Procedures

LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING

LAPAROSCOPIC ADJUSTABLE GASTRIC BANDINGA laparoscopic adjustable silicone band (Realize Band™ or LAP-BAND® system) is placed laparoscopically around the top portion of the stomach. This results in a loss of weight because of the restriction it creates in the amount of food the patient can eat and the decrease in hunger that the patient senses. Unlike other procedures, gastric banding does not require any cutting or removal of any part of the digestive system and is a reversible procedure. The amount of food and speed of eating are reduced as food slowly empties into the narrow opening to the remainder of the stomach. Since the size of the stomach that receives the food has been reduced by the band, it has a very limited capacity for food and the patient will feel satiated when it is full. The tubing around the stomach is connected to a port that is stitched to the belly wall on top of the muscles. The skin is then closed. The band can then be adjusted through this port to meet the patient's weight loss and nutritional requirements.

An average of 60% of excess body weight loss can be expected over 5 years with this procedure. This weight loss can be maintained with post-operative lifestyle behavior changes including diet, exercise and band maintenance. Patients can expect to meet with the doctor or physician assistant at least once a month for the first year to have, or determine, the need for a band adjustment. One of the keys to success is frequent doctor follow-up and assistance. Our bariatric surgeon will always keep you as a patient and will want to follow your progress for at least five years, if not for life.

 

LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS (LRYGB)

Gastric BypassThe Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is considered to be the "gold standard" procedure by the American Society of Bariatric Surgeons (ASBS). This operation is the most commonly performed and has a proven record for significant weight loss. It includes decreasing the size of the stomach and partially bypassing the small intestine to limit the amount of calorie intake. There are many different techniques that can be used for the LRYGB, all of which are acceptable. At Fairfield County Bariatrics the procedure is done laparoscopically with 5 to 7 small incisions. A camera, called a laparoscope, and long surgical instruments are used while the belly is inflated with carbon dioxide gas. The surgeon then operates while visualizing the internal organs on a high definition television screen. During the LRYGB, a 30-60cc pouch is created by stapling-off the stomach.

The remaining stomach stays alive and intact, and the far end is attached to the small bowel. This "remnant stomach" receives blood and produces digestive stomach acid. A 50cm section of small bowel is then measured, cut, and reattached to the stomach by stapling, hand stitching, or a combination of the two. Another 50cm of small bowel is then attached to the side of the limb to drain the new, small stomach pouch. Food is not absorbed completely because the food and digestive juices are separated for 33% of the length of the bowel. This results in weight loss.

Weight loss from this procedure averages 60-80% loss of excess body weight. The LRYGB is highly effective because patients not only eat less and feel full quickly, but they also do not fully absorb the food they eat. Doing the procedure laparoscopically results in a decreased morbidity and shorter hospital stay when compared to the open procedure. Most patients are discharged home in 2-4 days. An average of 60% to 80% of excess body weight loss can be expected within the first twenty months following this procedure. Most of the loss will occur within the first six months following the surgery. This weight loss can be maintained with post-operative lifestyle changes including diet and exercise.

 

LAPAROSCOPIC SLEEVE GASTRECTOMY

Sleeve GastrectomyThis procedure is often considered as an option for patients who may not choose the Laparoscopic Adjustable Gastric Band or the Laparoscopic Roux-en Y Gastric Bypass. This operation, like the others, also reduces the size of the stomach. It is performed laparoscopically with staples to create a small tube-shaped stomach about the size of a banana. A portion of the stomach is removed, resulting in patients having less hunger and feeling the sensation of fullness after eating less food. This procedure allows for normal digestion and absorption. The food that is consumed passes through the digestive tract in the usual order, which allows the food to be fully absorbed in the body. The procedure utilizes your natural pylorus valve to regulate when food should empty into the rest of the body. The average person will lose 60% of their excess weight.

 

REVISIONAL BARIATRIC SURGERY

Bariatric surgery is the most effective means for patients to achieve significant weight loss, minimizing complications and helping cure health issues. There are, however, circumstances where patients regain weight or do not lose the expected amount of excess weight. Various factors can cause this situation. Our surgeons perform a thorough analysis including a study of the previous surgery and all factors that entered into its ultimate result. A follow-up bariatric procedure referred to as a bariatric surgery revision, may be required to alter or repair the initial bariatric surgery. Fairfield County Bariatrics offers many Laparoscopic revisional bariatric and weight loss surgeries in Connecticut.

