Procedures

Primary Procedures

There are three primary weight loss procedures - The Roux en Y gastric bypass procedure, the vertical sleeve procedure and the gastric banding procedure. Each procedure is unique and provides a variety of options for our patients.

The Roux en Y Gastric Bypass Procedure

The Roux en Y gastric bypass procedure is the procedure that has been performed for many years. Many know this as "stomach stapling" and this procedure, until the early 2000's, was performed as an open procedure. The Roux en Y gastric bypass procedure separates the stomach and creates a new pouch stomach, roughly the size of an egg. The smaller pouch is then connected directly to the middle portion of the small intestine (jejunum), and bypasses the rest of the stomach as well the upper portion of the small intestine (duodenum). This causes weight loss for two reasons: The first, the stomach is smaller and patients experience fullness with smaller amounts of food. The second, there is malabsorption of the calories consumed due to the fact that the upper part of the small intestine is bypassed.

Roux en Y Gastric Bypass Video

The Vertical Sleeve Gastrectomy Procedure

Although many believe that the vertical sleeve gastrectomy is a new operation, the fact of the matter is is that is has been performed for many years as the first part of a two part operation. Originally the sleeve procedure was reserved for the super morbid obese patient. The patient would undergo the sleeve procedure, lose 150 to 200 pounds, and then would undergo a secondary procedure for further weight loss. What was found, however, was that many patients were continuing to lose weight without the secondary procedure. With less risk to the patient, and less cost to the insurance carrier, the insurance companies in 2009 began to pay for the sleeve gastrectomy as a stand alone procedure. While national research has demonstrated that sleeve patients lose slightly less weight than their Roux en Y counterparts, in my practice the weight loss with the sleeve approaches the weight loss with the Roux en Y procedure because I make small sleeves. With the sleeve procedure, the size of the stomach is reduced to the size of a small banana. The remaining stomach is removed. There is not a mal-absorptive component to this procedure but with the dramatic reduction of the size of the stomach, rapid weight loss is achieved, up to 35 - 40 pounds in the first month and maybe 30 pounds in the second month.

Gastric Sleeve Video

The Adjustable Gastric Banding Procedure

The gastric banding procedures became popular in the United States in the early 2000's, although this procedure had been performed in Europe for over twenty five years prior. There are two manufacturers for the banding device: The Lap-Band as well the Realize Band. Often I am asked what is the difference or which one is better. The answer, it's like a Chevy versus a Ford, both are similar and achieve the same result. Both bands are implantable devices that restrict the stomach by placing a band around the upper portion of the stomach. Six weeks following surgery, the band is adjusted with saline solution to allow for further restriction of the stomach. Typically a patient returns monthly for adjustments to the band until we find, what we term, the "sweet spot". The sweet spot is the adjustment that allows for the patient to experience fullness while still being able to lose weight. Although this procedure allows for slower weight loss, we continue to see patients lose weight with the band for up to 24 months.