Surgical Solutions

Dr. Jamie Ponce talks about the sleeve gastrectomy procedure.
 

The sleeve gastrectomy, also referred to as gastric sleeve surgery, is a very effective operation that can be done laparoscopic with small incisions and allows patients to lose weight and reduce hunger.

The weight loss with the sleeve gastrectomy has been in the range of 50% to 60% of the excess body weight. This operation is the only bariatric procedure that has no malabsorption (as the gastric bypass Roux-en-Y and Duodenal Switch do) and no foreign body (as the gastric banding does). It has a lower risk compared to the Gastric Bypass, and the relative invasiveness of the procedure is in between the bypass and the banding procedure.

Restrictive

A primary reason people lose weight with the gastric sleeve is because of the significantly smaller stomach size. The reduction of the size of the stomach, to about 60 – 80 cc in volume results in a powerful restrictive weight loss. This is about 7–80% smaller than the normal stomach size. As a result, patients feel full after a very small amount of food, and therefore lose weight because they eat less, and they are happy eating less.

Decreased Hunger

There are also significant effects on the hunger mechanisms that make the weight loss seen with the sleeve gastrectomy even better than would be seen just with a small stomach pouch. Hunger is favorably affected because there is a reduced capacity to produce ghrelin, a substance that plays a role in how you feel, and relieves hunger.

Preservation of Pyloric Valve

Another important fact about the sleeve is that it preserves the pylorus, which is the valve that regulates emptying of the stomach. This acts as a “natural band” and allows food to hold up in the stomach for a while, making the person feel full while the food trickles out. Coupled with the fact that there is no rearrangement of the bowel, it also means dumping and marginal ulcers are not a problem. The normal satiety mechanism (feeling of fullness) is enhanced by this mechanism.

The Operation

The sleeve gastrectomy (gastric sleeve surgery) operation is done with 5 small incisions, and takes about an hour to do. The stomach is restricted by dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible.

The stomach that remains is shaped like a banana and measures from 1-2 ounces (40-80cc). 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.

By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. There is no intestinal bypass with this procedure, only stomach reduction.

Having the laparoscopic sleeve gastrectomy involves an overnight stay in the hospital. There is no nasogastric tube, and you are able to return to work, resume heavy lifting and strenuous activity, in most cases, in about two weeks from the time of surgery. If you are able to do light duty at work, there is the possibility of going back to work sooner than two weeks for some patients.

The gastric band surgery is a safe, effective weight loss solution with fewer complications than with stomach stapling or Roux-en-Y Gastric Bypass (RNY) surgery. The gastric bypass involves cutting, bypassing or rearrangement of the digestive tract, which is difficult to reverse.

The Gastric Band surgery requires no stapling or cutting of the stomach, so there’s no staple line to increase the chances for complications and it allows us to easily adjust the amount of food a patient can eat without the need for further surgery. The gastric bypass procedure cannot be adjusted, even in cases where additional nutrition is required such as during pregnancy or severe illness.

Gastric band surgery is performed laparoscopically (with a camera) at our practice which serves patients from Atlanta and Knoxville. Our surgeon uses several small incisions rather than one large incision. The gastric band procedure is considered the least traumatic of all the operations for severe obesity.

The gastric band avoids irreversible damage to the stomach and bowel anatomy, and if for any reason it needs to be removed, the stomach generally returns to its original form. The gastric bypass involves permanent cutting, bypassing or rearrangement of the digestive tract, which is tremendously difficult, risky and almost impossible to reverse.

Dr. Jamie Ponce talks about gastric bypass surgery.
 

In the gastric bypass procedure – which is more specifically called the Roux-en-Y bypass – stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum (part of the small intestines), thus bypassing some of the intestines that take care of calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Restrictive

One reason people lose weight with the gastric bypass is because of the significantly smaller stomach size. Only a small portion of your stomach remains in use after the gastric bypass surgery, so patients generally report feeling more full after eating smaller meals.

Malabsorption

Malabsorption means that your body does not absorb all the calories that you eat. This happens because a portion of your intestine is bypassed. Since the intestines absorb calories, the food you eat will contribute fewer calories to your body. This is a benefit in losing weight, but also something to be careful about because the body will also absorb fewer nutrients. Taking supplements is necessary after a gastric bypass.

The Operation

In the Roux-en-Y gastric bypass procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum (part of the small intestines) thus bypassing calorie absorption.

This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name.

The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.