Surgical procedures
Gastric
Balloon
A plastic balloon is inflated in the stomach
to give the feeling of being full. The procedure is carried out
using endoscopy. After 6 months, the balloon must be removed to
avoid long term injury to the stomach. The procedure can be
repeated at a later date. Although the procedure is usually safe,
it is not permanent and weight gain after removal of the balloon
can occur.
Placement of a balloon may be helpful in some
patients by helping reduce their BMI to an extent that reduces
anaesthetic risk. It can also help patients understand the benefit
of bariatric surgery.
Laparoscopic Adjustable Gastric
Banding
This is classed as Intermediate internal
surgery. The procedure requires a general anaesthetic and keyhole
surgery. A plastic inflatable 'ring' is placed around the stomach
and is attached to an access port placed under the skin. The band
is inflated in stages over the first few months after surgery. When
correctly tightened the band causes a feeling of fullness after
eating and restricts food intake. Weight loss is slower than with
other procedures. Adjustments may be required from time to time in
the long term.
Dietary discipline, patient commitment and
good follow up are needed to achieve good weight loss. In the
'right' patient weight loss at three years can be similar to
gastric bypass. Of the surgical procedures, it is the safest, with
the shortest recovery period and is fully reversible with
laparoscopic surgery.
Sleeve (or Partial)
Gastrectomy
The sleeve gastrectomy reduces the size of the
stomach by permanently removing about 75%. It is divided vertically
from top to bottom leaving a banana shaped stomach along the inside
curve and the pyloric valve at the bottom of the stomach, which
regulates the emptying of the stomach into the small intestine,
which remains intact. This means that although smaller, the stomach
function remains unaltered.
This procedure causes a loss of appetite and a
moderate degree of restriction, so you will find that you can only
eat small meals. However, you will lose weight only if you also
comply with a low fat, low sugar diet. Because of the reduced
stomach size, you will also keep the feeling of fullness for
longer. However, there are few of the side effects as experienced
by bypass patients because the digestion pathway is unaltered. The
procedure is irreversible. Although the weight loss is comparable
to the Gastric bypass in the first year, it may not be as
sustainable because the small stomach can expand with time, over
two to three years. One in five patients will need a further
procedure to improve their weight loss.
This operation can usually be done
laparoscopically (key hold surgery) and the hospital stay
post–operatively is normally 2 days.
Most patients lose 30–50% of their excess
weight in the first 12 months after a sleeve gastrectomy operation.
The timing of the second stage operation (either duodenal switch,
gastric bypass or repeat sleeve gastrectomy) ranges from 12–24
months after the first, depending on the lack of further weight
loss or even tendency to gain weight.
Gastric Bypass
This uses the Roux-en-Y gastric bypass (RNY)
which is by far the most common of the many variations of gastric
bypass operation that is performed in the world today. A small
stomach pouch is created which reduces the amount of food you can
eat. Food leaves the new stomach pouch through a new opening and
bypasses the rest of the stomach and much of your small intestine.
This means that fewer calories are absorbed as the food passes
through your intestine (malabsorption). If you eat a large quantity
of sugar, the body responds by overproducing insulin which makes
you feel light–headed and queasy. This acts as a deterrent from
over–eating the wrong types of food.
The procedure can usually be performed by
Laparoscopic (keyhole) surgery and takes approximately 1-2 hours.
It is classed as major surgery and is difficult to reverse. Most
patients stay 2-4 nights in hospital. A long dietary rehabilitation
period is required.
Weight loss following a gastric bypass is
generally 70% of excess weight at two years. This is greater than
that achieved with a gastric band or sleeve gastrectomy alone. Your
diabetes is usually resolved within a day to six weeks following
the surgery. Your surgeon may recommend this option to
patients with particular dietary habits, diabetes,
gastro-oesphageal reflux or any BMI where the compliance to diet is
felt doubtful.
Complex/ Revision (Re-do) Bariatric
Surgery
Some patients have problematic past medical
histories, or have had previous, failed bariatric surgery. Our
specialist team have significant experience in managing and
correcting problem and complex cases.