Morbid Obesity, Center Excellence, Weight Loss Surgery, New York

Open Versus Laparoscopic Approach to WLS

99% of our procedures are performed laparoscopically.

Patients are done Open if there have been multiple previous upper abdominal scars.

The Common Types of Weight Loss Surgery

While the majority of patients who undergo these procedures are very successful, no procedure is perfect. Only through an honest discussion with a bariatric surgeon can patients decide which procedure may be best suited for them.

RESTRICTIVE (Adjustable Gastric Band/Sleeve Gastrectomy): Intake becomes a function of the patient's motivation to chew well and eat slowly.
COMBINATION (Roux-en-Y Gastric Bypass): Intake is a function of early satiety (feeling full) and moderate lack of absorption of nutrients.
MALABSORPTIVE (BPD with DS): Incorporates maximal safe malabsorption with moderate decrease of gastric restriction (allows larger meals)

The following diagrams are used with permission from the ASBS website.

Diagram of the Laparoscopic Adjustable Gastric Band (LAGB)
The band is placed to encircle the upper stomach The band gets "adjusted" tighter/looser to effect desired

Advantages of LAGB	Complications of LAGB
Adjustability of the band Reversibility (removal) Absence of anemia, dumping No malabsorption Short hospital stay Very low mortality rate	Injury to spleen, stomach, esophagus Hemorrhage Band slippage Obstruction Nausea/vomiting Tubing malfunction
Diagram of Sleeve Gastrectomy (SG)
About 70% of the stomach is removed

Advantages of SG	Complications of SG
No anastomosis made No malabsorption Usually gives better weight loss than LAGB Less food intolerances than LAGB Often done as 1st stage in high risk people to decrease weight to a "safer" level	Injury to spleen Hemorrhage May need another procedure if wght regained Leak from staple line
Diagram of Roux-en-Y Gastric Bypass (RYGBP)
A small stomach pouch (1-1 1/2oz.) is made The remaining stomach, duodenum and upper small bowel is bypassed The small intestine is connected to the stomach pouch 3-4 feet of the GI tract is "bypassed"

Advantages of RYGBP	Complications of RYGBP
Better weight loss than restrictive surgery Low incidence of protein-calorie malnutrition Rapid improvement or resolution of weight related comorbidities	Anastomotic leak Pulmonary embolus Wound infection
IF LAPAROSCOPIC Advantages	IF LAPAROSCOPIC Disadvantages
Shorter hospitalization Reduced postop pain Less pulmonary(lung) problems Faster recovery Fewer wound complications (hernia/infections)	Death Incisional/Internal hernia Stomal Stenosis Deficiencies (Calcium,Iron, vit B1, vit B12) Marginal ulcer
Diagram of Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
70% of stomach is removed The low small intestine is sewn to the end of the duodenum which remains attached to the stomach a long segment of the GI tract is bypassed

Advantages of BPD/DS	Complications of BPD/DS
Increased amount of food intake Less food intolerance possibly greater long term weight loss Faster weight loss compared to banding	Diarrhea and foul-smelling gas in some parts Avg loose bowel movements 2-3/day Malabsorption of fat soluable vitamins(A,E,D,K) Iron deficiency Possible protein calorie malnutrition, may require another operation to lengthen the absortion surface Requires proper life long monitoring of nutrition and micronutrient deficiencies.