Weight Loss Surgery Options & Choices

Surgical Center for the Treatment of Morbid Obesity
Louis Fox, M.D., F.A.C.S.
Medical City Hospital, Dallas, Tx. 75230
phone 972.566.4560 – fax 972.566.6239 laparoscopic gastric banding

Weight Loss Treatment Options

  • Diets – South Beach, Atkins, The Zone Diet, Sonoma Diet, Best Life Diet, Volumetrics Eating Plan
  • Exercise – Home, Health Clubs, Water Aerobics, etc.
  • Weight loss programs – Weight Watchers, Jenny Craig, Nutrisystem
  • Over the counter and prescription medicines – Alli, Hoodia, TrimSpa, Orlistat (Xenical), Meridia (Sibutramine), Phentermine
  • Hypnosis
  • Counseling
  • Behavior modification
  • Weight loss surgery – Bariatric Surgery

Note: The above are examples only, NOT recommendations.

Weight Loss Surgery Choices

Vertical Banded Gastroplasty (VBG)
VBG is a restrictive procedure in which the upper part of the stomach (along the lesser curvature) near the esophagus is stapled vertically for about 2.5 inches to create a small stomach pouch. The outlet channel is restricted by wrapping a prosthetic mesh or silastic ring to prevent stretching as well as slowing the emptying of food. Unfortunately, there has been an over 20% failure rate with this operation as well as a high incidence of weight regain.

Roux-en-Y Gastric Bypass:
  Open vs Laparoscopic
  Short vs. Long limb

Roux-en-Y Gastric Bypass is a combination procedure that combines both the restrictive and malabsorptive components. First, the stomach is stapled, cut, and divided to create a small pouch. The remainder of the stomach is not removed, but bypassed along with the first part of the intestines. Next, stapling and dividing of the intestines is performed to create a ‘Roux limb’ (named after Philibert Joseph Roux, a French surgeon in the 1800’s) that is now re-routed and connected to the small stomach pouch. The other end is attached into the side of the Roux limb of the intestine creating the ‘Y’ shape that gives the technique its name. This Roux limb of intestine that is attached to the small stomach pouch may be a ‘short limb’ or ‘long limb.’ As the ‘Y’ connection is moved farther down the intestinal tract, the amount of bowel capable of fully absorbing food (calories) and nutrients is reduced.

The gastric bypass may be performed by: 1. An open technique through an upper abdominal midline incision made from below the breast bone to above the umbilicus (belly button). Abdominal wall retractors are placed to give better exposure; or, 2. A laparoscopic approach that utilizes six small abdominal incisions. The abdomen is insufflated with carbon dioxide gas to create a distended space to work. A limitation to the laparoscopic approach is the steep learning curve of this technically challenging and complex procedure for the surgeon who has not been trained specifically in this laparoscopic surgery technique.

Laparoscopic Adjustable Gastric Band (LAGB):
  Otherwise known as the ‘Lap Band’

Lap Band surgery is purely a restrictive procedure (no malabsorption), in which an inflatable band is placed around the upper part of the stomach, creating a small stomach pouch. Thus, you will fill up very quickly with just a small amount of food. The band is ‘adjusted’ by injecting saline through an access port located under the abdominal skin. This tightens the outlet channel into the lower stomach where normal digestion begins. Food empties very slowly from the pouch, thus keeping you full for a longer period of time. There is NO stapling, cutting, or dividing of the stomach or intestines, nor re-routing of the intestines.

Sleeve Gastrectomy
This restrictive procedure staples and divides the stomach vertically along the lesser curvature from the esophagus to the pylorus (outlet valve of the stomach) which remains intact. This banana shaped stomach will hold a reduced volume of food. The remaining lateral 85-90% of the stomach is removed! This procedure is NOT reversible. There is no intestinal bypass component, thus no malabsorption. This procedure is the restrictive part of the Biliopancreatic Diversion with “Duodenal Switch” (see below). This operation is considered investigational by most insurance companies.

Biliopancreatic Diversion (BPD)
This operation involves stapling and cutting the upper stomach, usually horizontally, and removing about 70-80% of the lower stomach. This produces restriction of food intake and reduction of acid output. The remaining upper portion of the stomach is far larger than the ‘small pouch’ created for the gastric bypass. The principle of the anatomy is such that the small intestine is divided with one end attached to the stomach pouch. All the food passes through this shorter ‘alimentary limb’, but not much is absorbed (promotes malabsorption). The bile and pancreatic juices move through the longer ‘biliopancreatic limb’ which is connected toward the end of the intestine, a short distance before it enters into the colon. This short ‘common channel limb’ is where the food and digestive juices mix so food and nutrients may be absorbed.

Biliopancreatic Diversion with “Duodenal Switch” (DS)
This procedure is a modification of the BPD. The vertical narrow tube ‘gastric sleeve’ of stomach is created, preserving the pylorus. The remaining portion of the stomach is removed. Transection of the duodenum (first part of the small intestine), just beyond the pylorus, is performed so that the bile and pancreatic drainage is bypassed. The alimentary limb of intestine is connected to the duodenum. The ‘common channel limb’ is created as described above (See BPD). Anatomically, the main difference between the DS and BPD is the shape and size of the stomach. Also, the BPD involved attaching the intestine to the stomach pouch, whereas in the DS, the intestine is attached to the duodenum. The malabsorptive component is essentially the same as the BPD. Surgeons use various formulas to determine the appropriate length of the alimentary channel and the common limb channel to regulate the amount of absorption of calories, proteins, and other nutrients.

Dr. Fox has chosen to specialize in the out-patient Lap Band surgery as his only weight loss surgery procedure to be offered in his practice. To this end, he is 100% focused and committed to offer his patients the best weight loss results possible.

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