Bariatric Procedures

What types of bariatric surgical procedures can be performed?

There are four main types of procedures: » Gastric Bypass Surgery separates the stomach into two unequal compartments with less than 5% of the stomach remaining usable for food consumption. During digestion, the food empties from this tiny stomach pouch into the upper intestine. » Biliopancreatic Diversion creates a smaller stomach (similar to gastric bypass surgery), but in addition there is less absorption of ingested food inside the intestine. » LAP-BAND® (Adjustable Gastric Band) is a procedure in which the stomach is encircled with an inflatable plastic band that restricts food intake. » Gastroplasty is a procedure in which the stomach is stapled close to the top with a small outlet or stoma leading to the remainder of the stomach and digestive tract.

New Jersey Bariatrics performs all types of gastric restrictive operations. Approximately 90% of all operations performed by Dr. Brolin and Dr. Chau are laparoscopic gastric bypass procedures.

Roux-en-Y Gastric Bypass

Fig. 1: Roux-en-Y Gastric Bypass

Weight loss has been shown to occur more rapidly and over a longer period of time with gastric bypass as opposed to stapled gastroplasty (see below). The reasons for superior weight loss stem from the small degree of malabsorption caused by bypassing nearly all of the stomach and the first two feet of the small intestine (darker area in Figure 1). To date, weight loss with gastric bypass has been much more consistent than with stapled gastroplasty.

Recently, surgeons have performed several anti-obesity operations including gastric bypass using minimally invasive techniques. This approach uses five or six tiny incisions instead of one large incision to perform the operation. These operations require two skilled, well-trained surgeons, skilled assistants and many new specialized instruments.

During the procedure, a laparoscope is inserted into the abdomen. This provides the surgeons with a magnified view on a TV monitor. The result is better visualization throughout the procedure, allowing for more precise work.

By eliminating the large abdominal incisions, bowel manipulation and extensive dissection, patients are assured a faster recovery. Further advantages of the laparoscopic approach include less pain following the surgery, less scarring, and likely an earlier discharge.

This modification of the standard gastric bypass is available for patients who are "super obese," -- more than 200 pounds overweight. This operation adds malabsorption to restriction of intake. The stomach stapling component of the distal modification is the same as in the standard procedure; the only difference is the location of the distal connection of the intestine which is reconnected much closer to the colon. Adding malabsorption increases the risk of several nutritional (metabolic) complications.

Biliopancreatic Diversion (BPD)

Fig. 2: Biliopancreatic Diversion (BPD)

Biliopancreatic bypass (BPB) combines a modest amount of eating restriction with lack of complete digestion or absorption of food. This procedure and similar operations including the distal Roux-en-Y technique and duodenal switch are becoming increasingly popular. However, all of the BPB type operations have the potential for developing nutritional deficiencies.

In a BPB, about one half of the intestine is excluded (bypassed) before it is rejoined to the ileum (near the end of the small intestine) at a point between 2 and 4 feet above the colon (large intestine), forming the so called common channel (see Figure 2).

Some surgeons have modified the standard BPB operation to further reduce stomach capacity in the heaviest patients (BMI ≥ 50). Surgeons have also lengthened the common channel in less obese patients (BMI 40-50) to reduce the incidence of malabsorption-related complications. The duodenal switch operation is so named because the functional portion of the duodenum (the upper small intestine) is bypassed from digestive continuity in a reversal or "switch" technique.

LAP-BAND^® (Adjustable Gastric Band)

Fig. 3: LapBand (Gastric Banding)

In adjustable gastric banding (the LAP-BAND^® System), the stomach is encircled with an inflatable band that provides restriction of food intake (see Figure 3). This allows only a small portion of the stomach to be used for holding food. A person feels “full” on much less food. Weight loss achieved is less than with gastric bypass since no intestine is bypassed and there is no malabsorption.

This procedure is superior to gastroplasty (see below), as it is adjustable to optimize weight loss. Absence of stapling during this procedure makes it the least invasive and lowest risk.

» Is the LAP-BAND® Right for You?

Gastroplasty

Fig. 4: Vertical Banded Gastroplasty

The upper stomach is stapled in a vertical direction with a pre-measured plastic band separating the upper and lower stomach as shown in Figure 4. The band prevents the stomach from stretching at this point.

We use specific criteria pertaining to an individual's health and potential risks when deciding who should have a gastroplasty and who should have a gastric bypass. Most patients will qualify for laparoscopic gastric bypass surgery.

	Which bariatric procedure is right for me?
	This decision is typically made during the consultation between the doctor and the patient. Many surgeons perform only one type of procedure, so there may be little choice for the patient. At New Jersey Bariatrics, we perform nearly all types of gastric restrictive surgery (all procedures detailed on this page).