REVISIONS AFTER GASTRIC BANDING SURGERY

Although 90% of patients are successful, the revision rate for the laparoscopic adjustable gastric banding procedure is approximately 10% during the first two years following the surgery. This is due to device related problems or unsatisfactory weight loss. The gastric band can slip which would require a follow-up procedure to correct the problem. Some patients will choose to have the band replaced and others will select a different procedure. Occasionally the port may have to be replaced because of wear and tear. This can be performed with a very small incision under mild anesthesia. Bands that erode into the stomach may need to be removed.

REVISIONS AFTER GASTRIC BYPASS SURGERY

Revisions in gastric bypass patients happen in approximately 5 to 10% of the patients over a 5 year period. This would be due to complications, unsatisfactory weight loss or regaining weight. After gastric bypass surgery complications that may occur include ulcers, chronic vomiting, hernia and staple line failure. They are usually improved through laparoscopic revisional bariatric surgery. There are several options available to the patient:

  • If the problem is the lack of the desired excess weight or regaining weight, a non-surgical approach can be taken. This includes regulating eating habits, exercise, nutritional counseling, behavior modification therapy, psychological counseling and support groups.
  • If the problem is the lack of the desired excess weight or regaining weight, there are surgical options available that include the placement of an adjustable gastric band on the stomach pouch decreasing the size of the stomach or a conversion to distal gastric bypass.
  • If the stomach pouch or stomach opening has become enlarged we can add a laparoscopic band to reduce the amount of food intake and slow the movement of the food from the stomach to the small intestine. An alternate approach would be to remove more of the stomach or tighten up the stomach to make it smaller.
  • If the two parts of the stomach reconnect, they can be separated with the use of a stapling device in a revisional procedure.

GASTRIC BAND PLACED OVER
ROUX-EN-Y GASTRIC BYPASS

There can be situations where the gastric bypass will not lead to optimal weight loss. After surgery we make every attempt to maximize the weight loss with follow-up visits, nutrition and diet and exercise. If this doesn't work and the patient still wants a greater weight loss, the patient has the option of having a laparoscopic adjustable band placed on top of a gastric bypass. The gastric bypass remains intact. These patients derive the benefits of both procedures A laparoscopic adjustable silicone band (Realize Band™ or LAP-BAND® system) is placed laparoscopically around the top portion of the stomach. This results in a loss of weight because of the restriction it creates in the amount of food the patient can eat and the decrease in hunger that the patient senses. Unlike other procedures, gastric banding does not require any cutting or removal of any part of the digestive system and is a reversible procedure.

CONVERSION OF GASTRIC BAND TO
ROUX-EN-Y GASTRIC BYPASS

There can be situations where the gastric band will not lead to optimal weight loss. After surgery we make every attempt to maximize the weight loss with follow-up visits, nutrition and diet and exercise. If this doesn't work and the patient still wants a greater weight loss, the patient has the option of having the band removed and having a gastric bypass performed.

SINGLE INCISION LAPAROSCOPIC SURGERY

This is the latest development employing the most advanced technology in laparoscopic surgery. A single entry is made through the belly button instead of the five small incisions that are traditionally used. This results in less pain, no visible scars to the abdomen and a shorter recovery period.

Using this single incision technique a laparoscopic adjustable silicone band (Realize Band™ or LAP-BAND® system) is placed around the top portion of the stomach. All instruments are placed through one incision that is hidden in the belly button. The cosmetic appearance is better because there is only one scar. This results in a loss of weight because of the restriction the band creates, the amount of food the patient can eat, and the decrease in hunger that the patient senses. Unlike other procedures, gastric banding does not require any cutting or removal of any part of the digestive system and is a reversible procedure. The amount of food and speed of eating are reduced as food slowly empties into the narrow opening to the remainder of the stomach. Since the size of the stomach that receives the food has been reduced by the band, it has a very limited capacity for food and the patient will feel satiated when it is full. The tubing around the stomach is connected to a port that is stitched to the belly wall on top of the muscles. The skin is then closed. The band can then be adjusted through this port to meet the patient's weight loss and nutritional requirements. An average of 60% of excess body weight loss can be expected over 5 years with this procedure. This weight loss can be maintained with post-operative lifestyle changes including diet, exercise and band maintenance.

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