Types of Bariatric Surgery

Understanding Types of Bariatric Surgery

Advancements in medical technologies and techniques have spawned several types of bariatric surgery, all of which fall into two general categories: malabsorptive bariatric surgery and restrictive bariatric surgery. While malabsorptive bariatric surgery prevents the patients' bodies from being able to absorb all calories consumed, restrictive surgery limits the patients' stomach size to reduce the amount of food they can eat.

In a laparoscopic gastric banding operation (LAP-Band Procedure), an inflatable silicone prosthetic device is placed around the top portion of the stomach. This band will make a person feel full after eating just a small amount of food.
 
LAP-band procedures are restrictive and don't involve any cutting or removal of the digestive system. Because this procedure allows the stomach to be accessed through a small port, the surgery is considered to be minimally invasive. Initial weight loss is less than other malabsorptive methods, but over the course of a few years, average weight loss is about the same. Celebrities, including Sharon Osbourne and Anne Wilson, have popularized gastric banding.

The most popular, commonly performed type of gastric bypass surgery is the roux-en-y (RNY) gastric bypass surgery. RNY rearranges the stomach, duodenum and other parts of the intestine in a sort of Y configuration. This allows the small portion of the stomach to absorb nutrients and still derive nutritional benefits from the food.
 
Consequently, RNY patients will quickly feel full after eating only a small amount of food. This allows the body to burn off excess amounts of stored fat. As with gastric bypass and banding, patients need to eat healthful diets and regularly exercise after undergoing roux-en-y gastric bypass surgery.

Gastric Banding

Gastric banding, also referred to as laparoscopic surgery, creates upper and lower sections of the stomach by placing a ring or band around it to "pinch" it. After gastric banding, the upper portion of the stomach fills with food, which then slowly descends into the lower portion of the stomach, creating a sensation of fullness after ingesting far less than usual.
 
Consequently, gastric banding is effective at reducing the amount of food patients eat without having to use staples on the stomach.

In general, the gastric banding procedure lasts between one to two hours. Depending on the patient's health, the procedure can be performed on an outpatient basis or in the hospital. Here is a basic outline of the gastric banding procedure:

• The doctor makes a small incision (1 cm wide) in the lower torso.
• He places the gastric band device around the top of the stomach.
• To connect and control the band, doctors insert a tube beneath the skin that connects to a reservoir. This setup allows doctors to adjust the band after surgery by releasing saline into the band itself, thereby altering how restrictive it is.

Because gastric banding dramatically changes the way your stomach (and digestive system) works, you will have to make some significant lifestyle changes after having the banding surgery. Postoperative gastric banding patients will need to follow a special diet that, immediately after surgery, will consist of liquids only or liquids and soft foods. This will continue until the patient has become accustomed to the device, and the stomach has healed completely.
 
Significant weight loss of 1 to 2 pounds per week, sometimes more, is the norm after undergoing gastric banding. While the results may be slower than those from gastric bypass, the long-term results look to be equally promising, particularly given that the banding procedure tends to encourage healthier overall eating habits.
 
A reduction of 40 to 50 percent of a person’s excess weight (the weight over an ideal body weight) is common two years after having gastric banding.

Given that gastric banding is a major surgery, it has a number of possible risks and complications, including:
problems caused by the band, erosion of the stomach tissue from rubbing with the band, gastritis
problems with the band itself, either through misplacement or slippage
productive burping, a complication in which a patient regurgitates some food (The patient may be able to correct this by eating smaller portions more slowly).
Sometimes, the passage between the banded areas may become blocked, causing a minor problem that may require further treatment.

The primary advantage of banding over other surgical weight loss alternatives is that it is far less invasive. With gastric banding, no part of the stomach or intestines is cut, removed or significantly altered. The band device can also be removed entirely, giving patients a more flexible option than gastric bypass surgeries.
 
