The first type of surgery is the gastric band. The band has lots of names, but the official name is the laparoscopic adjustable gastric band. The idea of the band is a minimally invasive procedure that avoids all those stomach stapling problems of the old-fashioned stomach stapling operations. You minimize complications by performing less surgery, it’s very simple and easy, and it’s done laparoscopically to avoid post-operative pain.
The band is a device that is inserted into the top of the stomach, then wrap it around the top of the stomach and then cinch it down, and then through a series of adjustments, try to find the perfect balance for each patient between losing weight and throwing up. If it’s too loose, patients don’t lose much weight, if it’s too tight, patients throw up, and then over time with adjustments, keep it in that balance. So it’s really not designed for everybody, it’s designed for the active, exercising, motivated, disciplined person whose only problem is hungry, and if we help them with hunger, they will do the rest of the hard work of weight loss.
The next surgery is the gastric bypass. Gastric bypass comes in many forms. The best gastric bypass, the gold standard is the Roux-en-Y gastric bypass. It completely divides the stomach, then makes a one-ounce pouch, and leaves the rest of the stomach in. Bring a loop up of the small intestine and divide it and connect it, and what you’re left with is a bypassed stomach. The results of this operation are that these patients lose about 3/4 of the extra weight. It’s pretty quick. Reflux is 100% cured, diabetes goes away very quickly, in fact, most of the diabetics leave the hospital off their diabetes medicines, and then the other weight-related problems go away with the weight, so sleep apnea, arthritis, anything that’s directly related to the weight goes away as the patients lose the weight.
The third choice in surgery is the sleeve. In the sleeve, the stomach is cut vertically to remove most of the stomach, and what we’re left with is a tube or sleeve of the stomach. These patients have a very extreme weight loss because the sleeve takes away hunger. Patients lose about 2/3 to 3/4 of their extra weight, and it’s very similar to the bypass. All of our surgeries are done laparoscopically which means little incisions. These incisions heal very quickly, and pain is very minimal. Patients will spend one day in the hospital, so they’ll spend the night, go home the next day feeling like they had surgery, but fairly decent, and within a couple of days, a week or so, are right back to normal. They have a very strict diet after surgery for the first several months.
So for the first four weeks, patients will be on a liquid diet that consists of protein shakes and non-calorie liquids. Once they’re tolerating this well over the course of three or four weeks, we’ll advance them to soft foods, and as those are well-tolerated over time, They’ll advance to solid foods, and eventually, by about three months, patients are eating normal foods, steak, chicken, pork chops, hamburger, barbecue, normal solid food, but it takes them about that long to get there. It’s in very small amounts, small measured amounts, and as they tolerate that over time, we advance the meal size to be larger meals to get them more nutrition in.
So the question that many patients ask is which surgery is right for me? This is more of a patient’s choice, they are made aware of the different choices, the risk, the benefits, the pros, and the cons. Hopefully, this will help patients make a wise choice for them.