Which procedure to choose
Dr Atalla has extensive training and experience in a variety of laparoscopic bariatric procedures as well as general surgery. He will be happy to help you select the right procedure to suit your needs and your desired outcome, whilst taking into consideration any other medical issues you may have.
Gastric sleeve surgery is a restrictive type of procedure that permanently reduces the size of the stomach, thereby limiting food intake as well as the sensation of hunger. The remaining stomach is a tubular pouch that resembles a banana. It works through several mechanisms:
- The smaller volume new stomach pouch (average 150-200mls) holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed each time (you will feel full and satisfied after a small meal).
- The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger and satiety maintaining the fullness sensation longer (feel full for most of the day after meals).
Short term studies show that the sleeve is as effective as the gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.
- Decreases hunger
- Reduces appetite
- Improves portion control
- Reduction in conversion of calories to fat
- Increases feeling of fullness
- Enhances satiety and improves dietary choices
Gastric Bypass: Roux-en-Y
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.
There are two components to the procedure. First, a small stomach pouch is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach will eventually mix with the food.
The gastric bypass works through several mechanisms:
- Firstly, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into fewer calories consumed.
- Additionally, there is a segment of the small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, therefore, there is, to some degree, less absorption of calories and nutrients.
- Produces changes in gut hormones that promote satiety
- Suppresses hunger
- Reverses one of the primary mechanisms by which obesity induces type 2 diabetes
- Affects food choices due to dumping that may be encountered by some with high fat or high sugar intake.
Gastric Bypass: Roux-en-Y
Gastric Bypass: Single Anastomosis/mini/omega loop
The procedure works both by restricting the amount of food that can be eaten at any one time and altering gut hormones involved in appetite control. MGBP was first used in the late 1960s but abandoned in the 1970s. Today, because of developments in laparoscopic (“keyhole”) surgery, MGBP has started to come back into fashion and is being promoted as a quick and effective alternative to standard gastric bypass.
A longer thinner gastric pouch which is similar to a sleeve gastrectomy, however, the small bowel is attached to the bottom of the sleeve. This bypasses about 1.5-2.5 metres of the small bowel. This operation is extremely good for diabetic patients.
This option suits:
- Those who desire similar weight loss results to other procedures with improved recovery rate.
- Those looking for an effective Type 2 diabetic treatment
- Those who prefer the idea of a less technical operation
Adjustable Gastric Band
The Adjustable Gastric Band involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.
The common explanation of how this device works is:
- with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness.
- The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band.
- The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.
Reducing the size of the opening is done gradually over time with repeated adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged by studies that show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed as it would be normally.
- Reduces hunger
- Improves feeling of satiety
- Decreases the amount of calories that are consumed
The gastric balloon weight loss procedure involves placing a balloon filled with saline solution into the stomach, which fills up a significant area and reduces the space available for food. This non-surgical approach is a safe and quick method of shedding extra weight, while eliminating the need for incisions or stitches and the scars they leave behind. This method:
- May serve as an alternative to weight loss surgeries or
- Can be incorporated into a staged treatment plan for those at high risk for surgery
- Promotes feeling of fullness
- Impacts hunger
- May lead to significant weight loss depending on lifestyle changes
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