TYPES of WLS

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Weight Loss Surgery (WLS), such as the Gastric Bypass Surgery (GBS),

is the only medically proven way for Morbidly Obese individuals to

lose weight and keep it off for long periods of time, if not life.

It has been accepted by most practictioners as aremedy for Morbid

Obesity. It has helped many individuals reach and maintain their

target weight for more than five years.

While this procedure is not a " Miracle Diet " , it is very

effective " Tool " in helping a weight challenged individual regain

control over his/her weight problem. As you review the information

presented in this website, please keep in mind that this procedure

is not for everyone. It requires more than just a " operate on me "

approach. It requires a lifestyle change and must be used as a tool

for this change to be successful. Please see a physician for details

about the procedure if you think you can benefit from it.

There are multiple types of surgery that involve the bypassing or

modification of the stomach for purposes of weight loss.

To the left is a diagram of an unmodified digestive tract

Roux-en-Y (RNY) Procedure

The RNY procedure is the most commonly performed WLS. It involves

bypassing the stomach all together with the use of staples or

stitches. The first portion of the intestine is cut and placed next

to the esophagus. The stomach is then blocked off with the staples

or stitches forming the " pouch " (the patient's new stomach). The

pouch then discharges into the intestine where it meets up with the

digestive juices discharged from the stomach. On its journey from

the pouch to the digestive juices, the eaten content experiences the

mal-absorption stage of the new digestive track. This stage is

between the pouch and the old " cut off " point of the intestine. The

size of a patients stomach is reduced to no more than 2oz, and

sometimes as low as 1.5 oz, and is referred to as the pouch. The

pouch is about the size of a salad dressing cup. There are some

complications that can arise from this particular procedure

including " leakage " from the pouch and mal-absorption of vitamins

such as Iron. Leakage can result in serious illness up to death if

not detected by the operating physician in a timely manner. Most

physicians will do a " leak test " while the patient is still in

surgery, but sometimes a leak can go undetected or may develop a few

days after surgery. While death and serious illness are very rare

and uncommon when performing WLS, it should be considered when

making the decision to under-go WLS.

The effectiveness of the RNY procedure comes from the fact that the

patient is restricted to only limited quantities and types of food.

The most a patient can consume in the early stages of the procedure

is equivalent to a fourth of a cup. It is also common that a patient

will no longer be able to eat sweets and fats without

experiencing " dumping syndrome " . Dumping is where the body

recognizes food content that is not healthy. It fast tracks it

through the digestive system causing the patient extreme abdominal

discomfort, sweats, anxiety, and in most cases diarrhea as the

undesired food exits the body.

This procedure can be done in two ways. The first way would be

to " open " the patient up (Open RNY) and do the surgery with the

human hands. The other way would be to do the surgery

Lapriscopically " LAP RNY " . Both procedures share most of the same

risks, however, infection is more common when having the Open RNY.

The most common complaint with the LAP RNY is the discomfort in the

shoulder area. This is caused by the air that is injected through

the belly button for the purpose of " inflating " the area in which

the physician performs the procedure. Most of this air is trapped

and taken back out of the abdominal area, but not all of it can be

trapped, therefore giving the patient a feeling of gas build-up. The

benefits of the LAP RNY however is that the full recovery time is

substantially less. It takes an average patient 2 weeks to fully

recover from a LAP procedure whereas it takes about 3-4 weeks for a

patient who under went Open RNY to fully recover. The decision of

Open or LAP should be made between your Physician and you.

Roux-En-Y Bypass

As you can see to the left, this is an example of what the digestive

system looks like after Silastical Ring Vertical Banded Gastroplasty.

The Vertical Banded Gastroplasty (VBG and Laproscopic VBG)

limits food intake by creating a small pouch (1/2 ounce) in the

upper stomach with a narrow outlet (1/2 inch) reinforced by a mesh

band to prevent stretching. The pouch fills quickly and empties

slowly with solid food, producing a feeling of fullness. Over eating

results in pain or vomiting. This restricts food intake. This is the

simpler of the two operations, with a generally lower risk of

complication's and shorter hospital stay.

The disadvantage of Laparoscopic Vertical Banding - VBG is it

usually results in less weight loss than Laproscopic Roux-en-Y or

RNY. It does not restrict intake of high calorie liquids (sweets)

and the pouch can stretch with overeating. As a result 20% of people

do not lose weight and only half of people lose at least 50% of

their excess weight with a Vertical Banding Gastroplasty. This

procedure can usually be performed as a 23 hour procedure with

return to full activity in 7-10 days. A soft diet, with 6 small

meals is suggested for 3 weeks after surgery.

Lap Band

By creating a smaller gastric pouch, the LAP-BAND System limits the

amount of food that the stomach will hold at any time. The

inflatable ring controls the flow of food from this smaller pouch to

the rest of the digestive tract. The patient will feel comfortably

full with a small amount of food. And because of the slow emptying,

the patient will continue to feel full for several hours reducing

the urge to eat between meals.

The advantages of LAP-BAND surgery include:

Reduced surgical trauma and pain

Less invasive for the abdominal wall (requires small incisions of 5

to10 millimeters) and for the stomach (no cutting or stapling of the

organ is needed)

Shorter hospitalization than standard surgery

Respect of the anatomical and functional integrity of the stomach

without by-passing portions of the stomach or intestines

Individualized to the patient's needs via inflation or deflation of

the band

Fully reversible by simply removing the band.