Weight-Loss Options

Laparoscopic Gastric Bypass

The bariatric surgeons on the medical staff at White Rock Medical Center offer My New Beginning patients a weight-loss surgical procedure called gastric bypass surgery, also known as Roux-en-Y gastric bypass.

During this procedure, a portion of the stomach is closed off using a stapler device. This creates a small pouch that is then connected to the distal small intestine. During digestion, food bypasses the rest of the stomach and the upper portion of the small intestine. Food is absorbed differently because the stomach, duodenum, and upper intestine no longer have as much contact with the food. Because of the new structure of the stomach, patients are not able to eat as much food. This may lead to more weight loss these patients realize after surgery.

Gastric Bypass Advantages:

• Produces significant, long-term weight loss (60% to 80% excess weight loss)
• Restricts the amount of food that can be consumed
• May lead to conditions that increase energy expenditure
• Produces favorable changes in gut hormones that reduce appetite and enhance satiety
• Typical maintenance of >50% excess weight loss

Source: American Society for Metabolic and Bariatric Surgery

Gastric Bypass Disadvantages:

• Is technically a more complex operation than AGB (adjustable gastric band) or LSG (laparoscopic sleeve gastrectomy), and potentially could result in greater complication rates
• Can lead to long-term vitamin/mineral deficiencies, particularly deficits in vitamin B12, iron, calcium, and folate
• Generally has a longer hospital stay than the AGB
• Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation and follow-up compliance

Source: American Society for Metabolic and Bariatric Surgery

Laparoscopic Sleeve Gastrectomy (Gastric Sleeve)

For bariatric patients who are obese but are not experiencing serious medical conditions such as diabetes and heart disease, gastric sleeve or sleeve gastrectomy may be an option.

Gastric sleeve surgery, or sleeve gastrectomy, is a weight-loss surgery option designed to reduce the size of the stomach by converting it into a narrow tube.

The bariatric surgeon starts this minimally invasive procedure by making a few small incisions into the abdomen. Then, a stapling device is used to remove the volume of the stomach by 75% to 80%. The new, smaller stomach is about 25% its original size (roughly the size of a banana), and it produces less of the hormone that causes hunger. This ensures that the patient will be able to consume less food while feeling just as full.

With this type of bariatric procedure, this is no surgery involving the intestines. The stomach is able to preserve its natural function because it is not re-routed, which leads to no malabsorption or severe vitamin deficiencies.

Gastric Sleeve Advantages:

• Restricts the amount of food the stomach can hold
• Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
• Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
• Involves a relatively short hospital stay of approximately two days
• Causes favorable changes in gut hormones that suppress hunger, reduce appetite, and improve satiety

Source: American Society for Metabolic and Bariatric Surgery

Gastric Sleeve Disadvantages:

• Is a non-reversible procedure
• Has the potential for long-term vitamin deficiencies
• Has a higher early complication rate than the AGB

Source: American Society for Metabolic and Bariatric Surgery

Laparoscopic Duodenal Switch

The duodenum, or first portion of the small intestine, is divided just past the outlet of the stomach. During a duodenal switch, a segment of the distal (last portion) small intestine is brought up and connected to the outlet of the newly created stomach. Now when the patient eats, food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.

This procedure decreases the amount of acid produced by the remaining stomach. Gastrin, a hormone produced by G-cells in the antrum (cavity within a bone), is responsible for stimulating the upper stomach to produce acid. After entering the upper stomach, food passes through a newly created connection (anastomosis) into the small intestine (alimentary limb). The bile and pancreatic secretions pass through the bypassed biliopancreatic channel and connect with the alimentary channel (where food travels) approximately 20 to 40 inches (50 to 100 cm) from the colon. Some of these secretions are reabsorbed in this channel before meeting the alimentary tract. The part of the intestines where bile and pancreatic fluids (from the biliopancreatic channel) and food (from the alimentary channel) mix is called the common channel. Surgeons use various formulas to determine the appropriate length of the alimentary and common channels.

Advantages of Duodenal Switch Weight Loss Surgery:

• Increased amount of food intake compared to the bypass and band
• Less food intolerance
• Possibly greater long-term weight loss
• More rapid weight loss compared with gastric banding procedures

Revision Surgery

Although the gastric band procedure may lead to long-term weight loss success, there is a specific group of people for which the gastric band surgery ultimately may not be the best solution. We want you to know that if you have been unsatisfied with your weight-loss progress after the gastric band surgery, there are other options, including gastric band to gastric sleeve revision.

Converting the gastric band to gastric sleeve is about a 90-minute process and is performed by laparoscopy, meaning it is minimally invasive in making incisions on the abdomen.

Robotic-assisted Weight Loss Surgery

da Vinci Surgery is minimally invasive weight loss surgery option for patients considering Gastric Sleeve surgery in Dallas. The gastric sleeve procedure works by reducing the size of the stomach by converting it into a narrow tube.

The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. da Vinci enables your doctor to operate with enhanced vision, dexterity and control.

Potential benefits of robotic-assisted weight loss surgery may include:

• Less pain
• Decrease in blood loss
• Less scarring
• Fewer complications
• Shorter hospital stay
• Shorter recovery time
• Faster return to normal daily activities
• Better clinical outcomes

Medical Weight Loss

Medication and Behavioral/Dietary Program

Whether you have 10 pounds to lose or are working on a more ambitious weight-loss goal, My New Beginning will work with you to create a personalized weight-loss plan. We have many patients who desire a non-surgical approach to weight loss, and at My New Beginning, we have developed a comprehensive plan to help you achieve your weight-loss goals!

To achieve optimal results, our medical weight loss program includes the following:

• Weight-loss medications
• Metabolic testing and assessment
• Vitamin and protein supplementation
• Individualized nutritional assessment and plan by a Registered Dietician
• “Am I Hungry?” Mindful Eating series/support group by a Licensed Clinical Psychologist

Request a Bariatric Surgery Consultation

Our team is here to support you through every step of the journey. Take the first step toward a fresh start and schedule a consultation with us today.

LAP-BAND® is a registered trademark of Allergan, Inc.

Important Information for Patients:
All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risks specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to other surgical techniques; the need for additional or larger incision sites; a longer operation or longer time under anesthesia than your surgeon originally predicts. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/safety.

All people depicted unless otherwise noted are models. © 2013 Intuitive Surgical. All rights reserved. All product names are trademarks or registered trademarks of their respective holders. PN 870791 Rev D 04/13

Snyder BE, Wilson T, Leong BY, Klein C, Wilson EB. Robotic-assisted Roux-en-Y Gastric bypass: minimizing morbidity and mortality. Obes Surg. 2010 Mar;20(3):265-70. Epub 2009 Nov 3. 4Hagen ME, Pugin F, Chassot G, Huber O, Buchs N, Iranmanesh P, Morel P. Reducing Cost of Surgery by Avoiding Complications: the Model of Robotic Roux-en-Y Gastric Bypass. Obes Surg. 2011 May 3. [Epub ahead of print]