Another advantage of gastric banding is that it doesn't cause malabsorption issues, meaning that patients won't suffer from nutritional deficiencies because the relevant part of the intestines is not bypassed, as it is in gastric bypass surgery.
 
Gastric banding also has a far smaller mortality rate: 1 in 2000, versus 1 in 200 mortality rate for gastric bypass surgery.
 
As with other bariatric procedures, gastric banding results in dramatic weight loss that will have a profound impact on other areas of the patient’s health. Cardiovascular problems, as well as stress on joints and body structures, are some of the other health problems that gastric banding can alleviate.
 
However, gastric banding does have some negative aspects. The need for consistent adjustment of the band device to reach the ideal restriction for desired weight loss can be irritating, at best, and physically exhausting, at worst. Band adjustments are done in-office by a radiologist, usually four to six times in the first year after the procedure.
 
To adjust the band, the patient swallows some liquid that will appear on the X-ray fluoroscope. This allows the technician to assess the condition, position and level of restriction offered by the band. As the technology advances, many offices are doing adjustments without the aid of the fluoroscope, making these visits much faster and easier.

Roux-en-Y Bariatric Surgery

Roux-en-y bariatric surgery, or gastric bypass, is currently the most common type of bariatric surgery. The success rate for roux-en-y surgery is high among morbidly obese individuals who make a lifetime commitment to better eating and exercise habits. In fact, after roux-en-y bariatric surgery, patients can expect to lose up to 75 percent of excess poundage in about 12 months.

Roux-en-y gastric bypass is performed as either an open or a laparoscopic procedure, a single-incision operation that typically takes less time to complete. Benefits of laparoscopy include a reduction in overall postoperative pain and a shorter recovery process. Both involve the same, or similar, techniques.

The roux-en-y gastric bypass operation usually proceeds according to the following steps:

• The patient follows standard pre-surgical instructions in preparation for anesthesia.
• The surgeon and team make either one long incision or several incisions in the abdominal region.
• Tissue just under the skin is split and moved to the sides.
• Team members shift the liver out of the field of view.
• Surgeon divides the stomach, stapling the larger portion closed and leaving a small pouch at the top.
• The mid-section of the small intestine is divided. One section, known as the "Roux" loop, is surgically connected (as a stoma) to the newly created stomach pouch.
• The free end of the upper small intestine is stitched into place, creating a "Y" connection.
• The surgical team then checks for leakage around the staples and new connections, after which the procedure is complete.

The roux-en-y procedure accomplishes two important tasks. First, it separates the stomach, creating a smaller pouch for food that gives patients a sense of "feeling full" after eating significantly smaller amounts of food. Second, a bypass of the upper portion of the small intestine reduces the ability to absorb calories and nutrients. This quality is known as a "malabsorptive" property.
 
Roux-en-y bariatric surgery does not involve removal of the stomach. The stomach is still able to produce digestive juices. While the duodenum (the first section of the small intestines) is no longer attached to the stomach, this "bypassed" section is surgically connected further down the intestinal tract - at a "Y" intersection - to provide some of the benefits of normal food breakdown.
 
The "proximal" approach, the method most commonly used, involves a higher attachment of the upper small intestine. In fewer cases, a "distal" roux-en-y involves reattachment of the small intestine further down intestinal tract. The further the duodenum is attached, the more like a patient will experience malabsorptive values, resulting in even less caloric processing (and less nutrient absorption).
 
Another variation of the roux-en-y procedure involves creating a "Y" formation between the stomach pouch and the intestinal attachment.

Potential candidates for roux-en-y bariatric surgery are morbidly obese patients that are least 100 pounds overweight, with a body mass index (BMI) of 40 or above.
 
"Severely" obese individuals, those who fall into the 35 to 39 BMI range, are also potential surgical candidates if excess weight is interfering with their ability to work.

One of the benefits of RNY is the greater weight loss generally seen in the first twelve months. In addition, individuals tend to be more successful in keeping the weight off. Some weight gain may reoccur over time, however, as the small stomach pouch begins to stretch to accommodate more food.

