We perform three main types of bariatric surgery:
Laparoscopic Gastric Bypass
In this operation, there are three steps:
- First, the stomach is stapled into a small gastric pouch about the size of a tennis ball.
- Next, the small intestine (the jejunum) is divided, and the downstream end of this division is connected to the gastric pouch.
- The upstream end is then plugged back into the intestine about 3 feet further downstream.
The small gastric pouch will cause patients to get full faster, and the bypass of the remainder of the stomach and first portion of the small intestine will cause patients to digest inefficiently. Both of these lead to weight loss.
Patients can expect to lose approximately 60% of their pounds over their ideal body weight.
This operation is performed laparoscopically by Dr. Romanelli and Dr. Kuhn, and is performed with robotic assistance by Dr. Romanelli.
Laparoscopic Gastric Banding
Gastric banding was first introduced to the world in the early 1990s and to the United States in 2001. The Baystate Weight Loss Surgery Program began offering laparoscopic adjustable gastric banding in December 2005.
There are currently two banding products available:
- LAP-BAND® (Allergan, Inc., Irvine, CA)
- Realize® (Ethicon Endo-Surgery, Inc., Cincinnati, OH).
We currently use the Realize®, which became available in March 2008. This operation causes food to move slowly through the very beginning of the stomach, stimulating the brain to make you feel full early into a meal. Patients can expect to lose 40-50% of their pounds over their ideal body weight.
Laparoscopic gastric banding is currently performed by Dr. Romanelli.
Laparoscopic Sleeve Gastrectomy
Laparoscopic sleeve gastrectomy is the newest weight loss option. In fact, it is so new that not all insurance companies cover it. This was originally performed as part of a larger weight loss operation called biliopancreatic diversion with duodenal switch (an operation that causes weight loss by giving the patient malabsorption, causing diarrhea and nutritional abnormalities). Surgeons began to perform the stomach part of the BPD-DS separately in very, very obese patients. They soon discovered that the stomach part of the operation – sleeve gastrectomy – was very effective in causing weight loss. Similar to the gastric band, the concept of the sleeve is that the stomach will rapidly fill to the top because the part of the stomach that stretches has been removed. This allows patients to:
- Get full very early into the meal
- Reduce their portion size
- Take in fewer overall calories.
This operation was first performed at Baystate by Dr. Romanelli in August 2006. The one unique characteristic about sleeve gastrectomy is that it is permanent – the remainder of the stomach is removed and taken out of the body (as opposed to gastric bypass, where it is disconnected from the gastric pouch but left in the body). The patient can expect to lose up to 55% of their pounds over their ideal body weight.
Laparoscopic sleeve gastectomy is currently performed by Dr. Romanelli and Dr. Kuhn.