Procedure Information

Our surgeons perform all bariatric surgical procedures at WakeMed Cary Hospital. Cary Hospital is proud to announce it has been designated a Bariatric Surgery Center of Excellence® by the American Society for Metabolic and Bariatric Surgery.

Weight loss surgery is performed using a few different methods. The two most common weight loss surgery options include laparoscopic gastric bypass surgery and laparoscopic gastric banding surgery.

Laparoscopic surgery is less invasive than open surgery, so patients usually have less discomfort, a shorter recovery time and fewer complications. However, there may be times when your bariatric surgery procedure will need to be performed as open surgery rather than laparoscopic. Read on to learn more about the different procedures.

Remember that your surgeon, your bariatric surgeon at WakeMed Physician Practices - General Surgery, will help you make the best decision about surgery after a careful evaluation that will include assessing your physical and emotional condition, and providing nutrition and fitness counseling along with discussing your willingness to make lifestyle changes.

Gastric Banding Surgery (Adjustable Weight Loss Surgery)

Adjustable gastric banding (AGB) is the only adjustable weight loss surgery. It works by placing an inflatable silicone band around the top part of the stomach, which will create a small pouch and, in effect, make the stomach smaller.

This pouch holds about a half-cup of food, rather than the roughly six cups that a normal stomach holds. It fills with food quickly, which means you won't be able to eat as much, and will feel full faster, yet it also allows you to absorb nutrients from food normally.

The band can be adjusted to meet a patient's needs. For instance, it can be deflated if a woman becomes pregnant, and it can be tightened for patients who are not losing enough weight to make a healthy difference.

Currently there are two Adjustable Gastric Banding Systems on the market in the United States. Your surgeon uses the REALIZETM Personal Banding Solution, FDA approved in 2007.

During the procedure, your surgeon uses laparoscopic techniques, making a small incision and using long-shafted instruments to implant an inflatable silicone band into the patient's abdomen. Like a belt, the band is fastened around the upper stomach to create a new, tiny stomach pouch that limits and controls the amount of food you eat. It also creates a small outlet that slows the emptying process into the stomach and the intestines.
 
The band is connected by tubing to a reservoir, which is placed under the skin during surgery. To change the size of the band, saline solution is injected into or withdrawn from the tubing with a fine needle, which inflates or deflates the band's inner surface. 

Results

Gastric banding patients typically lose 47% of their excess weight.

Health Benefits

Studies found that gastric banding:

  • Resolved type 2 diabetes in 47.8 percent of Resolved high blood pressure in 38.4% of patients.
  • Improved high cholesterol in 78.3% of patients. 

Quality of Life

One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss:

  • Overall quality of life improved greatly
  • They experienced improved physical functioning and appearance
  • They experienced improved social and economic opportunities

Recovery

Your healthcare team will advise you when to return to work and when you are able to resume normal activities.
 
Potential Concerns of Gastric Banding

  • Gastric banding can help you feel satisfied sooner and with less food, but it won't eliminate the desire to eat. You will need to follow your specific diet and exercise guidelines provided by your bariatric surgeon to achieve success.
  • Gastric banding requires intensive follow-up care. This is because the band is adjustable. Keep in mind that even after reaching and maintaining your success weight, you may still need to see your bariatric surgeon for further adjustments.

Adjustable Gastric Banding is not right for you if:

  1. You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis or Crohn's disease.
  2. You have a problem that could cause bleeding in the esophagus or stomach, such as esophageal or gastric varices (a dilated vein).
  3. You have portal hypertension, cirrhosis, or pancreatitis.
  4. The anatomy of your esophagus, stomach, or intestine is not normal (congenital or acquired). For instance, you might have a narrowed opening.
  5. You have experienced an intra-operative gastric injury, such as a gastric perforation at or near the location of the intended band placement.
  6. You have an infection anywhere in your body or one that could contaminate the surgical area.
  7. You are on chronic, long-term steroid treatment.
  8. You might be allergic to materials in the device.
  9. You or someone in your family has an autoimmune connective tissue disease. This would include diseases such as systemic lupus erythematosus or scleroderma. The same is true if you have symptoms of one of these diseases.

Sleeve Gastrectomy

See how sleeve gastrectomy surgery works in this short animation.