"Dumping syndrome," the situation in which the body quickly expels food after eating, is a common side effect of following RNY. While RNY prevents the body from being able to process fats and sugars as it did before, it also causes the body to react adversely to eating too fast or too much at one time. Dumping syndrome typically results in:

• diarrhea
• feeling faint
• nausea
• profuse sweating
• vomiting.

Dumping syndrome, while not a life threatening, is unpleasant and is often accompanied by severe pain under the breastbone.

Other risks of roux-en-y may include:

• Difficulty in viewing other internal organs during medical examinations: The RNY procedure inhibits the view of some parts of the abdominal cavity, making it difficult to diagnose other conditions.
• Gallstones: These can develop with any rapid weight loss. Because of this risk, some surgeons elect to remove the gallbladder at the time of bariatric surgery. Others prescribe medications to reduce the potential for stone formation.
• Pouch enlargement: This can lead to eventual weight gain. In some cases, the new stomach sac is too large to be effective in weight loss.
• Staple breakdown: If staples break down, they can potentially leak into the abdominal cavity, causing other serious complications.

Post-Surgical Treatment

After roux-en-y bariatric surgery, most individuals can expect a two to six night stay in the hospital. At home, light activity can resume within a few days, but returning to heavier tasks requires several months. Initially, a liquid diet will help the healing and adjustment process. Overtime, patients can gradually transition to pureed foods and then to solids.
 
Long-term success with a roux-en-y bariatric surgery will depend on the individual's determination to achieve a better lifestyle.

"The Severe Obesity Centre"

Obese people are on the increase and their chances of contracting modern illnesses are double. With an aim of reducing obesity in the country, Damansara Specialist Hospital has created “The Severe Obesity Centre” operated by a team of very experienced surgeons, doctors and medical assistants to perform “Laparoscopic Gastric Bypass” to assist obese people to reduce weight.

Also known as “Roux-en-y”, Laparoscopic Gastric Bypass” will restrict obese people’s food intake and reduce food absorption. After the surgery, all food taken will bypass the stomach and go directly into the intestine.

Damansara Specialist Hospital Severe Obesity Centre started its operation in November 2006. Interested patients will need to go through a series of tests and counseling by a team of Doctors comprising General & Gastro Intestinal Surgeon, Advance Laparoscopic & Obesity Surgeon, Psychologist, Radiologist, Anesthetic, Gastro, Lung and Cardiac Specialists and Plastic Surgeon.

Both Dr. Haron and Dr. Sukumar are Consultant Surgeons of Advance Surgical Training (AST). AST is based in Florida USA and managed under the supervision of Dr. Norman Samuels, American Executive Surgeon and Dr. Paul Wizman, Medical Director of Bariatrix, Florida. Both Dr. Samuels and Dr. Wizman are very experienced surgeons and have done over 2,000 and 1,000 surgeries respectively. Dr. Samuels said Laparoscopic Gastric Bypass is not new and has been in practice for sometime. The main advantage of this surgery is low risk and patients can recuperate within a short period.

Damansara Specialist Hospital is currently conducting free tests and diagnoses for the public who are obese and want to know whether they are suitable to do this surgery. Dr. Samuels said this surgery is suitable for obese people between the ages of 18 to 63 years.

Dr. Wizman said from testing, diagnose, counseling to surgery will cost around 48,000 Ringgit Malaysia. He said patients also need to return to the hospital for post surgery observation for a period of time.

Dato Dr Haron Ahmad, Surgeon
Ex-Professor and Head of Surgery of UKM Medical faculty 

Dr. Paul Wizman, Surgeon

Medical Director of Bariatrix, Florida

 
Dr Sukumar Nadesan, Surgeon
Have conducted numerous workshops in endoscopy, basic and advance surgical training.
Have published about 20 papers. And speaker in a few local television medical programmes.
Read more... 
 
