Laparoscopic (minimally invasive) general surgery was developed in 1990 for the removal of gallbladders. The surgery was then extended to hernia surgery, removal of appendix and colon, and correction of reflux (heartburn). Laparoscopic gastric bypass surgery was introduced in 1994.
The minimally invasive approach to obesity surgery is exactly the same as the open approach except five to six small incisions (1/4 to 1/2 inch) are used instead of a 10 to 12 inch abdominal incision. The laparoscopic approach results in less pain after surgery, more rapid recovery, smaller scars, fewer wound problems and less stress during surgery.
In a minimally invasive procedure, a laparoscope which is connected to a video camera, is inserted through the small abdominal incisions, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. The entire operation is performed "inside" the abdomen.
Below are explanations of three weight loss surgeries and what to expect before, during and after each.
Roux-en-Y Gastric Bypass Surgery
Gastric bypass surgery was developed as a tool to help morbidly obese people lose weight, and reduce or eliminate the related medical conditions associated with obesity. At the Midwest Institute of Advanced Laparoscopic Surgery, Dr. Glascock performs the Roux-en-Y gastric bypass surgery, the premier method of gastric bypass surgery. With this type of surgery, the stomach is permanently divided to create a small pouch. This causes restriction in food intake. Next, a section of the small intestine is attached to the pouch to allow food to bypass most of the stomach and the first several feet of small intestines. This causes reduced caloric and nutrient absorption. The Roux-en-Y gastric bypass (RnYGB) procedure works in two main ways.
- First, the size of the stomach is reduced so it will only accommodate a few ounces of food. With the small size of the stomach, people feel full quickly and tend to eat less.
- Second, food is rerouted, bypassing several feet of small intestine, reducing the amount of calories absorbed.
Sweets tend to be avoided due to feeling ill after high calorie meals (called dumping syndrome).
Learn more about Roux-en-Y Gastric Bypass Surgery
Adjustable Gastric Banding (Lap-Band® Procedure)
In this procedure, an adjustable band, known as the Lap-Band® procedure, is placed around the upper or top part of the stomach. Water is injected into the band, which exerts pressure around the stomach creating a small gastric pouch with a narrowed stomach outlet. The band functions by restricting the volume of the functional stomach, and delays the emptying from the stomach pouch causing an early and prolonged sense of fullness following a meal. The diameter of the band outlet is adjustable to meet individual needs.
Learn more about Adjustable Gastric Banding
The vertical sleeve gastrectomy, or sleeve gastrectomy, is a type of restrictive weight loss surgery. Vertical gastrectomy surgery causes weight loss by restricting the amount of food that is able to be consumed before feeling full.
The vertical gastrectomy surgery isolates a small section of the stomach for processing food, limiting the size of meals to approximately one ounce after surgery.
The patient who undergoes this procedure must make significant changes in food intake and lifestyle in order for the procedure to have a successful long-term outcome. Because the stomach has the ability to stretch to accommodate food, the stomach can expand from the one-ounce capacity the surgery permits. Meals should be small -- less than half a cup -- and drinking fluids with meals can fill the pouch, preventing the intake of solid food at that time.
Learn more about Sleeve Gastrectomy
What are the risks of the surgery?
No surgical procedure is without risks. Risks for minimally invasive weight loss surgery are similar to other major abdominal surgeries. The risks, as well as the benefits of surgery, are discussed in detail with each individual patient. In general, complications resulting from severe obesity in the long-term are greater than the risk of surgery. The overall complication rate is small, at less than five to 10 percent. The major surgical risks include, but are not limited to:
- Leaking at the newly created stomach (two to three percent)
- Wound infections (five percent)
- Narrowing of the connection between the stomach and small intestine
- Blood clots (three percent )
- Vitamin deficiency (iron, B12 and calcium)
- Other infections (five percent)
The risk of death following the operation is small, but does exist, as it does with all types of major surgery.
What to expect from your first appointment
Prior to your arrival at the office, you will be asked to complete a demographic information sheet and a detailed questionnaire about your weight history and current medical condition. After watching the video, we will discuss and clarify your medical history, conduct a physical examination, and go into a detailed discussion about bariatric surgery specific to your situation. The doctor will determine if you are a reasonable candidate for gastric bypass. The remainder of the discussion will be to ensure that you are as informed as possible about the procedure and its ramifications. The doctor will also discuss the benefits and risks of the procedure.
You will see the doctor approximately two weeks prior to surgery after pre-op evaluations are completed. The doctor will review all medical data and make sure that planned testing has been done, and will answer any questions that you may have. Instructions for possible medication changes will be discussed preceding the surgery.
What to expect in the hospital
Your operation will be performed on the day of your admission. The procedure takes approximately three hours. Advantages of the laparoscopic approach include reduced postoperative pain, shorter hospital stay (two to three days), and a faster return to work (two to three weeks). You will be given explicit instructions on what and how much to eat. Pain is usually mild and controlled easily by medication. Nurses, dietitians, radiologists, and staff surgeons will all be monitoring your care closely.
What to expect right after my surgery
The day after your surgery you will be expected to sit up and walk around. At first you will be restricted as to what types of foods and how much food you can eat. Your physical activities will also be conservative. Within three to four weeks after your surgery your physical activities should be close to normal levels.
Weight loss results following surgery
Typically for the first year and up to two years you will lose about 15 to 25 pounds per month, depending on your beginning weight. After this time your weight will stabilize. The average patient loses about 70 to 85 percent of his/her excess weight. About 35 to 40 percent of patients will reach their ideal body weight range. Regaining lost weight after surgery may occur in a small percentage of patients. The doctor will review your weight, diet and overall health during follow-up appointments.
How well you maintain your diet and exercise regime will determine the stability of your weight. Our staff will monitor your weight frequently and provide important dietary and exercise counseling. In addition to the weight loss, you will also improve your overall health, noticing an elimination of many weight-related illnesses such as sleep apnea, diabetes, high blood pressure, and hypercholesterol. Nearly all patients report a significant improvement in their quality of life after surgery.