Obesity Surgery - Treatment Options
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Laparoscopic Gastric Banding (LAP-BAND®)
Laparoscopic Gastric Banding is the simplest and safest obesity
operation; however it generally has the lowest percentage of excess
weight loss.
A silicone band with a balloon on the inner surface is implanted around the top of the stomach. The balloon is able to be inflated via a reservoir under the skin of the abdominal wall. The operation works mainly by switching off the desire to eat and giving the patient a sense of satiety. It requires regular follow up and adjustment. The expected weight loss from this surgery is on average 60% of excess weight. The operation is very safe, with a death rate less than 0.2% and just an overnight hospital stay. Longer term complications have reduced as we learn more about patient management.
Laparoscopic Roux-En-Y Gastric Bypass (REYGB)
The Roux-en-Y gastric bypass procedure is usually performed
laparoscopically (i.e. keyhole surgery with a telescope) by our
service; however, in some cases, it may be necessary to perform an
open procedure through a large cut in the abdomen, usually if you
have had an open operation before. This type of bypass
operation has proven to be an effective, consistent way of losing
weight and keeping it off, but to achieve these results it requires
lifelong changes to lifestyle and eating.
It is considered the “gold standard” of weight loss surgery. A small stomach pouch is created, restricting the amount of food that can be eaten initially, but long term, the operation also works by switching off the desire to eat. The risks of surgery are higher than with gastric banding, with a death rate of 0.5% being reported. Initial weight loss at 1 year of 78% of excess weight is expected. Patients generally spend 3 days in hospital.
Laparoscopic Sleeve Gastrectomy
Sleeve Gastrectomy was
originally developed as the first stage of a two stage malabsorptive
procedure in high-risk patients. Surgeons found that if they removed
three-quarters of the stomach, left the patients to lose weight,
then came back and finished the operation, the death rate was much
lower. However, some patients did quite well even without the second
procedure, although the majority did have some weight regain long
term.
In this relatively new operation, 2/3 of the stomach is removed laparoscopically. This severely restricts intake for the first year. Because there are no joins, its seems safer than a bypass, but still has a complication rate from leaks and bleeding. The advantages are that there is less malabsorption of minerals and vitamins. People do sometimes get reflux for prolonged periods afterwards. Weight loss after a year is about 67% of excess weight, but there is a tendency to regain weight after this. Patients are in hospital for 2-3 days.