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Bariatric Surgery

Bariatric surgery provides durable and sustainable long-term weight loss.  Basically, surgeries for weight loss can be regarded as:

  1. Restrictive – making the size of the stomach smaller; thus, limiting the amount of food intake
  2. Maldigestive – diverting food away from the stomach and limiting the length of the intestine that comes in contact with food; or
  3. Combination of restrictive and malabsorptive

In addition to durable and sustainable weight loss, the more important benefits of bariatric surgery are the improvements in general health and quality of life. Once you make the decision to proceed with surgery for weight loss, we will guide you to choose from different procedures based on your goals, your current health and your lifestyle. You are required to attend a Bariatric Surgery Information Session (before your surgery) and the Bariatric Surgery Pre-Operative Support Group (before your surgery). 

These groups provide additional information and the opportunity to ask questions. For more information about bariatric surgery email bariatriccenter@tgh.org or call (813) 844-7473

Types of Bariatric Surgery

Roux-en-Y Gastric Bypass (RYGB)

This type of bariatric surgery induces weight loss by limiting the amount of food you eat and by limiting digestion and absorption of food. It has a low incidence of protein-calorie malnutrition and diarrhea and has a rapid improvement of weight-related medical conditions. It can be performed laparoscopically (using a camera through small incisions) and has been reported to produce a 55-70 percent reduction in excess body weight. (This procedure is associated with a national 0.4% mortality rate in low-risk patients.) The RYGB operation involves dividing the stomach into two compartments. A very small pouch (approximately 30 ml or 1 ounce) remains connected to the esophagus (food pipe).

The larger portion of the stomach (excluded stomach) is separated from the pouch but remains in place. The excluded stomach is not removed, as it remains a viable organ and continues to produce necessary digestive hormones and acid. The small intestine is divided downstream from the stomach, and one of its ends is attached to the small stomach pouch. Ingested food goes into the small intestine and bypasses the stomach, hence the name of the operation. The intestine is then reconnected downstream from the pouch to receive the acid secretions made by the bypassed portion of the stomach. Absorption of food occurs in the common channel where ingested food meets acid and bile from the bypassed stomach. 

The alteration in absorption requires that gastric bypass patients take lifelong vitamin and nutritional supplementation to prevent deficiencies. Because more than one-third of the patients who lose weight rapidly develop gallstones, we routinely remove the gallbladder during surgery. This adds an additional 20 minutes to the procedure but adds little risk to the operation. In addition, a very small biopsy of the liver will be obtained to check if your liver shows signs of damage from obesity. The majority of gastric bypass surgeries are done laparoscopically. However, on occasion (two percent), the open approach is done by making an incision between the breast bone and the navel. The choice of either approach depends on your body habitus and if you have had previous abdominal procedures. You and your surgeon will decide which method is best for you.

Sleeve Gastrectomy

The sleeve gastrectomy is a purely restrictive procedure.  It has recently been recognized as a stand-alone procedure, but it has been done for many years. A stapling device is used to divide the stomach vertically, thereby making the stomach a banana-like tube that restricts intake of food. Because we are not re-routing the intestines like in gastric bypass, there is no malabsorption, but lifelong vitamin and nutritional supplementation is still required. The sleeve gastrectomy reduces the size of the stomach. A portion of the stomach, called the fundus, is removed. This removes the source of hormones that stimulate hunger. The exact science behind the changes is unclear. However, 50 percent of patients feel fewer hunger and sweet cravings. Patients can expect a reduction of 50-60 percent of excess body weight with the national mortality rate of 0.1 percent.

Laparoscopic Adjustable Gastric Banding

Laparoscopic adjustable gastric banding is a purely restrictive procedure. It involves placing a band around the junction of the esophagus (food pipe) and stomach.  This band is connected to a reservoir (port) placed under your skin that will be used to adjust the band.  Inflating the band constricts the area where food passes and, therefore, restricts the amount of food that can be consumed. It has been shown to have up to a 40 percent reduction in excess body weight and a national mortality rate of 0.1 percent. Weight loss occurs gradually. This procedure is best for patients who enjoy participating in an exercise program and are more disciplined in following dietary restrictions. Adjustments of the band may be done every four to eight weeks in the physician’s office, as needed. Although many patients lose weight, some or all of the lost weight can be regained by eating soft foods that are high in carbohydrates and fat (junk food, soda, ice cream, etc.). Since all food passes through the stomach, this operation does not cause malabsorption; nevertheless, lifelong vitamin and nutritional supplementation is still required.

Click below to view a video of a laparoscopic adjustable gastric banding procedure.

See the comparison chart below to compare the three procedures.  Click here to download the comparison guide as a PDF document.

Type of bariatric surgery