Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

The Procedure

The most common gastric bypass surgery is a Roux-en-Y gastric bypass. In normal digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.

In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum). This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).

Gastric bypass surgery for obesity

Image copyright 2000 by Nucleus Communications, Inc. All rights reserved. http://www.nucleusinc.com

This surgery usually involves a 4- to 6-day hospital stay (2 to 3 days for a laparoscopic approach). Most people can return to their normal activities within 3 to 5 weeks.

With Laparoscopic Adjustable Gastric Banding (LAGB), an inflatable balloon, which lays on the internal wall of the band and which is in contact with the stomach, it joins a valve (placed beneath the skin and on the abdominal muscles) through a thin tube (see diagram). Thus, during the postoperative phase, with a simple ambulatory method together with a radiological follow-up, the band can be adjusted with a very thin needle and through the valve, inflating the balloon and reducing the way out to the rest of the stomach. The patient does not need to be operated on when the band is adjusted.

The placement of the adjustable gastric band is a permanent procedure which is performed through laparascopy . It is minimally invasive, simple, it doesn’t cut the stomach nor puts staplers (i.e. metallic sutures), it has no need for anastomosis (i.e. joint with the intestine), and it does not alter the food’s path, that is to say, it doesn’t exclude the stomach. This band preserves the stomach’s integrity, and it can be removed, because the method is reversible.

The Procedure
LAGB is performed the day the patient is admitted in hospital. A general anaesthetic is given, usually through laparoscopy, and it lasts approximately 2 hours. The patient is generally discharged 24 hours after his or her admission in hospital.

The stomach is the digestive organ that is connected between the esophagus and the small intestine. Food enters the stomach through the esophagus where it is broken down and then transferred to the small intestine where the nutrients are absorbed. Vertical gastrectomy (surgical removal of all or part of the stomach.) removes up to 95 percent of the stomach and leaves behind a thin tube-like stomach roughly 2 ounces (60 milliliters) in volume.

The Procedure

The Vertical Gastrectomy procedure is also called vertical Sleeve Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction and even Vertical Gastroplasty. The excess stomach volume is removed, not left in place. This possibly eliminates most Ghrelin hormone production and helps to reduce the sensation of hunger that people have.

In this gastric restrictive procedure the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are rare. Vertical banded gastroplasty may be performed using an open or laparoscopic approach.

The stomach that remains is shaped like a banana and measures from 2-5 ounces (60-150cc) depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume. Note that there is no intestinal bypass with this procedure, only stomach reduction.

Intra-Gastric Balloon, or Endoscopic Gastroplasty, involves placing a balloon inside the stomach, by an endoscopy. When the balloon is inflated, it fills 60% of the volume inside the stomach. This is a restrictive procedure, which is recommended for patients who suffer from non-severe obesity (overweight from 20 to 60 pounds) or patients who don’t want to undergo a more complicated procedure.

The Procedure

The endoscopic gastroplasty does not require surgery as the balloon is easily placed and removed by an endoscopy. The patient is sedated and there is no pain or discomfort throughout the procedure.  It is a temporary procedure and the balloon is usually removed within six months.