Surgical Procedures

The stomach is divided to create a small pouch that can hold approximately 30cc (1/8 cup) from its original capacity of 2000 - 3000cc. This dramatically limits the amount of food that can be eaten. The remaining stomach is stapled closed and surgically separated but not removed.

The small intestine is divided further downstream and attached to the new pouch so that any food eaten bypasses the old stomach. The connection from your new stomach to the intestine is small, approximately 1.0-1.5 cm wide (approximately 1⁄2 inch) to limit the food that passes through.

The stomach and the duodenum (the first section of small intestine) continue to produce and receive liver bile, enzymes and pancreatic juice needed for digestion. This bowel is then rejoined to the side of the jejunum, the second part of the intestine to form a common limb. This opening is wide so food can pass through easily. Pancreatic juices and liver bile from the duodenum now reaches the food as it travels down the jejunum. Liver bile begins fat absorption at this time. Fat is only being partially absorbed. Sugars are absorbed but discouraged because they cause most patients to experience the "dumping syndrome". This is a very uncomfortable feeling of flushing, cold sweats, palpitations, weakness and abdominal cramps.

Absorptive Changes

The Laparoscopic Adjustable Gastric Banding

This FDA approved surgery has gained popularity recently and is performed in less than one hour. A silicone band is placed around the upper part of the stomach and is connected to a reservoir that is placed under the skin on the abdominal wall. By injecting water into the band through the reservoir (adjustments), a greater restriction can be achieved. A well adjusted band not only limits intake but also lessens hunger.

The patient must have the same criteria for eligibility into the bariatric program as the gastric bypass. For more information please call our office to attend an information session, support group or education class. We have seen some wonderful results with this procedure.

This procedure originated as the first part of the Duodenal Switch, or Biliopancreatic diversion and has gained popularity since research has shown that this procedure alone is highly effective in treating morbid obesity alone. Long term studies are currently being done and we perform this procedure by special request.

The operation is laparoscopic, and consists of cutting the stomach longitudinally, such that the volume of the stomach is reduced to less than 100 cc’s. Important hunger hormones, Grehlin, are removed with the resection. There are no tubes, or foreign bodies. It is a purely restrictive surgery similar to the band.