confidence, better interpersonal relationships, increased productivity, greater job satisfaction, and more enjoyment of life as a whole.

Please understand, however, that there is no guarantee of how much weight a given individual will lose, how long the weight loss will be maintained, or what social or other benefits might occur. Much depends upon the patient's ability to adopt new habits of living and eating after the operation. The surgery itself helps to make this easier, but the patient must be willing to do his or her part. (See Postoperative Guidelines).