Other Weight Loss Surgical Procedures

The bariatric surgeons at the Newton-Wellesley Hospital Center for Weight Loss Surgery perform hundreds of gastric bypass surgeries a year, with an excellent overall success rate. The primary weight loss procedure performed at our facility is the Roux-en-Y Gastric Bypass Surgery, considered by many to be the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States.

We do not offer our patients malabsorptive procedures, such as Biliopancreatic Diversion (BPD), which can cause severe vitamin deficiency and diarrhea, nor do we offer purely restrictive procedures, such as the Lap Band or Vertical Banded Gastroplasty, because of their higher risks and poor weight loss outcomes long term.

Lap Band Surgery
The Lap Band is a restrictive weight loss procedure. A band is placed around the top part of the stomach, separating the stomach into one small and one large portion.

The band can be adjusted to increase or decrease restriction, surgery can be reversed and digestion and absorption are normal.

This procedure is not offered at the Center for Weight Loss Surgery.


Vertical Banded Gastroplasty
Vertical Banded Gastroplasty (VBG) is a purely restrictive procedure. In this procedure, the upper stomach near the esophagus is stapled about 2.5 inches (6 cm) vertically to create a smaller stomach pouch. The outlet from the pouch is restricted by a band or ring that slows the emptying of the food and creates the feeling of fullness.

Advantages

  • The major advantage of this restrictive procedure is that a reduced amount of well-chewed food enters and passes through the digestive tract in the usual order. This allows nutrients and vitamins, as well as calories, to be fully absorbed into the body.
  • After 10 years, studies show that patients can maintain 50 percent of their targeted excess weight loss.

Risks

  • After surgery there is always the risk that stomach stapling can result in staple-line disruption causing leakage and/or serious infection. This can require prolonged hospitalization with antibiotic treatment and/or additional operations.
  • Staple-line disruption in the long term can also lead to weight gain. Surgeons will sometimes divide the staple-line wall of the pouch from the rest of the stomach to reduce the risk of long-term, staple-line disruption.
  • The band or ring applied can lead to complications of obstruction or perforation, requiring surgical intervention.
  • While the surgery often creates a sense of fullness, it usually does not provide the necessary feeling of satisfaction that one has had "enough" to eat.
  • Because restrictive procedures completely rely on a small stomach pouch to reduce food intake, there is the risk of the pouch stretching or the restricting band or ring at the pouch outlet breaking or moving, therefore allowing patients to eat too much.
  • Approximately 40 percent of patients undergoing these procedures have lost less than half their excess body weight.
  • As is the case with all weight loss surgeries, readmission to a hospital may be required for fluid replacement or nutritional support if there is excessive vomiting and adequate food intake cannot be maintained.

This procedure is not offered at the Center for Weight Loss Surgery.


Biliopancreatic Diversion
These operations also reduce the size of the stomach. But the stomach pouch created is much larger than with other procedures. The goal is to restrict the amount of food consumed and change the normal digestive process - but to a much greater degree.

The anatomy of the small intestine is changed to divert the bile and pancreatic juices so they meet the ingested food closer to the middle or the end of the small intestine. Absorption of nutrients and calories is also reduced, but to a much greater degree than Vertical Banded Gastroplasty.

Since food bypasses the duodenum (short section of the small intestine connecting the rest of the intestine to the stomach), these procedures have the same risks as gastric bypass - but to a greater degree.

Three different malabsorptive procedures include:

  1. Biliopancreatic Diversion (BPD)
  2. Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)
  3. Biliopancreatic Diversion with "Duodenal Switch"

Biliopancreatic Diversion (BPD)
BPD removes approximately 3/4 of the stomach to produce both restriction of food intake and reduction of acid output. Leaving enough upper stomach is important to maintain proper nutrition. The small intestine is then divided with one end attached to the stomach pouch to create what is called an "alimentary limb."

All the food moves through this segment - however, not much is absorbed. The bile and pancreatic juices move through the "biliopancreatic limb," which is connected to the side of the intestine close to the end. This supplies digestive juices in the section of the intestine now called the "common limb." The surgeon is able to vary the length of the common limb to regulate the amount of absorption of protein, fat and fat-soluble vitamins.

Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)
RYGBP-E is an alternative means of achieving malabsorption by creating a stapled or divided small gastric pouch, leaving the remainder of stomach in place. A long limb of the small intestine is attached to the stomach to divert the bile and pancreatic juices.

This procedure has  fewer operative risks by avoiding removal of the lower 3/4 of the stomach. Gastric pouch size and the length of the bypassed intestine determine the risks for ulcers, malnutrition and other effects.

Biliopancreatic Diversion with "Duodenal Switch"
This procedure is a variation of BPD in which stomach removal is restricted to the outer margin, leaving a sleeve of stomach with the pylorus and the beginning of the duodenum at its end.

The duodenum, the first portion of the small intestine, is divided so that pancreatic and bile drainage is bypassed.

The near end of the "alimentary limb" is then attached to the beginning of the duodenum, while the "common limb" is created in the same way as described above.

Advantages

  • These operations often result in a high degree of patient satisfaction because patients are able to eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.
  • These procedures can produce the greatest excess weight loss because they provide the highest levels of malabsorption.
  • In one study of 125 patients, excess weight loss of 74 percent at one year, 78 percent at two years, 81 percent at three years, 84 percent at four years, and 91 percent at five years was achieved.
  • Long-term maintenance of excess body weight loss can be successful if the patient follows a straightforward dietary, supplement, exercise and behavioral regimen.

Risks

  • For all malabsorption procedures there is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time or be a permanent lifelong occurrence.
  • Abdominal bloating and malodorous stool or gas may occur.
  • Close lifelong monitoring for protein malnutrition, anemia and bone disease is recommended. Lifelong vitamin supplementing is required. If eating and vitamin supplement instructions are not rigorously followed, at least 25 percent of patients will develop problems that require treatment.
  • Changes to the intestinal structure can result in the increased risk of gallstone formation and the need for removal of the gallbladder.
  • Re-routing of bile, pancreatic and other digestive juices beyond the stomach can cause intestinal irritation and ulcers.

These procedures are not offered at the Center for Weight Loss Surgery.

 

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