Goal: Lose 75+ lbs
Sleeve gastrectomy, Roux-en-Y gastric bypass or duodenal switch may be appropriate if your weight loss goal is 75 pounds or more. These are the safest, most effective surgical options to lose the weight and end symptoms of diabetes, gastric reflux, sleep apnea, joint pain, high blood pressure and other weight-related conditions. In addition, we’ll work closely with you to develop a comprehensive, individualized plan to achieve a healthy new way of living. Our credentialed, multidisciplinary team offers medical management, advanced nutrition and exercise plans, counseling, behavior modification and group support as part of every surgical weight loss program.
Sleeve gastrectomy restricts the amount of food that can be eaten by removing 85 percent of the stomach. The surgeon creates a small, sleeve-shaped stomach — larger than the stomach pouch created during Roux-en-Y gastric bypass — about the size of a banana. The idea is to preserve the functions of the stomach while signficantly reducing its volume and without bypassing the intestines or causing any gastrointestinal malabsorption. There also appear to be some metabolic effects with the sleeve, adding to its potential benefit.
Sleeve gastrectomy is an approximately 60-minute surgery involving an average hospital stay of one to two days. The recovery period is two to three weeks. Potential complications include leaks and stricture. This non-reversible surgery may be a standalone bariatric procedure or be performed as the first procedure in a two-part treatment for patients with a BMI of 60 or higher. The second part of the treatment is duodenal switch or a possible Roux-en-Y gastric bypass.
Life After Sleeve Gastrectomy
In our experience, patients typically lose 50 to 60 percent of their excess weight following sleeve gastrectomy, and most of the weight is lost during the first year post-surgery.
Like any bariatric procedure, sleeve gastrectomy can help you feel satisfied sooner and with less food, but it won’t eliminate the desire to eat. To reach your goals, you will need to follow the specific diet and exercise guidelines provided by your health care team. Required diet changes include smaller meals focusing on protein intake.
For more information about the effect of surgery on weight-related co-morbid conditions, see Results of Bariatric Surgery.
Roux-en-Y gastric bypass surgery uses a combination of restriction and malabsorption to reduce calories. During the procedure, which takes an average of 75 minutes to perform, the surgeon creates a smaller, egg-sized stomach pouch, using about 5 percent of your stomach and separating off the rest. The surgeon then attaches a section of the small intestine directly to the pouch. This allows food to bypass a large portion of the small intestine, which absorbs calories and nutrients. Having the smaller stomach causes patients to feel fuller sooner and eat less food. At the same time, bypassing a portion of the small intestine means the patient’s body absorbs fewer calories. Gastric bypass procedures are potentially reversible, although this is not usually performed.
Life After Gastric Bypass
In our experience, gastric bypass patients typically lose 75 percent of their excess weight in the first year after surgery. Over time, they typically maintain 60 percent to 70 percent percent of their excess weight loss. After the surgery, most individuals leave the hospital in one to two days, and require a three-week recovery period. Long-term success for this procedure—that is, whether patients keep the weight off — is over 90 percent, according our program data.
Like any bariatric procedure, gastric bypass can help you feel satisfied sooner and with less food, but it won’t eliminate the desire to eat. To reach your goals, you will need to follow the specific diet and exercise guidelines provided by your health care team. Required diet changes focus on increasing protein intake and supplementing with a daily multivitamin including iron as well as B12 and calcium supplements.
Potential complications of gastric bypass include leakage and a condition known as dumping syndrome, which can occur from eating high fat, high-sugar foods. While it isn’t considered a health risk, the results of dumping can be very unpleasant and may include vomiting, nausea, weakness, sweating, faintness and diarrhea.
For more information about the effect of gastric bypass on weight-related, co-morbid conditions, see Results of Bariatric Surgery.
The duodenal switch is both a restrictive and malabsorptive procedure. The stomach size is reduced and there is less absorption of calories and nutrients, with a portion of the intestine being bypassed. In the duodenal switch, 85 percent of the stomach is removed, similar to the sleeve gastrectomy, with a larger section of the small intestine bypassed than with the gastric bypass. Bile and digestive juices enter the small intestine lower down the tract, which results in additional malabsorption of calories and nutrients.
The duodenal switch is generally reserved as an option for patients with extreme obesity or for revisional procedures. It can positively impact diabetes. At times, this surgery is performed in two stages. Stage one involves the sleeve gastrectomy. Stage two involves the bypass of the small intestine.
Strict compliance with follow-up visits and post-operative recommendations is most important after the duodenal switch. The duodenal switch has a greater potential to cause vitamin, mineral and protein deficiencies. Therefore, adherence to dietary and vitamin supplementation guidelines is critical to avoiding serious complications over time.