Sleeve Gastrectomy is a laparoscopic procedure that reduces the size of the stomach.  A normal stomach can hold over a liter of contents.  Removing most of the stomach reduces the amount of food the stomach can hold.  The size of the stomach after surgery is about one tenth the normal size. 
No rerouting of the intestinal tract takes place during a sleeve gastrectomy and no intestine is bypassed.  Food passes through the intestinal tract in its normal order.   This operation is not adjustable or reversible. 
The new smaller stomach holds about a half-cup of food, rather than the roughly six cups that a normal stomach holds. It fills with food quickly, which means you won't be able to eat as much, and will feel full faster, yet it also allows you to absorb nutrients from food normally.

During the procedure, our surgeons employ laparoscopic techniques, making a small incision and using long-shafted instruments to exam the patient's abdomen.  The stomach is freed from its attachments and divided with a stapling device.  The stapling device seals the stomach and divides tissue. The new smaller stomach is shaped like a banana.   The new smaller stomach limits and controls the amount of food you eat.

Results
Gastric sleeve patients typically lose 55% of their excess weight.

Health Benefits
Studies found that gastric sleeve:

  • Resolved type 2 diabetes in 55 percent of patients.
  • Resolved high blood pressure in 49% of patients.
  • Improved or resolved high cholesterol in 81% of patients.

Quality of Life
One meta-analysis stated that for bariatric surgery patients who experienced significant weight loss:

  • Overall quality of life improved greatly.
  • They experienced improved physical functioning and appearance.
  • They experienced improved social and economic opportunities.

Recovery
Your healthcare team will advise you when to return to work and when you are able to resume normal activities.

Potential Concerns of Gastric Sleeve

  • Gastric sleeve can help you feel satisfied sooner and with less food, but it won't eliminate the desire to eat. You will need to follow your specific diet and exercise guidelines provided by your bariatric surgeon to achieve success.
  • Gastric Sleeve requires follow-up care. Keep in mind that even after reaching and maintaining your success weight, you may still need to see your bariatric surgeon for further followup.

Gastric Sleeve may not be right for you if:

  1. You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis or Crohn's disease.
  2. You have a problem that could cause bleeding in the esophagus or stomach, such as esophageal or gastric varices (a dilated vein).
  3. You have portal hypertension, cirrhosis, or pancreatitis.
  4. The anatomy of your esophagus, stomach, or intestine is not normal (congenital or acquired). For instance, you might have a narrowed opening.
  5. 5.You have had prior gastric surgery.
  6. 6.You are not healthy enough for an major surgery.

 

 

 

Gastric Bypass Surgery

This method of laparoscopic bariatric surgery also limits the amount of food you can eat. It changes your digestive system by transecting the stomach to create a very small stomach pouch.

The food then passes out of the pouch through a small opening into the small intestine. Most of the stomach and the first part of the small intestine are bypassed by the food.

Thus, the operation is termed a "gastric bypass with Roux-en-Y gastrojejunostomy." The point where the bile and pancreatic secretions are returned to mix with the ingested food is placed several feet down from the stomach. (If the gallbladder is diseased, it may be removed during the operation.)

The operation is usually done with laparoscopic instruments through several small incisions, using specialized instruments.

Occasionally, it requires an incision from the breastbone to just above the umbilicus in order to gain access to internal organs. If for whatever reason, the operation cannot be safely completed using the small incisions, the abdomen will be opened, and the operation will be completed as an open procedure. Not every patient is a candidate for the laparoscopic gastric bypass procedure.

Laparoscopic gastric bypass surgery is not right for you if:

  1. You have had a malignancy within the last 5 years.
  2. You have any of the medical conditions that would make an operation too risky.
  3. You have had extensive abdominal surgery

Results

Gastric bypass patients have typically lost about 61% of their excess weight.

Recovery

Gastric bypass patients often are able to:

  • Leave the hospital after two days
  • Return to work after 21 days

Potential Concerns of Gastric Bypass Surgery

  • A condition known as dumping syndrome can occur from eating high-fat, high-sugar foods. While it isn't considered a health risk, the results can be unpleasant and may include vomiting, nausea, weakness, sweating, faintness, and diarrhea.
  • Patients must supplement their diet with a daily multivitamin and calcium. Patients must take vitamin B12 and iron.

Why Would I Have an Open Procedure?

In some patients, the laparoscopic-or minimally invasive-approach to surgery cannot be used.

You may have an open procedure (or your surgeon may switch during the procedure from laparoscopic to open) if:

  • Prior abdominal surgery that has caused dense scar tissue
  • The surgeon is unable to see organs
  • There are bleeding problems during the operation

Based on patient safety, the decision to perform the open procedure is a judgment made by your surgeon either before or during the actual operation.

 

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