The sleeve gastrectomy is a purely restrictive procedure. It has recently been recognized as a stand-alone procedure, but has a shorter track record. The standard approach to the sleeve gastrectomy is laparoscopic through small incisions and with a camera. A stapling device is used to divide the stomach vertically, thereby making the stomach a banana-like tube that restricts intake of food. The remaining portion of the stomach, called the fundus, is removed. This removes the source of hormones that stimulate hunger. 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. However, 50 percent of patients feel fewer hunger and sweet cravings.
Patients can expect to lose 50 to 60 percent of their excess weight. In addition, a very small biopsy of their liver will be obtained to check if your liver shows signs of damage from obesity.
Risks of sleeve gastrectomy may include:
- Staple line leaks
- Prolonged nausea/vomiting
- Abscess in the abdomen
- Infection of incisions
Roux-en-Y Gastric Bypass (RYGB)
This operation 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. 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.
Risks of Roux-en-Y Gastric Bypass (RYGB) may include:
- Blood flow blockage in the lung
- Infection at the point of incision
- A leak from the stomach into another area of the body
- Dumping syndrome (a combination of symptoms including nausea, bloating, vomiting, cramps and diarrhea), which may occur if food passes too quickly through the body
- Staple line leak
- Infection of the incisions
- Abscess in the abdomen
What patients can expect after adolescent weight loss surgery
On average, adolescents stay in the hospital after weight loss surgery for two to three days. Many patients will return to school or work within two weeks.
The final decision and choice of bariatric procedure comes after enrolling into our program and assessment by our inter-disciplinary team. Careful consideration will be given to your medical conditions and expectations before making the final recommendation. Your surgeon will help you in making the choice for which procedure is best for you.