Weight Loss Surgery
DMC Huron Valley-Sinai Hospital offers three options for weight loss surgery:
- Laparoscopic Roux-en-Y Gastric Bypass (RYGB)
- Laparoscopic Sleeve Gastrectomy (SG)
- Laparoscopic Adjustable Gastric Band (i.e. "LapBand")
Laparoscopic Roux-en-Y Gastric Bypass (RYGB)
The Roux-en-Y Gastric Bypass is almost always performed laparoscopically, through several small incisions, rather than one large one. The Roux-en-Y Procedure is approximately a two to three hour procedure.
The stomach is stapled into 2 pieces, one small and one large. The small piece becomes the “new” stomach pouch. The pouch is 5% of the size of the old stomach, therefore holds much less food. The larger portion of the stomach stays in place, however will lie dormant for the remainder of the patient’s life. The beginning section of the small intestine (the jejunum) is divided using a surgical stapler approximately 2 feet from the end of the stomach. The section coming from the stomach is reattached to the small intestine approximately 5 feet from the recently stapled end of the small intestine. This forms the Roux limb. The Roux limb is then brought next to the pouch. The end of the Roux limb is then attached to the newly formed pouch. The Roux limb carries food to the intestines. The Y limb carries digestive juices from the pancreas, gall bladder, liver and duodenum to the intestines. The food and the digestive juices mix where the Roux limb and Y limb meet. The separation of the ingested food from the enzymes prevents its absorption in the bypassed segment of intestine.
The gastric bypass procedure results in a significant, immediate lowering of your metabolic thermostat's set point. The gastric bypass is thought by many to be the most effective weight loss operation available and is considered the gold standard that all other procedures are compared to.
Laparoscopic Sleeve Gastrectomy (SG)
Unlike the gastric bypass, the Sleeve is only a restrictive procedure – it does not prevent the absorption of calories. This surgery is almost always performed using a laparoscope. The stomach is decreased to approximately 3-5 ounces by one long staple line. The remainder of the stomach is removed. The small intestine remains the same, and food digests like it normally would. This allows for normal absorption of vitamins and minerals.
This is a newer procedure and has many advantages which include no foreign materials and no need for adjustment. Although it can be converted into a gastric bypass procedure, it is irreversible – the excess stomach is removed. The sleeve gastrectomy does work to lower your thermostat’s set point, but less so compared to the gastric bypass. The Sleeve Gastrectomy is recommended in patients with a Body Mass Index of less than 50. This procedure is not recommended for patients with significant heartburn issues.
Laparoscopic Adjustable Gastric Band (i.e. "LapBand")
The laparoscopic adjustable gastric band is another option for bariatric surgery which has the highest long-term complication rate and is least effective. This procedure takes approximately one hour, with a 23 hour stay in the hospital. Many times surgery is done on patients with previously placed bands to have them removed along with a revision to another procedure, such as the RYGB or SG described above.
Gastric banding is the simplest restrictive operation used for weight loss. A band made of silicone material is placed around the stomach near the upper end, creating a small upper pouch and a narrow passage into the larger lower portion of the stomach. The band is connected through a tube to a port (reservoir), which is placed under the skin of the upper abdomen. The collar around the stomach outlet is adjusted by adding or removing small amounts of saline solution by inserting a needle into the injection port in the physician’s office.
This technique leaves the digestive tract in the normal sequence for digestion and absorption. The only intended effect is a reduction in capacity for a meal. Small pouch volume and correct outlet diameter are very important for the success of this operation.
One advantage of gastric banding is that the stomach is not cut, stapled, or entered. Thus, the risk of infection is less and there is no possibility of a leak. However, there is always a risk of injuring the esophagus or stomach when placing the band, but this risk is very small. The weight loss results after gastric banding are quite variable with around one-third of patients doing extremely well, while two-thirds continue to struggle with their weight.
How Do I Decide which procedure is best for me ?
Time Off Work
- Patients who suffer from heartburn
- Slow Metabolism
- Limited Mobility
- Want the Most Effective Surgery
- Willing to accept a small risk
- Do not suffer from recurrent kidney stones
- 2-3 Weeks
- Occasionally 4-6 Weeks
- Previous Abdominal Surgery
- Good if you suffer from recurrent kidney stones
- Good if NO Heartburn
- Do not want adjustments or foreign object
- 2-3 Weeks
- Occasionally 4-6 Weeks
- Young, Active
- Willing to Work Hard at Weight Loss
- Knowledgeable about Nutrition and Exercise
The process begins with an informational seminar and a pre-operative visit with your surgeon. At the seminar, you will receive more information about the process and have a chance to ask the surgeon any questions you may have.
Insurance and Payment Options
It is important that you contact your insurance company and ensure that your policy contains coverage for bariatric surgery and get a list of all of the requirements necessary for authorization. It is important that you also clearly understand what your out of pocket costs for the surgery will be so you can plan appropriately. Subject to applicable hospital policy, there may be cash pay arrangements available to patients whose insurance policy does not cover the surgery.
Non-Surgical Weight Management
The bariatric surgeons of DMC Huron Valley-Sinai Hospital offer a physician-supervised weight loss program and also see post-operative patients to address weight re-gain after bariatric surgery.
Clinical dieticians are also available for one-on-one nutritional evaluation and counseling. If you wish to set up an appointment with a Registered Dietician, please call (248) 937-5059.
DMC Huron Valley-Sinai Hospital offers pre-operative classes to help prepare you for your surgery and know what to expect. Group classes are offered twice a month and one-on-one appointments with the Bariatric Nurse Navigator are also available if needed.
Post-operative Support Group
DMC Huron Valley-Sinai Hospital hosts monthly post-operative support groups for anyone who has undergone bariatric surgery. These support groups are open to the community.
Huron Valley-Sinai Hospital has a Bariatric Nurse Navigator to assist patients on their weight loss journey.
For information, please call (248) 937-3732.