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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.

Type of Surgery

Roux-en-Y Gastric Bypass

Sleeve Gastrectomy

Brief description

Reduces stomach to size of walnut; reroutes food away from stomach.

Stomach divided vertically; portion of stomach removed.

How it works

Restricts food volume and alters the absorption of nutrients.

Restricts food volume and may decrease hormones that affect hunger

Nights in hospital

2-3

2-3

Longevity

Since 2970s

2009 approved as a primary procedure

Expected weight loss

55-70%

50-60%

Surgical risk

Moderate

Low to moderate

30-day mortality rate

0.4%

0.1%

Ease of reversibility (always requires another surgery and is accompanied by weight regain)

Moderate to difficult; can be reversed to normal anatomy and function.

Part of stomach (85%) is permanently removed. Can be converted to gastric bypass.

Pros

• Rapid and more total weight loss

• Most commonly studied procedure

• Rapid improvement or resolution of weight-related co-morbidities

• 85% remission of diabetes

• No device is implanted.

• Simpler than gastric bypass

• No intestinal rerouting

Cons

• Potential for nutritional and vitamin deficiency

• “Dumping Syndrome”

• Acid reflux may develop later.

• Not reversible

• Long-term data is limited.