Abington Memorial Hospital's Institute for Metabolic and Bariatric Surgery
Surgical Weight Loss Procedures
The surgical weight loss procedures result in a pouch that restricts the amount of food patients can consume and/or reduces the amount of calories and nutrients the body can absorb.
The Roux-en-Y Gastric Bypass Procedure
The Roux-en-Y Gastric Bypass Procedure is currently the most frequently performed surgery for long-term surgical weight loss management in the United States. We offer the Roux-en-Y Gastric Bypass procedure as a traditional surgical procedure, a minimally invasive laparoscopic approach or with the use of robotic technology, depending on each patient's characteristics.
First performed in 1967, the surgical procedure creates a stomach pouch out of a small portion of the stomach and attaches it directly to the small intestine, bypassing a large part of the stomach. This procedure limits both food intake and the amount of fat, calories and nutrients absorbed to help achieve permanent weight loss. Afterwards, hunger or cravings will be satisfied with smaller portions of food.
One of the predominate procedures of weight loss surgery, Roux-en Y Gastric Bypass achieves excellent results in terms of permanent weight loss — often as high as 75 percent of excess body weight. The procedure also boasts exceptional results in the reduction or elimination of related diseases — reducing the chances of diabetes by 84 percent in most patients.
Adjustable Gastric Banding
Adjustable Gastric Band is a surgical weight loss aid placed around the upper part of the stomach to create a small pouch, which can only hold a small amount of food-thus restricting the amount of food consumed at any given time. The lower, larger part of the stomach remains below the band. A small outlet created by the band connects both parts. Food passes through the outlet from the upper stomach pouch to the lower part more slowly, enabling patients to feel full both earlier and longer. Both the amount of food a patient eats and his or her appetite is reduced. Adjustable Gastric Banding allows your surgeon to easily change the size of the opening after the procedure. Following three clinical trials, the procedure was approved by the FDA as a treatment for morbid obesity in 2001.
An alternative to a gastric bypass, the procedure has a very low complication rate, with shorter recovery time. Best results occur for patients with BMIs between 40 and 50. Typically, it's performed as an outpatient procedure, but an overnight stay may be required. The Adjustable Gastric Banding procedure is also reversible and considered safer for patients over age 65.
However, compared to the Roux-en Y Gastric Bypass, which yields a loss of excess body weight as high as 75 percent, Adjustable Gastric Banding produces a slower and less overall weight loss, at around 35 to 40 percent excess body weight. Strong patient commitment and frequent follow-up is required. A port that allows the surgeon to make adjustments remains permanently just beneath the abdominal skin surface. There is also a small chance that another operation will be needed sometime in the future.
Biliopancreatic Diversion with Duodenal Switch
The Biliopancreatic Diversion with Duodenal Switch procedure, also known as malabsorptive weight loss, changes the normal process of digestion by making the stomach smaller and allowing food to bypass part of the small intestine, so that you absorb fewer calories.
In a Biliopancreatic Diversion with Duodenal Switch, a smaller portion of the stomach is removed, but the remaining stomach remains attached to the duodenum (the upper part of the small intestine). The duodenum is connected to the lower part of the small intestine. This procedure is typically performed with a minimally-invasive laparoscopic approach — using small instruments and a camera to guide the surgery — but can also be performed using robotics. Biliopancreatic Diversion with Duodenal Switch is the most effective procedure, as the total excess body weight loss is as high as 80 percent, with only a five to eight percent chance of regaining weight. The procedure also boasts a 99.7 percent reduction of non-insulin diabetes.
Vertical Sleeve Gastrectomy
Vertical Sleeve Gastrectomy is a purely restrictive operation that generates weight loss by limiting the amount of food (and therefore calories) that can be eaten. The stomach is restricted by dividing it vertically and removing 85 percent or more, without bypassing the intestines or causing any gastrointestinal malabsorption.
The procedure significantly reduces the size of the stomach — eliminating the portion that produces the hormone that stimulates hunger (Ghrelin) — but still allows the stomach to function normally so most food items can be consumed, although in small amounts. By avoiding the intestinal bypass, the chance of intestinal obstruction, anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated, making the surgery an appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
On average, patients who undergo the Vertical Sleeve Gastrectomy procedure experience a 60 to 80 percent loss of excess weight. It is currently indicated as an alternative to the Adjustable Gastric Banding procedure for lower weight patients and as a safe option for patients with a higher BMI.