Clinically severe obesity is a chronic condition that is very difficult to treat. Surgery to promote weight loss by restricting food intake or interrupting digestive processes is an option for clinically severe obese people. Bariatric surgery is the standard of care when other medically supervised methods have failed, and it offers the best option of long-term weight control for those with clinically severe obesity.

The bariatric surgeons at St. Vincent's Medical Center perform two types of weight-loss surgeries. They use techniques that produce weight loss primarily by limiting how much the stomach can hold. All bariatric surgeries are done laparoscopically unless the open procedure is deemed necessary.

How These Procedures Promote Weight Loss:

1. RESTRICTION

The Lap-Band® (laparoscopic gastric banding) procedure limits the amount of food the stomach can hold (restriction) by placing an inflatable silicone band around the upper part of the stomach. This surgery is done laparoscopically and is considered minimally invasive.

The surgeon will make a small tunnel behind the top of the stomach to guide the band through and wrap it around the upper part of the stomach. The band is then locked in place and connected by tubing to an access port that is placed beneath the skin. The band is adjustable and is filled with saline on the inner surface creating a new small stomach pouch above the larger part of the stomach. Adjustments of the band (or “fills”) will start 6 weeks following surgery.

The band is considered a “tool” which helps you achieve sustained weight loss by limiting how much you can eat, reducing your appetite and slowing digestion. Patients report feeling full and satisfied after a small amount of food, and not feeling excessively hungry most of the time.

2. RESTRICTION AND MALABSORPTION

In the Laparoscopic Roux-en-Y Gastric Bypass procedure, the surgeon creates a smaller stomach pouch with the existing stomach and then bypasses the larger portion of the stomach and part of the small intestine (duodenum and some of the jejunum). The newly created pouch is then attached to a part of the intestine below the bypass. This limits the amount of food the stomach can hold (restriction) and causes food that is eaten to be poorly digested and absorbed (malabsorption). The result is that the patient cannot eat as much and they absorb fewer nutrients and calories.

Patients tend report a feeling of fullness right after surgery. In the beginning, a patient may only be able to consume ¾ cup of food at one sitting. This will increase to 1-2 cups after 1-2 years. It is important to remember that this weight-loss surgery, like all others, is considered a “tool”, and one must adhere to diet, exercise, support and counseling to achieve maximum results.

Vitamin and mineral supplements and a high protein intake will be required for life to prevent nutritional deficiencies.