Yale-New Haven Hospital offers three, minimally invasive (i.e. laparoscopic) Bariatric surgical procedures.
Roux-en-Y Gastric Bypass
Roux-en-Y gastric bypass — the most common Bariatric surgery — is a minimally invasive procedure that creates a smaller, golf ball-sized stomach out of the existing one. Having less space in the stomach means smaller amounts of food will make patients feel full, so they consume less. Also, by bypassing the larger portion of the stomach and rerouting the path to the intestine, food comes in contact with digestive juices for a shorter period of time, so less calories are absorbed. In addition, alteration of the stomach also causes changes in the hormones which help regulate appetite and hunger.
Lap-Band® surgery is another minimally invasive option that helps patients lose weight by reducing the capacity of the stomach. Surgeons implant an inflatable silicone band around the upper portion of the stomach to create a new, tiny stomach pouch. This limits the amount of food that can be consumed in one sitting, as well as the types of foods that can be eaten. Like gastric bypass, Lap-Band® surgery is considered a major abdominal surgery. However, with no cutting, stapling or stomach rerouting involved, it is considered to be a safer procedure.
One of the newest minimally invasive techniques available to weight-loss patients, laparoscopic sleeve gastrectomy is particularly well-suited for those at the highest risk for surgery, either because of their medical history or their weight. Under certain conditions, it is also offered as a first-step, lower-risk bridge to other bariatric operations. The procedure involves removing 80 percent of the stomach, leaving only a tube or "sleeve" of stomach behind. This restricts the amount of food that a patient can eat, and often leads to significant weight loss, in addition to also changing hormone production related to hunger.
Choosing the Right Procedure
Whenever bariatric surgery is required as part of a comprehensive weight loss strategy, the patient's surgeon will help decide which procedure is best. The final choice is based on a number of factors and eligibility requirements, including medical history, age, body mass index (BMI), and previous weight-loss treatment results. These same factors will also affect how much weight a patient can expect to lose after surgery.
Whichever option is chosen, the health benefits of bariatric surgery — coupled with a customized, post-operative treatment plan — are widely recognized. Weight loss resulting from any of these procedures can significantly improve conditions associated with morbid obesity, such as sleep apnea, diabetes, high cholesterol, gastroesophageal reflux disease (GERD) and high blood pressure. In fact, studies show that the risk of death from these conditions returns to normal after successful weight loss surgery and obesity treatment.
The following chart provides a quick overview of the innovative bariatric procedures performed at Yale-New Haven Hospital. This is a good place to start when discussing the options with your physician.
Compare your weight loss surgery options
||Roux-en-Y Gastric Bypass
||Laparoscopic Sleeve Gastrectomy
|How it's done
||Upper portion of stomach is stapled and connected to lower part of intestine, creating a smaller stomach pouch (approx. 1 ounce)
||Adjustable silicone band placed around top of stomach, creating a smaller pouch (approx. 1-2 ounces)
||80% of the stomach is removed, leaving a smaller tube or "sleeve" behind
|How it works
||Greatly restricts the amount of food that can be consumed, as well as amount of calories and nutrients that are absorbed into the body
||Mildly restricts the amount and type of foods that can be eaten, requiring less caloric intake before patient feels full
||Greatly restricts the amount of food that can be consumed, without loss of calorie or nutrient absorption into the body
|Excess weight loss (Results vary between patients)
||75-80% average at 10 years
||60-70% average at 10 years
||60% average at 2 years
||Statistically significant weight loss results and improvement in obesity-related health issues. It is considered the "gold standard" of bariatric procedures.
||No cutting, stapling or stomach rerouting required and band can be adjusted until correct capacity is achieved
||Most effective option for patients at highest risk for surgery or as bridge to other procedures
||Moderately affects the absorption of essential vitamins and nutrients like B12, folic acid, and iron
||Requires the most effort to achieve success, with slowest reported weight loss
||Relatively new procedure, with long-term effectiveness yet to be proven
Laparoscopic operations carry the same risk as the procedure performed as an open operation. The benefits of laparoscopic surgeries are typically less discomfort, shorter hospital stay, earlier return to work and reduced scarring.
Drainage After Surgery
Depending on the surgery, you may have a small tube to allow drainage of any accumulated fluids from the abdomen. This is a safety measure, and it is usually removed a few days after the weight loss (bariatric) surgery. Generally, it produces no more than minor discomfort.
What to Expect When in Recovery
Most gastric bypass or sleeve gastrectomy patients will receive a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. As with any major surgery, you are in danger of death from a blood clot or other surgical side effects. Statistically, the risk of death during these procedures is less than 1 percent. Your doctors will have assessed you for risks and prepared accordingly. All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients.