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Weight Loss Surgery (Bariatric Surgery)

Surgery Options

At Boston Medical Center, we offer three types of weight loss surgery, the gastric bypass, the adjustable gastric band and the vertical sleeve gastrectomy. All three procedures limit the amount of food you can eat, and result in excellent weight loss. The surgeries are commonly performed laparoscopically. There are some important differences that must be considered when you and your surgeon are deciding on the best procedure for you.

Gastric Bypass Surgery

This is a diagram of the gastric bypass procedure. Your stomach will be made smaller by stapling and dividing it into two compartments.

This is a diagram of the gastric bypass procedure. Your stomach will be made smaller by stapling and dividing it into two compartments. The smaller compartment is called a pouch. The larger part of the stomach is bypassed, meaning that the food is going around it, rather than passing through it. A small opening called an outlet is made in the newly formed pouch and is connected to a limb of intestine. The food will pass directly from the pouch into the intestine, but it will take several hours for the pouch to empty because the outlet opening is small making you feel full longer. Also because the pouch holds about 2 ounces of food, you will eat less food at one time – this will help you lose weight. You will eat smaller quantities of food and you will feel full very quickly. Because the limb of intestine used to empty your stomach will bypass the upper part of your intestines, it will reduce the absorption of food, which will also help you to reduce and control your weight. You will need vitamin and mineral replacements because the main stomach and the first part of the small intestine are bypassed.

As you begin to eat and take medication, remember that everything passing through the stomach must be small enough to fit through the opening of the outlet. As a guideline, food should be able to pass through a straw, which is why you are placed on a special liquid diet immediately following surgery. The goal is to let the stomach heal; only liquids and soft solids should be eaten during the first two months. Since many pills are quite large and will not fit through the outlet, we ask you to crush all medications or take them in liquid or chewable form. You will receive written instructions on the proper diet to follow from your dietitian. The food will pass directly from the pouch into the intestine, but it will take several hours for the pouch to empty because the outlet opening is small making you feel full longer. Also because the pouch holds about 2 ounces of food, you will eat less food at one time – this will help you lose weight. You will eat smaller quantities of food and you will feel full very quickly. Because the limb of intestine used to empty your stomach will bypass the upper part of your intestines, it will reduce the absorption of food, which will also help you to reduce and control your weight. You will need vitamin and mineral replacements because the main stomach and the first part of the small intestine are bypassed.

It is very important that you do not overeat, especially during the first two months following the surgery when the stomach is healing. If you eat more than your stomach can hold, you risk vomiting. Remember, the stomach is very delicate.

You also need to know about dumping syndrome, a side effect of the operation. Dumping syndrome might include one or all of the following symptoms: light-headedness, dizziness, heart palpitations, sweating, nausea, cramps, and/or diarrhea. This condition is the result of eating the wrong food, overeating, or drinking with or too soon after eating meals. The food enters the intestines quickly and causes it to distend, producing some or all of the symptoms mentioned above. Highly concentrated foods such as sweets and high-fat foods can cause dumping, so these foods should be avoided. Your dietitian will review with you substitutions for these foods.

Vertical Sleeve Gastrectomy or Gastric Sleeve

This is a diagram of the sleeve gastrectomy or gastric sleeve procedure.

With the sleeve gastrectomy or gastrics sleeve, your stomach will be made smaller by stapling and dividing the majority of your stomach and removing it from your body. The remaining stomach is shaped like a long narrow tube with a small reservoir for food at the end of the tube. This reservoir only holds about 3 ounces of food, meaning you will feel full more quickly and therefore lose weight.

The sleeve gastrectomy retains the normal valve (pylorus) that allows food to exit your stomach. Because of this, the stomach is able to move food into the small intestines at a normal rate, which avoids the dumping syndrome that is common with the gastric bypass procedure. Additionally, the acids and digestive enzymes that help absorb vitamins and minerals are not bypassed during a gastric sleeve, which places you at lower risk for vitamin deficiencies. However, since your stomach is smaller, it will absorb these substances less efficiently, so you will still need to take vitamin replacements.

As you begin to eat and take medications, there will be some swelling of the tube that makes it difficult for any solid food to pass. As a guideline, food should be able to pass through a straw, which is why you are placed on a special liquid diet immediately following surgery. The goal is to let the stomach heal; only liquids and soft solids should be eaten during the first six weeks. Since many pills are quite large and will not fit through the tube, we ask you to crush all medications or take them in liquid or chewable form. You will receive written instructions on the proper diet to follow from your dietitian.

Intra-Gastric Balloon

The Gastric Balloon is a recently FDA-approved technique that extends the spectrum of weight loss procedures to patients who may otherwise not qualify for weight loss surgery. The balloon is placed endoscopically through the mouth with no surgical incisions and can be done as an outpatient procedure.  After six months the balloon is endoscopically retrieved, once again as an outpatient. Indicated for patients with a BMI between 30 and 40, the balloon allows surgeons to offer weight loss options across the entire continuum of obesity.  

Revisional Weight Loss Surgery

The weight loss surgeons at Boston Medical Center have extensive experience in the field of revisional surgery for weight loss. This includes the removal of adjustable gastric banding devices (the Lap Band®), or conversion to another type of weight loss surgery. Additionally, in many cases we are able to revise or optimize existing surgeries using laparoscopic or even incisionless techniques. If you are struggling with weight loss or complications from previous weight loss surgery or simply would like a second opinion, please contact our offices to schedule a consultation.

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