Over the years, many procedures have been used but currently only four procedures are in use by our unit:

The intragastric balloon is done endoscopically without the need for any incision.

The other three procedures are done laparoscopically (key-hole surgery).

 


For more information click on the procedure.

Restrictive operations:

> > Intragastric balloon
> > Gastric banding
> > Gastric sleeve

Restrictive/malabsorptive procedure

> > Gastric bypass

The various procedures are always discussed with the patient taking into account the advantages and complications and the appropriate one is suggested to the patient.

 

Intragastric balloon (BIB®-Bioenterics Intragastric Balloon)

Indications:

Placement:

For temporary weight loss in obese or severely obese patients. It is used many times prior to the other three procedures to reduce the patient's weight reducing the surgical risks. Only endoscopy, with no surgical incisions. It does not require General Anaesthesia as it is done under conscious sedation. The placement takes between twenty and thirty minutes. A folded BIB balloon is inserted through the mouth into the stomach. The position is checked with the gastroscope. It is then inflated with saline to fill up most of the stomach.

Safety:

Safe procedure. Only endoscopy.

Advantages:

Disadvantages:

> > It is a safe, fast procedure offering
      significant weight loss in approx
      six months.
> > It is a much cheaper alternative to the
      other surgical options.
> > It can remain in the stomach only for
      six months
> > Regular visits to the surgeon and
      dietician during that period.
> > Occasionally it may cause obstruction
      and surgery to remove it is required.

Gastric Banding

During this procedure an adjustable stomach band is inserted. The band is inserted around the upper part of the stomach dividing the stomach into two parts (pouches). The upper pouch is very small while the lower one consists of the rest of the stomach.

This procedure is a restrictive type of procedure. Firstly it restricts the amount somebody can eat. The person can eat only the amount necessary to fill the pouch (20-30cc). If he/she eats more than that amount pain and vomiting develop. There is also a balloon contained in the inside surface of the band, which is slowly filled during the first visits to the doctor. That is done through a small reservoir which is positioned under the skin in the abdomen. During the post-operative visits the surgeon makes the opening smaller or larger by injecting saline into the reservoir, through the skin. That controls the size of the opening between the upper and the lower pouch. A small diameter allows slower emptying maintaining satiety for much longer.

Indications: Who is a candidate?

> > BMI: 40.
> > BMI: 35 and concurrent medical problems.
> > Somebody who has been overweight for more than five years and has had multiple
      trials with the various diet programs

Advantages:

Disadvantages:

> > Less invasive and less traumatic,
      making it safer than bypass.
> > Done with the laparoscopic technique.
> > Reversible.
> > Adjustable.
> > You can lose between half to two
      thirds of your excess weight.
> > Long lasting results.
> > Morbidly obese patients have
      additional medical problems (diabetes,
      hypertension, sleep apnoea)).
> > Morbidity and mortality associated
      with the procedure.
> > Weight loss slower than the bypass.
> > Requires discipline, change in life
      style, diet. A sweet eater and
      somebody who drinks a lot of alcohol
      are not candidates.
> > Complications as any other surgery

Gastric Sleeve

This is a restrictive type of weight loss surgery.

It is done with key hole surgery (laparoscopy). Part of the stomach is removed forming a small, tubular, sleeve-shaped stomach, which has the shape and the size of a small banana. The size is about 15% of the original size of the stomach.

The weight loss is a result of the small stomach, reducing the amount somebody can eat comfortably and also hormonal after most of the stomach is removed.

 

Indications: Who is a candidate?

> > BMI: 40.
> > BMI: 35 and concurrent medical problems.
> > Somebody who has been overweight for more than five years and has had multiple
      trials with the various diet programs

Advantages:

Disadvantages:

> >

Significant weight loss

.
> > Very low complication rate (much
      safer and cheaper than the gastric
      bypass)
.
> > Reduced need for follow up (no need
      for filling as is the case with banding).

> > Most medical co-morbidities improve
      after the procedure
.
> > Can be supplemented with a second
      stage procedure in the future for
      additional weight loss
.
> > Irreversible removal of part of the
      stomach

> > Very small risk of leakage from the
      stapling line (cut edges of the
      stomach are approximated with
      staples
)

Gastric bypass (Laparoscopic Roux-en-Y gastric bypass).

A very successful procedure and consequently the gold standard in the USA. It combines the restrictive with the malabsorptive component of the other procedures.



The stomach is divided into two parts, with the upper one 20-30cc large. The upper jejunum is divided and the one end is attached to the upper stomach pouch bypassing the larger lower part of the stomach.



It works in two ways. The small pouch allows only a small amount to be eaten. The arrangement of the two intestinal limbs does not allow the food to mix with the digestive enzymes causing malabsorption. This procedure is also performed laparoscopically (key-hole surgery).

Indications: Who is a candidate?

Complications

> > BMI: 40.
> > BMI: 35 and concurrent medical
      problems.
> > Somebody who has been overweight
      for more than five years and has had
      multiple trials with the various diet
      programs
> > Short term: It is a procedure with
       morbidity and mortality much higher
       than the previous two procedures.
> > Long term problems: the patient could
      develop chronic diarrhoea, anaemia,
      and calcium and vitamin deficiencies.

Advantages:

Disadvantages:


> > Very successful procedure.
> > Significant weight loss.
> > Fast results.
> > Even sweet eaters lose weight
      (dumping syndrome).

> > More complicated procedure than the
      above. Associated with more
      morbidity and mortality (danger of
      dying during or immediately after the
      procedure).
> > Irreversible.
> > Metabolic problems more common.