When you eat or drink before surgery, food travels down your esophagus into your stomach, which can stretch to about the size of a football. From there, it passes into the first part of the small intestine, the duodenum. Many vitamins and minerals, as well as some carbohydrates are absorbed in the duodenum. Next food moves into the rest of the small intestine where most of the absorption takes place before moving to the colon, or large intestine, before being excreted.
For the gastric bypass, a small, 1-ounce pouch is created at the top of the stomach, completely separate from the larger stomach remaining. The pouch can only stretch to the size of a small lemon. The small pouch releases food slowly into your digestive system, resulting in the sensation of fullness with very little food intake. The new opening to your small intestine from your stomach is called a stoma. It is very small, about as big as the end of your pinky finger or nostril. Everything you eat after surgery must be able to fit through that hole.
The next step in the surgery is to divide and then reattach the small intestine. Bypassing part of the intestine creates malabsorption, which further reduces calories and promotes weight loss.
Another procedure we use is called adjustable gastric banding. Unlike gastric bypass surgery, this procedure is minimally invasive and does not involve rerouting the small intestines, but also uses a band to close off a portion of the stomach to create a small pouch. This makes it feel like the stomach is much smaller than it actually is and restricts overeating, so it's another good way for patients to lose excess weight fairly quickly. The band can also be adjusted over time to control the size of the stomach.
In this procedure, 80 percent of the stomach is removed laparoscopically so that the stomach takes the shape of a sleeve, approximately the size of a banana. There's no rerouting on the intestines, so there is no malabsorption. It is a purely restrictive operation like the band, but generally produces weitht loss more like that of a gastric bypass because the stomach can only hold about six ounces of food.
The gastric bypass is considered the gold standard of weight loss surgeries for two reasons. It is restrictive, meaning you simply can't put much food in your pouch and it is malabsorptive, meaning you don't absorb as many calories because the duodenum is bypassed. Weight loss results when you consume fewer calories than the body burns. If you eat more calories than your body needs and don't exercise, you gain weight.
Weight loss with the adjustable gastric banding is much slower, about 1-3 lbs/week. However, unlike the bypass, the band can be adjusted and weight loss can continue indefinitely. The band can be loosened for pregnancy or during illness and then tightened again when weight loss can continue. At the 5-year point, patients can lose the same amount of weight with either procedure.
Studies show that virtually all patients undergoing the gastric bypass experience significant relief from obesity-related conditions such as diabetes, hypertension, arthritis, reflux and sleep apnea. Typically, 50-60% of excess weight is kept off even after 5 years. Long-term research shows that satisfaction with the procedure is directly related to the amount of weight lost. The patient's commitment to maintaining new diet and exercise behaviors is crucial for success. The surgery is one tool to help reach a healthy weight and lifestyle.
With the adjustable gastric banding, patients also can lose 54-75% of excess body weight and can show significant improvement in related diseases such as reflux, heart disease, high blood pressure, diabetes and sleep apnea.
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Waukegan, IL 60085