Diet and Weight Loss Weight Loss Surgery

Weighing the Decision to Have Obesity Surgery

What does gastric banding involve?
Gastric banding, which is called a Lap-Band when done laparoscopically, is a purely "restrictive" operation where a band goes around the top of the stomach. We can adjust the band in the office with a needle that goes under the skin that allows us to inject fluid into the band. The more fluid in the band, the tighter the band will be.

This operation works by limiting, or restricting, the amount of solid food that a patient can eat by making them feel full quicker when they eat solid food. This procedure however, does not do anything to limit high calories from liquid or junk food. These foods will pass right through relatively unrestricted and then get absorbed, so patients have to voluntarily stay away from those foods.

Some patients clearly do better with this surgery, some do worse. For example, eating too much or not chewing food well can cause vomiting, so some patients deal with this by taking the easy way out, which is to have liquid calories or soft foods.

What does gastric bypass involve?
The gastric bypass is a more complex operation. The stomach is divided into two parts using a stapler, creating a small upper pouch and a large lower pouch. We then bring up a limb of intestine and sew it to that smaller stomach pouch so it empties from a small opening directly into the intestines. The large pouch is bypassed so food doesn't get partially digested before going into the intestine. This procedure also causes early satiety and a hormonal reaction that may cause less food intake causing the patient to eat less and lose weight.

One of the side effects from this surgery occurs when food moves too quickly though the intestine, usually from having sweets and fats. So if a patient has a couple scoops of ice cream after a gastric bypass, they will get what we call dumping syndrome. This causes lightheadedness, dizziness and a sense of tiredness. If they eat too much fat, they can get abdominal cramps and diarrhea. So this operation does not limit solid food intake as tightly in the long run as banding surgery, but it has a force that keeps you away from the sweet and junk foods.

What is a biliopancreatic diversion?
Biliopancreatic diversion, or another version of the operation called duodenal switch, involves removing three-quarters of the stomach and bypassing more of the intestine than you do with a gastric bypass. So it is more dramatic. It has more risks of complications upfront and it has significantly more risk of nutritional consequences because you are not able to absorb enough of the main nutrients that your body's needs, especially proteins.

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