Surgical Weight Loss Therapies
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Weight loss (bariatric) surgery is an option for many significantly obese individuals (those who are 80 or more pounds overweight) and in many cases offers the best hope for successful weight loss and improved health. NewYork-Presbyterian’s surgeons are leaders in bariatric surgery and pioneered the concept of “metabolic surgery”: the use of weight loss surgery to achieve improvements in diabetes, high blood pressure, and high cholesterol/triglycerides. Our clinical and preclinical research has clarified how bariatric surgical techniques influence the regulation of hormones to improve overall health, not just achieve a reduction in body weight.
A Team Approach to Weight Loss Surgery
Your team includes surgeons, gastroenterologists, endocrinologists (hormone specialists with experience in medical weight loss approaches), registered dietitians, and other healthcare professionals who collaborate to select the weight loss surgery best suited for you. We typically perform these operations using minimally invasive laparoscopy, resulting in small incisions, less pain after surgery, and a quicker recovery and return to your normal activities.
Sleeve gastrectomy, now the most common weight-loss operation in the United States, is a surgical procedure in which the stomach size is reduced to the shape of a banana or “sleeve,” restricting the amount of food you can eat.
- How it is performed. The surgeon removes 60 to 75 percent of your stomach. Although originally devised as the first stage of a two-stage procedure for super-obese or high-risk patients, we now commonly use sleeve gastrectomy on its own to achieve weight loss in people with a body mass index (BMI) over 40.
- Sleeve gastrectomy effectiveness. People undergoing this procedure usually lose 50 to 65 percent of their excess body weight over a 6-12 month period. When performed alone, sleeve gastrectomy also decreases the production of the hormone ghrelin, reducing feelings of hunger and resulting in weight loss comparable to gastric bypass.
Roux-en-Y Gastric Bypass Surgery
Gastric bypass, also known as Roux-en-Y gastric bypass, is the most proven and “time-tested” successful weight loss surgery in the United States. NewYork-Presbyterian surgeons have more than two decades of experience performing this procedure.
- How it is performed. Your surgeon creates a small pouch in the top of your stomach that forms a “new stomach,” limiting the amount of food you can eat during a meal and helping you feel fuller sooner. The surgeon then creates a small opening, or stoma, in the pouch and attaches that opening to a section of your small intestine. The reconnected intestine causes food to bypass part of the intestine, so some of the nutrients and calories will not be absorbed. The altered anatomy also leads to changes in your hormones which further helps you to feel full sooner and treats diabetes.
- Gastric bypass effectiveness. Most people lose 50 to 70 percent of their excess body weight within 12-18 months after surgery, with most of that loss sustained over the next ten years. Many obese people with diabetes find that with this surgery, their diabetes resolves rapidly—sometimes within days or weeks.
Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
Biliopancreatic diversion with duodenal switch (also called a duodenal switch, or BPD-DS) is a complex procedure that promotes weight loss by combining two procedures: sleeve gastrectomy, to reduce food intake; and intestinal bypass, to limit absorption in the intestine. Plus, it combines the hormonal changes of both operations and is very effective against diabetes.
- How it is performed. With this procedure, the surgeon removes about 60 to 70 percent of your stomach so that it takes the shape of a banana (sleeve gastrectomy). The lower intestine is then divided much further downstream than with gastric bypass so that two-thirds or more of the intestine is bypassed, leaving only a few feet of the intestine where food and digestive enzymes meet; this is the intestinal bypass portion of the operation. The name “duodenal switch” comes from the fact that in this operation, the intestinal bypass starts at the duodenum (the first part of the intestine), which is divided and attached to the lower portion of the small intestine (the ileum).
- Duodenal switch effectiveness. Most people lose 60 to 80 percent of their excess body weight over a two-year period, with 70 percent of the weight loss sustained beyond ten years.
Single Anastomosis Duodenal Switch (SADI/SIPS)
Similar to BPD-DS, the single anastomosis duodenal switch — also known as single anastomosis duodeno-ileal bypass (SADI) or stomach intestinal pylorus-sparing surgery (SIPS) — has the dual effect of restricting stomach size as well as inhibiting the absorption of some nutrients to help you achieve and maintain your weight loss goals. In this procedure, however, the intestine is rerouted at a single point. The effective bypass in this procedure is slightly less than that of a traditional duodenal switch, yet still induces significant weight loss. This approach minimizes long-term nutritional deficiencies. SAID/SIPS is a simpler procedure than BPD-DS and is more effective than sleeve gastrectomy alone.
Laparoscopic Gastric Banding
Adjustable gastric banding (Lap-Band or Realize Band) is less invasive than other procedures, in that neither your stomach nor intestine is cut. Instead, a band is placed around your stomach that can be adjusted to restrict the amount of food you eat before feeling full.
- How it is performed. Your surgeon places an adjustable band around the upper part of your stomach to create a small pouch above the band. By adding fluid to the band after you recover from surgery, the surgeon adjusts the size of the opening between the smaller, upper pouch and the remaining lower portion of your stomach. The tightness of the band opening controls the passage of food between the two parts of your stomach, giving you a feeling of fullness after eating that lasts significantly longer than it would without the band. Your surgeon works closely with you to tailor the band adjustment to your needs.
- Gastric banding effectiveness. Losing weight after adjustable gastric band surgery is more gradual than with gastric bypass. You can expect to lose 40 to 50 percent of your excess weight within two years of surgery. The amount of weight lost depends on how you adapt and maintain new eating habits, regular exercise, and follow-up with your care team. Short-term and especially long-term results are not as good as those achieved with other surgical weight loss operations, but better than those associated with endoscopic treatments.
What If I Need Weight Loss Surgery Again?
Revisional surgery is an option for some people who have already undergone a weight loss procedure and need another one to repair the first one, or for those who have gained weight or have not lost enough weight after the first operation. NewYork-Presbyterian surgeons are among the most experienced in the region — having performed revisional procedures for nearly two decades — and have created procedures that lower the risk of a second surgery. Most often, patients need a revision surgery to convert an older weight loss procedure to a more modern, effective one, such as the Roux-En-Y gastric bypass or a duodenal switch.