Roux-en-Y Gastric Bypass

Weight loss has been shown to occur more rapidly and over a longer period of time with gastric bypass as opposed to stapled gastroplasty. The reasons for superior weight loss stem from the small degree of malabsorption caused by bypassing nearly all of the stomach and the first two feet of the small intestine. To date, weight loss with gastric bypass has been much more consistent than with stapled gastroplasty.

Laparoscopic (Minimally Invasive) Gastric Bypass
This approach uses five or six tiny incisions instead of one large incision to perform the operation. These operations require two skilled, well-trained surgeons, skilled assistants and many new specialized instruments. During the procedure, a laparoscope is inserted into the abdomen. This provides the surgeons with a magnified view on a TV monitor. The result is better visualization throughout the procedure, allowing for more precise work.

By eliminating the large abdominal incisions, bowel manipulation and extensive dissection, patients are assured a faster recovery. Further advantages of the laparoscopic approach include less pain following the surgery, less scarring, and likely an earlier discharge.
 

Biliopancreatic bypass (BPB)

Biliopancreatic bypass (BPB) combines a modest amount of eating restriction with lack of complete digestion or absorption of food. This procedure and similar operations including the distal Roux-en-Y technique and duodenal switch are becoming increasingly popular. However, all of the BPB type operations have the potential for developing nutritional deficiencies.

In a BPB, about one half of the intestine is excluded (bypassed) before it is rejoined to the ileum (near the end of the small intestine) at a point between 2 and 4 feet above the colon (large intestine), forming the so called common channel.

Some surgeons have modified the standard BPB operation to further reduce stomach capacity in the heaviest patients (BMI ≥ 50). Surgeons have also lengthened the common channel in less obese patients (BMI 40-50) to reduce the incidence of malabsorption-related complications. The duodenal switch operation is so named because the functional portion of the duodenum (the upper small intestine) is bypassed from digestive continuity in a reversal or "switch" technique.

Lap Band (Gastric Banding)

In adjustable gastric banding (the Lap Band® procedure), the stomach is encircled with an inflatable band that provides restriction of food intake. This allows only a small portion of the stomach to be used for holding food. A person feels “full” on much less food. Weight loss achieved is less than with gastric bypass since no intestine is bypassed and there is no malabsorption.

This procedure is superior to gastroplasty (see below), as it is adjustable to optimize weight loss. Absence of stapling during this procedure makes it the least invasive and lowest risk.

Gastroplasty

The upper stomach is stapled in a vertical direction with a pre-measured plastic band separating the upper and lower stomach. The band prevents the stomach from stretching at this point. We use specific criteria pertaining to an individual's health and potential risks when deciding who should have a gastroplasty and who should have a gastric bypass. Most patients will qualify for laparoscopic gastric bypass surgery.