Carolinas HealthCare System

Surgical Weight Loss

Bariatric surgery alters the stomach and digestive process. This can be accomplished by:

  • Restriction: limiting the amount of food intake
  • Mabsorption: bypassing the small intestine where calorie absorption occurs
  • Combination of both restriction and malabsorption

Carolinas Healthcare System offers three procedures performed at our Bariatric Center of Excellence hospitals.

Roux-en-Y Gastric Bypass

Type: Combination of restriction and Malabsorption

Overview

Roux-en-Y gastric bypass is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the jejunum, reducing calorie absorption. This is done by dividing the small intestine just beyond the duodenum to construct a connection with the newly formed stomach pouch. The other end is connected to the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name.

Advantages of this procedure

  • Rapid initial weight loss
  • Resolution of Co-morbidities (obesity related health issues)
  • Decreased hunger
  • Weight loss can average 60 to 80 percent of excess body weight a year after surgery
  • Ten to 14 years after surgery, 50 to 60 percent of excess body weight loss has been maintained by some patients
    • Stomach cutting, stapling and intestinal re-routing required
    • Required supplementation of diet with a daily multivitamin, calcium, and sometimes vitamin B12 and/or iron
    • Non-adjustable
    • Bleeding requiring transfusion or surgical intervention
    • Bowel obstruction
    • Blood clots (PE)
    • Ulcers
    • Dumping syndrome, an unpleasant side effect that may include vomiting, nausea, weakness, sweating, faintness, and diarrhea

Disadvantages of this procedure

To learn more about your gastric bypass surgery options, please attend a free weight loss seminar today!

Vertical Sleeve Gastrectomy

Type: Restrictive

Overview

In this procedure, the stomach is restricted by stapling and dividing it vertically. About 85 percent or more of the stomach is removed. The stomach that remains is shaped like a very slim banana and measures from two to four ounces. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the function of the stomach while drastically reducing the volume. Note that there is no intestinal bypass with this procedure, only stomach reduction.

Advantages of this procedure

  • By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
  • Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, in small amounts
  • Less chance of developing stomach ulcers
  • Amount of weight loss with the sleeve gastrectomy is slightly less than with a gastric bypass but slightly more than with adjustable gastric banding.
  • The average hospital stay is 1-2 days.
  • The estimated weight loss is 60-70% of excess weight typically within the first year.

Disadvantages of this procedure

  • Increased gastro-esophageal reflux
  • Dehydration
  • Leak from the staple line
  • Torsion of the stomach
  • Gastrointestinal inflammation or swelling
  • Stoma obstruction
  • Stretching of the stomach
  • Vomiting and nausea
  • Gallstones, pain from passing a gallstone, inflammation of the gallbladder, or surgery to remove the gallbladder

To learn more about vertical sleeve surgery, register for a free weight loss seminar today!

Laparoscopic Adjustable Gastric Banding

Type: Restriction

Overview

During the procedure, an inflatable silicone band is placed into the patient's abdomen. Like a wristwatch, the band is fastened around the upper stomach to create a new, tiny stomach pouch that limits and controls the amount of food you eat. It also creates a small outlet that slows the emptying process into the stomach and the intestines. As a result, patients experience an earlier sensation of fullness and are satisfied with smaller amounts of food. In turn, which results in weight loss.

Advantages of this procedure

  • Less invasive - Of all the operations for morbid obesity, gastric banding is considered to be the least traumatic. The operation can usually be performed as an outpatient procedure (no hospital stay).  Can return back to work in a few days.
  • Adjustable - One of the major advantages of the gastric banding system is that the diameter of the band outlet is adjustable to meet individual needs, which can change as weight is lost. The inner surface of the band can be inflated with saline solution or deflated to modify the size of the opening in the stomach (stoma). Adjustments are performed every 3-4 weeks until adequate restriction is achieved
  • Reversible - Adjustable gastric banding systems can be removed if necessary and the stomach usually returns to its original form.

Disadvantages of this procedure

  • Band Leak: National Average is 0-3%
  • Bleeding requiring transfusion or surgical intervention: national average is 5%
  • Infection
  • Blood clots (PE)
  • Migration of implant (band erosion, band slippage, port displacement)
  • Tubing-related complications (port disconnection, tubing kinking)
  • Gastroesophageal reflux disease (GERD)
  • Inflammation of the esophagus or stomach

To learn more about adjustable gastric banding surgery, register for a free weight loss seminar today!

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