Procedures

Home > Services > Bariatric Surgery > Procedures

Procedures

At Centra, the bariatric procedure that you get will be the right one for you. There are three common procedures (gastric bypass, sleeve gastrectomy, and laparoscopic banding), and all three are now offered at Centra.

Gastric bypass

Gastric bypass
Gastric bypass

Roux en Y gastric bypass, or “gastric bypass,” (Figure 1) has been used since the late 1960s as a weight loss procedure and until recently was the most commonly performed bariatric procedure in the United States.


In gastric bypass, the upper portion of the stomach where food would first enter is stapled and separated from the remaining portion of the stomach during surgery. This stomach “pouch” holds approximately 1 to 2 ounces of food or fluid (about the size of a golf ball or egg) and creates a sensation of fullness or “satiety”, after a very small meal. The small intestine is redirected to accept food from this small stomach pouch.


The remaining stomach (called the “remnant” or “excluded stomach”), duodenum and the initial part of the jejunum stay in place and continue to make digestive juices, but are “bypassed,” resulting in a different kind of journey for our food and digestive juices. This change causes some natural chemicals (hormones) to circulate through the body that make a person feel less hungry, more full and promote blood sugar control and more energy burning.

Weight loss


Gastric bypass yields an estimated excess weight loss of 70-85 percent at one year.


Reversibility


This procedure is considered irreversible, but in rare cases can be reversed for a life-threatening medical need.

Gastric bypass causes food to skip the duodenum, where most iron and calcium are absorbed, so the risks for nutritional deficiencies become higher.

Laparoscopic sleeve gastrectomy

Laparoscopic sleeve gastrectomy
Laparoscopic sleeve gastrectomy

Sleeve gastrectomy is a stapling procedure where approximately 80 percent of the stomach is surgically removed, resulting in an evenly sized tubular stomach, or “sleeve”.


The sleeve holds approximately 3 to 4 ounces of food or fluid. This change to the stomach creates a sensation of fullness, or “satiety,” after a very small meal.

The portion of stomach removed contains many cells that produce a hormone called ghrelin, which is associated with the sensation of hunger. Some patients do report feeling less hungry after this weight loss procedure.

Weight loss


Sleeve gastrectomy yields an estimated excess body weight loss of 50 to 70 percent by one year after surgery.


Reversibility


This procedure is not reversible. Once the larger portion of stomach is removed, it cannot be put back into the body.

Laparoscopic adjustable gastric band

Laparoscopic adjustable gastric band
Laparoscopic adjustable gastric band

Gastric banding uses the LAP-BAND® System, which is an adjustable band that buckles around the top of the stomach, narrowing the opening to the remaining larger portion of the stomach. A 1 ounce “pouch” is created at the top of the stomach where the band is placed.

Adjustments

The inside surface of the band has an adjustable balloon that is connected by tubing to a port. Adjustments to the balloon are made by inserting a needle containing fluid into the port that permanently rests underneath the skin of the abdomen. Nothing “sticks out” of your skin, but you and your surgeon may be able to feel the port under the skin.

The injection of more fluid into the port causes the balloon to inflate narrowing the passageway for food. Removing fluid deflates the balloon and widens the passageway. The concept is to create anatomy that provides a sensation of fullness or “satiety,” after a very small and slow meal.

Think of this as an “hourglass” shape and function of the stomach: if you have a very wide-open middle part of the hourglass, everything drops through quickly and the upper part of the hourglass doesn’t feel “full.” If the hourglass is too narrow in the middle, everything is stuck and can’t make it through to the lower part. The key is finding the middle ground, where a small meal takes some time to move through the narrow spot, not too tight and not too loose.

Weight loss


Weight loss is often less than the gastric bypass or sleeve procedures. Estimated excess body weight loss at two years is about 40 to 50 percent. This means, of the extra weight a person is carrying, they may lose up to half of it over a few years’ time.
You are expected and required to be seen by your bariatric doctor every four to six weeks for the first year to achieve adequate restriction by adjusting the band.


Reversibility


No cutting, reconnecting or re-routing of the stomach or intestines is required. Also, the adjustable gastric band is removable, although weight may return quickly after the band is removed, so removing the band is not recommended unless a complication has developed with the band.