To qualify for bariatric surgery, you must have either a BMI greater than or equal to 35 with two medical problems outlined by the NIH criteria, or a BMI of 40 or greater. Patients must have proof of longstanding obesity with failed attempts to diet and exercise. All of the operations below have proven to be very good operations, but the correct operation for each individual is determined by a number of factors. How much weight do you need to lose to be healthy? Do you have diabetes? What are your strengths and weaknesses? How many abdominal operations have you had? Have you ever had bariatric surgery? How is your discipline? How is your compliance with medical therapy? Do you have the capability to exercise? How is your bowel function? Do you have reflux disease or a hiatal hernia? How is your health overall? All factors must be considered. Dr. Mimms will determine if you are a good candidate for surgery, and if you are a candidate, he will suggest an operation that will suffice as a tool to help you to take control of your life and be healthy. Overall, you will make the final decision. Dr. Mimms will discuss the , and expected results for each operation during the .
Da Vinci Roux en Y Gastric Bypass
This is the most common weight loss operation performed in the United States. It combines both components of surgical weight loss: restriction and malabsorption. So, patients will eat less and absorb less. The restriction is created because the surgeon will cut the first portion of the stomach into a small pouch that can hold very little food. A portion of the small intestine is divided, and the intestine is joined to the pouch. This bypasses the remaining stomach, which is no longer attached to the esophagus and does not receive meals, as well as the first portion of the small intestine, which is important for absorption of nutrients. Therefore, less food is absorbed. This combination provides the most success with surgical weight loss. Watch the YouTube video by Realize to gain a better understanding of the operation.
Da Vinci Sleeve Gastrectomy
This is a very good and very effective operation. It used to be a part of an operation that was commonly used several years ago, but recent data suggests that this operation produces comparable results as a stand alone procedure. Patients are expected to lose only approximately 5% less of the excess body weight than that for the bypass mainly because it lacks the malabsorption. It is an easier and shorter operation that is associated with fewer complications, but it must be performed by a surgeon who either has a long history of bariatric expertise or one who has been fellowship trained. Some experts believe that this operation will become the most common weight loss procedure performed in the United States. The surgeon will use a stapling device to cut the stomach into a narrow tube, and a portion of the stomach is removed. Therefore, the stomach is restricted to a much smaller volume, and the patient will eat less. Watch the Youtube video by Realize to gain a better understanding of the operation.
Laparoscopic Adjustable Gastric Band
This operation is a restrictive procedure that allows the surgeon to modify the restriction over a period of time. The surgeon will place a silastic ring, called a gastric band, around the inlet of the stomach. This slows down the rate that food traverses the band. A pouch is created above the ring; and when the pouch is dilated with food, a signal of satisfaction is sent to the brain. The band is attached to a port that lies under the skin, which can be accessed in clinic to adjust the restriction on the stomach. The patient must have great discipline because this operation will not dissipate hunger, and the patient must decide to change how and what he/she eats without much help. The band will facilitate weight loss, but it is largely determined by how well the patient sticks to a diet and exercise regimen. It is a shorter operation and carries fewer risks than the bypass. Watch the YouTube video by Realize to gain a better understanding of the operation.
Laparoscopic Revision of Bariatric Surgery
Although there are many success stories after bariatric surgery, recidivism is not uncommon. Some patients will require revisional bariatric surgery. The surgeon will determine which patients are good candidates. Some patients have pouches that are too large or complications from other bariatric procedures. The most common revision is a conversion from a vertical band gastroplasty or silastic ring vertical gastroplasty to a gastric bypass. The pictures depicts the two aforementioned operations that are commonly converted to a gastric bypass. Other revisions consist of converting a sleeve gastrectomy to a bypass (not common), and more commonly a band to a bypass. The patient must demonstrate readiness for lifestyle modification in order to qualify for a revision.