The Vertical Sleeve Gastrectomy (VSG) is an operation in which approximately 85% of the left side of the stomach is surgically removed.  This laparoscopic surgery results in a new stomach, which is roughly the size and shape of a banana.  Since this operation does not involve any “rerouting” or reconnecting of the intestines, it is a simpler operation than the gastric bypass or the duodenal switch, with fewer risks involved.  Unlike the Adjustable Gastric Band (Lap Band) procedure, the VSG does not require the implantation of an artificial device inside the abdomen, nor does it require the intensive follow-up for adjustments.

Because the new stomach continues to function normally, there are far fewer restrictions on the foods which patients can consume after surgery; however, the quantity of food eaten will be considerably reduced.  The removal of the majority of the stomach also results in the virtual elimination of hormones produced within the stomach which stimulate hunger, known as Grehlin.  The VSG requires stapling of the stomach.  There is minimal risk of leakage and other complications.  The surgeon performs several leak tests during and after surgery to ensure this does not occur.  The VSG is a non-reversible procedure.

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The Adjustable Gastric Band (Lap Band) is a restrictive laparoscopic surgery.  It’s a medical device, designed to be placed around the upper most part of the stomach, reducing the capacity, and giving it the shape of an hour glass.  The band divides the stomach into two portions, one small upper stoma and a larger lower portion.  No stomach stapling is required; however, the band is sutured to your stomach to help hold it in place.  Because the upper stoma is significantly reduced, your food intake is greatly decreased.  The food you eat will remain in the upper stoma longer which creates a feeling of fullness for a longer period of time. You will simply feel the need to eat less and less often.  Any food you eat will be absorbed by your body, just as before the operation, as your digestive system is not altered in any way.  The weight loss is achieved simply by the fact that you will be eating less food, as long as the Gastric Band is properly adjusted.  The Gastric Band surgery is one that requires a consistent commitment by YOU.  Without the proper fill/ adjustment, you will not lose weight.

The Gastric Band is designed so that it can be inflated or deflated to meet your weight loss requirements, without any further surgery.  This is achieved by injecting or removing saline, via a “port”, which is placed under the skin, in your abdomen (usually below the waist).  The port is connected directly to the Gastric Band and the saline being injected or removed inflates or deflates a “balloon” on the inside of the band, creating more or less restriction, as needed.  For optimum weight loss or maintenance, your band will need to be adjusted several times in the first year as you lose weight, and less as you stabilize.  Your first fill is generally 6-8 weeks after surgery, to ensure proper healing and placement of the Gastric Band.  Weight loss is generally slower with the Gastric Band than with other, more invasive weight loss surgeries.

There are some complications that may occur with the Gastric Band.  Examples are:  band slippage, erosion into the stomach wall, port repair, replacement or repositioning, stretching of the upper stoma, gastric perforation or tearing of the stomach, rejection of foreign device in the body, etc.  Most Gastric Band complications occur when food intake is continually more than the capacity of the stoma, which induces repeated vomiting.

The Gastric Band procedure is considered reversible since the band can be removed.  However, there may be permanent scar tissue that has formed around your stomach, preventing your stomach from returning to its pre-surgery shape.  Most patients do not voluntarily remove their Gastric Band, unless complications occur, therefore, this procedure should be considered as a permanent weight loss surgery.

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In a Roux-en-Y Gastric Bypass (RNY), the stomach is cut and stapled, creating a small pouch at the top of the stomach.  The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), therefore, bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).  This creates the malabsorption component of this laparoscopic surgery, resulting in sustained weight loss of greater than 50% of excess body weight in over 80% of patients.

RNY has been around the longest and is the most frequently performed operation for weight loss in the United States, accounting for more than 90% of all weight loss surgeries, primarily because more insurance companies cover this procedure than any other, but not because it may be the best choice available.

This procedure is more surgically invasive than any other weight loss surgery, because of the re-routing of the intestines and malabsorption.  The risks involved may include:  deficiencies of vital nutrients (such as Iron, Calcium, and B12), Osteoporosis, leakage of the staple line or reconnection point of the small intestine, bowel obstruction, etc.  Dumping Syndrome can also occur, which is the result of rapid emptying of stomach contents into the small intestine, which happens if too much sugar or fat is consumed.  While generally not considered to be a serious risk to your health, the results of this can be extremely unpleasant and can include nausea, weakness, sweating, faintness and on occasion, diarrhea after eating.  The RNY is a non-reversible procedure.

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The Mini-Gastric Bypass (MGB) is a less invasive alternative to the Roux-en-Y Gastric Bypass (RNY) surgery, but produces similar results.  The MGB is performed laparoscopically, where the stomach is cut and stapled, creating a long narrow tube (as opposed to the “pouch” in RNY) and separates the remaining stomach with staples.  The tube is connected directly to the lower intestines, approximately 6 feet from the starting point.  This connection bypasses the upper portion of the small intestine where the body absorbs most of the food’s nutrients.  When you eat, the food goes directly from the tube to the lower portion of the small intestines.  The rest of the stomach is sealed separately, so that food is not able to enter it.

Some of the possible complications are similar to those of RNY, including leakage, bowel obstruction, dumping syndrome, etc.  As compared to the RNY, the MGB is less expensive, has shorter surgery time, fewer staple lines which reduces the possible risks, and can be easily reversed or revised.  

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Total Gastric Vertical Plication (TGVP or Plication) is a fairly new restrictive, laparoscopic technique that reduces the size of the stomach and limits food intake.  The Plication involves sewing one or more large folds in your stomach, in which the stomach volume is reduced about 70%, making your stomach the shape of a tube.  The sutures used are non-absorptive and there is no cutting, stapling, removal of the stomach or intestines, or uses any foreign implants.  This creates less risk for complications and also allows for full absorption of vital nutrients (no malabsorption created).

Although this is a newer procedure, the current statistics show a loss for most patients of approximately 62-67% of excess body weight.  You may hear other surgeons explain that this procedure is reversible, but it has been shown that when the sutures are removed, scar tissue may have formed around the folds of the stomach, preventing it from returning to its original shape (think of it as the sides of a balloon sticking together).  Due to this fact, this procedure should be considered as a permanent weight loss surgery.

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With the increase in the number of weight loss surgeries performed every year, there are some individuals who have experienced an unsatisfactory result from their bariatric procedures.  Although it can be an emotional setback for obese patients when bariatric surgery does not lead to the expected amount of weight loss, the only failure is in giving up.  

Revision Surgery is performed on patients who have either had complications from a previous surgery, or have not successfully achieved significant weight loss from the initial surgery.  Due to the unique needs of each and every patient seeking revision weight loss surgery, each revision must be tailored to meet the particular needs of the patient.  

A few examples of Revision Surgery would be:

• Lap Band to Gastric Sleeve (VSG) Revision
• Lap Band to Bypass (RNY) Revision
• Bypass to Bypass Revision
• Lap Band over Bypass Revision

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