Dato’ Dr Wan Nik Ahmad Mustafa
Anaesthetist
  
Dr Ibtisan Bte Ibrahim
Anaesthetist 
 
Ms Boh Shi Hui
Dietitian
 
ICU & Ward Nurses 

Who is a Candidate?

Roux-en-Y Gastric ByPass
Private Hospital Fees & Govt Taxes 3 days in ICU 7 days in recovery ward Surgeons & Anesthetist fees Dietetic Counselling Physiotherapy Pathology 24 hour on-call post-operative care Pre and Post-surgery consultations by surgeon All transfers to / from the hospital and airport / hotel Mobile Phone for your convenience and to keep in contact with your family PLUS: the second person travels free! No extra accommodation or service charges for a friend to travel with you.
LAPband Gastric Banding
Private Hospital Fees & Govt Taxes 3 days in ICU 7 days in recovery ward Surgeons & Anesthetist fees Dietetic Counselling Physiotherapy 24 hour on-call post-operative care Pre and Post-surgery consultations by surgeon All transfers to / from the hospital and airport / hotel Mobile Phone for your convenience and to keep in contact with your family PLUS: the second person travels free! No extra accommodation or service charges for a friend to travel with you.
Gastric Sleeve Surgery
Private Hospital Fees & Govt Taxes 3 days in ICU 7 days in recovery ward Surgeons & Anesthetist fees Dietetic Counselling Physiotherapy 24 hour on-call post-operative care Pre and Post-surgery consultations by surgeon All transfers to / from the hospital and airport / hotel Mobile Phone for your convenience and to keep in contact with your family PLUS: the second person travels free! No extra accommodation or service charges for a friend to travel with you.
Obesity Assessment Package
General Counseling by Medical Officer General Assessment Height Weight BMI Waist Circumference Blood Pressure Random Blood Sugar (finger prick) Cholesterol Level (finger prick)
Premier Medical screening package
Consultation by Physician BMI Waist  & Hip Circumference Blood Pressure Pulse Rate Body Fat Mass Comprehensive Blood & Urine Screening Full Blood Count Blood Group Liver Function Test Renal Profile (Kidney Analysis) Bone Analysis (Calcium / Phosphorus) Diabetic Screening (Fasting blood sugar) Lipid / Coronary Profile (Cholesterol breakdown) Hepatititis B Screening Bepatitis A Antibody Screening VDRL Screening (Syphilis) Rheumatoid factor (Arthritis) HIV Antibody Screening Urine Analysis Serum Cortisol Lung Function Test Stress Test with ECG Diet Counseling session

What is gastric bypass surgery?

Gastric bypass is a surgical method used to help people with morbid obesity lose weight and reverse other health problems associated with being overweight, such as high blood pressure and Type II diabetes. The Roux-en-Y gastric bypass, creates a small pouch in the top of the stomach to which the small intestine is connected. With a smaller stomach, the patient feels "full" sooner and is less likely to overeat. Depending upon what is best for each individual patient, the bypass is performed as an "open" procedure, or with a minimally invasive technique using laparoscopes.

Can anyone who is overweight have gastric bypass surgery?

The surgery is not a cosmetic procedure, but rather, a course of last resort for people who are at least 40kg over their ideal weight and have a body mass index (BMI) of over 32. Patients with a slightly lower BMI may be considered for the procedure if they have other obesity-related problems such as Type II diabetes, cardiovascular disease, or sleep apnea. Gastric bypass is also generally reserved for patients who have been unable to lose weight through weight reduction programs and exercise.

What is "stomach stapling", and is it the same thing as gastric bypass?

"Stomach stapling" is a catch-all term commonly used to describe a variety of obesity reduction surgeries. It can mean gastric bypass or an entirely different procedure. However, when gastric bypass surgery is performed, part of the stomach is stapled.

What are the risks of gastric bypass surgery?

As is true with any operation, there are complications associated with gastric bypass surgery. One of the most serious is leakage where the stomach pouch meets the small intestine.

