There are three different types of weight loss surgery performed at Baystate Medical Center.
- Open Roux-en-Y Gastric Bypass
- Laparoscopic Roux-en-Y Gastric Bypass
- Laparoscopic Adjustable Gastric Banding “Lap-Band”
Open Roux-en-Y Gastric Bypass
The Open Roux-En-Y gastric bypass is considered the “gold standard” for weight loss surgery. It is classified as a “combination” weight loss surgery because it is both restrictive and malabsorptive in nature. During the operation, a 6-10 inch incision is made along the upper portion of the belly. The surgeon will staple the top portion of the stomach to create a small stomach pouch, this small stomach pouch functions to restrict food intake (the restrictive portion of the operation). A section of the small intestine called the jejunum is then attached to the small stomach pouch. This allows food to bypass the lower stomach, and the first segment of the small intestine. This bypass reduces the amount of calories and nutrients the body absorbs (the malabsorptive portion of the operation).
Laparoscopic Roux-en-Y Gastric Bypass
The Roux-En-Y gastric bypass is considered the “gold standard” for weight loss surgery. It is classified as a “combination” weight loss surgery because it is both restrictive and malabsorptive in nature. During the operation, five to eight small incisions are made to insert a small video camera and the tools needed to perform the operation. The surgeon will staple and separate the top portion of the stomach from the bottom to create a small stomach pouch. This small stomach pouch functions to restrict food intake (the restrictive portion of the operation). A section of the small intestine called the jejunum is then attached to the small stomach pouch. This allows food to bypass the lower stomach, and the first segment of the small intestine. This bypass reduces the amount of calories and nutrients the body absorbs (the malabsorptive portion of the operation).
The main differences between the open and laparoscopic approach to weight loss surgery is:
Open Laparoscopic
One large incision Five to eight small incisions
Longer recovery time Shorter recovery time
The advantages of gastric bypass surgery are many. Most patients experience an improvement in medical conditions, a decrease in prescription medications, improved fertility in females and an improved quality of life. Patients can be expected to lose 60-70% of their “excess weight” 2 years after gastric bypass. After five years, small weight gains are normal and patients show an average excess weight loss of 50-60%.
To calculate your approximate “excess weight”, determine what your weight would be at a BMI of 23. Subtract this weight from your current weight to get your excess weight.
Example:
If you are 5’3” tall your weight at a BMI of 23 would be 130 (your doctor or dietitian can help you calculate this)
If you weigh 225 pounds, subtract 130 pounds to get your excess weight
225-130 = 95 pounds Excess Weight
After gastric bypass you can plan to lose approximately 60% of your excess weight. To calculate this amount, multiply your excess weight by .6
If your excess weight is 95 pounds x .6 = 57 pounds is the amount you can expect to lose after gastric bypass surgery.
Laparoscopic Adjustable Gastric Banding "Lap-Band"
The lap-band is an Adjustable Gastric Banding System that causes weight loss by restricting the amount of food that can be consumed. The lap-band is considered a "restrictive operation" Because it reduces the amount of food the stomach can hold and slows the passage of food through the stomach. This operation is only performed laparoscopically which means four to eight small incisions are made to insert a small camera and the tools needed to perform the operation.
Like a wristwatch, the band is fastened around the upper stomach to create a new, small stomach pouch that limits the amount of food a person can eat. It also creates a small, outlet that slows the emptying of food into the stomach and the intestines. The size of the outlet is adjusted though a small port that sits underneath the skin about 6 weeks after the operation. This adjustment helps patients get the maximum restriction necessary to help them loose weight. As a result of the lap-band, patients experience an earlier feeling of fullness and feel satisfied with smaller amounts of food resulting in weight loss.
Advantages of the lap-band operation are that it can be performed quickly and with less pain than the gastric bypass procedures. The hospital stay is approximately one day and patients can return to their usual daily activities after about one week. The lap-band procedure is purely restrictive in nature and therefore eliminates the concern for anemia, vitamin deficiencies or dumping syndrome that are often seen in malabsorptive procedures. The operation is also easily reversible if the patient requires removal of the band due to complications or intolerance. Patients can be expected to lose weight at a much slower pace with a total average loss of 40-45% of excess weight two years postoperatively.
To calculate your “excess weight”, determine what your weight would be at a BMI of 23. Subtract this weight from your current weight to get your excess weight.
Example:
If you are 5’3” tall your weight at a BMI of 23 would be 130
If you weigh 225 pounds, subtract 130 pounds to get your excess weight
225-130 = 95 pounds Excess Weight
After lap-band surgery you can plan to lose approximately 45% of your excess weight. To calculate this amount, multiply your excess weight by .45
If your excess weight is 95 pounds x .45 = 43 pounds is the amount you can expect to lose after lap-band surgery.
Comparison of Procedures:
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Open Gastric Bypass
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Laparoscopic Gastric Bypass
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Laparoscopic Adjustable Gastric Banding
(Lap-Band)
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Technique
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Open
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Laparoscopic
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Laparoscopic
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Length of Surgery
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2-4 hours
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2-4 hours
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1 hour
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Time in Hospital
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2-4 days
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2-3 days
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1 day
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Return to Work
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4-6 weeks
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2-4 weeks
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1 week
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Permanence
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Not reversible
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Not Reversible
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Reversible
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Weight Loss
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Gold standard for weight loss
60-70% Excess Body Weight at 2 years
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Gold standard for weight loss
60-70% Excess Body Weight at 2 years
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Less weight loss
40-45% Excess Body Weight at 2 years
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Risk of Death
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0.5-1%
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1.0%
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<0.1%
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