1. Restrictive Weight Loss Surgery
In this type of weight loss surgery, the surgeon seals of a part of the stomach as a result of which the food stays in the area above the seal. When the person eats, the food passes slowly between the seal and the space in between making the person feel full after consuming a small amount of food. Due to this, capacity of the stomach decreases which in turn decreases the person’s appetite. There are two forms of restrictive weight loss surgeries-
- LAP-BAND® System – This is a popular weight loss treatment as it is reversible. This restrictive procedure is for people who are suffering from severe obesity and helps to control the calorie intake by decreasing the capacity of the stomach. The LAP-BAND® System is a band that encircles the stomach. Composed of a safe form of plastic (Silastic®) the plastic material does not have any adverse reaction on the body. The size of the stomach pouch can be changed as it is filled with saline solution which causes the tube to expand. This allows the surgeon to changes the capacity of the stomach, even post surgery.
- Vertical Banded Gastroplasty (VBG) –For this procedure a bariatric surgeon uses a combination of staples with bands to seal off, a major part of the stomach so that only a small pouch remains for collecting and digesting food.
Advantages of Vertical Banded Gastroplasty (VBG)-
- Effective way to stimulate weight loss
- Long term efficacy
- Decreased risk of nutritional deficiency as compared to gastric bypass patients who skip their vitamin supplements
- This form of surgery ensures that there is no risk of rapid gastric emptying which is a condition in which the food remains for a very short period in the stomach and reaches the small intestine in an undigested condition.
- Vertical banded gastroplasty can be performed in two ways, as a laparoscopic procedure or a conventional open procedure. This ensures quick surgery and can accommodate a wide variety of patients.
Disadvantages of Vertical Banded Gastroplasty (VBG)
- Effective way to stimulate weight loss
- LAP-BAND® system produces offers same amount of weight loss without permanent surgical changes to the digestive tracts.
2. Malabsorptive Weight Loss Surgery
Malabsorptive Weight Loss Surgery decreases the capacity of the body to absorb calories.
There are two forms of this surgery
- Biliopancreatic Diversion (BPD) In this procedure, the bariatric surgeon reduces the size of the stomach by creating a stomach pouch and then diverts the gastric juices in the small intestine. The initial part of the small intestine absorbs all the calories. As a result of the surgery, the food bypasses this section and hence the calorie absorption is reduced. The section that bypasses the first part of the intestines contains the bile and pancreatic juices and gets attached to the small intestine.
- Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)In this form of surgery, the stomach pouch created is a little larger in size but it involves bypassing a large section of the small intestine.
Open versus Laparoscopic Surgery
All the above forms of bariatric surgery can be performed using different techniques which are
- Open Bariatric SurgeryThis form of surgery involves a large cut which stretches from the patient’s breastbone to just above the umbilicus. This form of a surgery involves long recovery period and may leave a large permanent scar.
- Laparoscopic Bariatric SurgeryThis form of surgery involves small incisions anteriorly through which a video camera is inserted (laparoscope). The doctor observes the image on screen and performs the operation accordingly. This technique allows the doctor with magnified views inside the abdomen due to which they can perform all the intricate tasks with ease. In this technique, the incision is small due to which the patient has less pain and the wound heals faster with less severe scars.