With no treatment, approximately one in four gastric bypass patients will develop gallstones following surgery. That is why a bile thinning medication is prescribed after surgery.

Some other complications include abdominal hernia, wound infection, and bowel obstruction. There is also the possibility of lung-related conditions, such as pulmonary embolism, and additional stress on the cardiac system; for these reasons, the patients are closely monitored during the post-surgical hospital stay. In very rare situations, a patient may even die as a result of the surgery or one of its complications.

Gastric bypass surgery reduces stomach capacity quite significantly. Does the stomach ever stretch back to a larger size?

Surgery reduces the stomach capacity by about 90 percent. Immediately after surgery, the pouch can hold approximately two ounces. Gradually, the stomach pouch does stretch somewhat and the capacity increases, but not to its original size.

How effective a procedure is the Roux-en-Y gastric bypass?

The results are very encouraging. But the surgery is not a magic "cure all" in itself: Eating healthy foods and exercising regularly are the other parts of the equation for success.

How long does recovery from gastric bypass surgery take?
Patients can expect to be out of bed by evening of the same day of the surgery, with a total hospitalization stay of about 8-10 days. The surgical recovery period averages between 3-5 weeks.

How many kilos can someone expect to lose after surgery, and how long does it take to achieve the desired weight loss?

A. Every person's weight loss experience is different. As a rule of thumb, the heavier the patient, the more weight they are likely to lose. Most patients can expect to lose two-thirds of their excess weight. Most of that weight loss will occur within the first 18 months. That loss is almost always followed by a slight weight gain while the body is stabilizing, and is followed by another period of weight loss.

Losing the weight is only part of the picture, however. The difficulty can be in keeping it off. That is where gastric bypass surgery has proven to be so effective. Five years after surgery, 95% of all patients have maintained a loss of more than 50% of their excess weight. Keep in mind that on average, with a traditional diet-based weight loss program, only about 1% of morbidly obese persons maintain their weight loss at that level.

Do patients ever have to "diet" again following gastric bypass surgery?

The patient will have to adopt a healthy eating plan and an exercise program for the rest of his or her life.

What is "dumping syndrome"?

When large amounts of high-calorie foods (especially those containing sugar) pass quickly from the stomach pouch into the intestine, fluid rushes into the small intestine to dilute the high concentration of sugar. The patient may feel faint, break out in a cold sweat, and have intestinal cramps followed by diarrhea. Fortunately, "dumping syndrome" can be averted simply by the patient avoiding high intakes of sweets.

What happens if someone "cheats" on the recommended post-surgical diet?

Usually, "cheating" cures itself, as the consequences can be quite uncomfortable for the patient. Eating high-calorie foods can bring on "dumping syndrome," which results in cold sweats, a feeling of faintness, intestinal cramps, and diarrhea. It is such an unpleasant experience that most people do not keep on "cheating."

How does gastric bypass surgery affect which medications a patient is able to take?

Patients should avoid aspirin or aspirin-containing medications and anti-inflammatory drugs; they can irritate the intestinal tract’s inner lining and sometimes cause ulcers. For the same reason, alcohol and tobacco products should be avoided, as well.

Is pregnancy possible following gastric bypass surgery?

Many obese women of childbearing age do not have menstrual periods, a condition known as amenorrhea, and thus, are unable to become pregnant. After the surgery and subsequent weight loss, regular menstrual cycles typically resume. Barring other fertility-related problems, these women are able to become pregnant. However, it is not advisable to attempt a pregnancy until 18 months after the surgery. Before then, the rapid weight loss and nutritional deficiencies can harm a developing fetus.

When the waiting period is over, these women–with proper pre-natal care and monitoring by their obstetrician and bariatric team–can go on to have uneventful pregnancies and healthy babies. Despite the reduced size of her stomach, the mother-to-be can still intake sufficient calories for both the fetus and herself.

Is the gastric bypass covered by insurance?

No it is not but we could get support from KWSP.