As one of the newer standalone stapled weight loss procedures, the gastric sleeve has quickly become the most popular bariatric surgery in the United States. It is a straightforward procedure that removes 70-80% of the existing stomach pouch in a vertical manner, using restriction alone to achieve long-term results similar to the gastric bypass. The gastric sleeve does not alter the small intestine in any way.

How It Works

The gastric sleeve is a surgical weight loss procedure that permanently removes approximately 75-80% of the stomach. This laparoscopic procedure makes the sleeve long and tubular, resembling a “banana shape” allowing the stomach to remain intact with no part of the intestine modified or bypassed.

The sleeve benefits patients by removing the fundus of the stomach, which produces much of the “appetite hormone” ghrelin. As a result, patients receive additional help suppressing their hunger or appetite.

As with all surgical procedures, there is a degree of risk which may be exacerbated by poor health due to obesity.

Results of the Gastric Sleeve

Typical weight loss in the average patient may range from 50 to 75%, and many patients may see an improvement or elimination of type II diabetes, high cholesterol, high blood pressure and sleep apnea. While the gastric sleeve offers more modest weight loss rates versus the gastric bypass, long-term excess weight loss and maintenance is almost the same.

Potential Benefits of the Gastric Sleeve:

• Lower incidence of long-term complications compared to gastric bypass surgery
• Excess weight loss results are exceptional
• Obesity-related disease improvement rates are excellent
• No implants as with gastric banding
• Performed laparoscopically, and with robotic assist in some cases, which means less pain, less blood, generally fewer initial complications and a short hospital stay
• Less maintenance compared to the gastric band

After Gastric Sleeve Surgery

Typically, the sleeve requires an overnight stay, a day shorter than the gastric bypass and longer than gastric banding (an outpatient procedure). Once home, patients will limit strenuous activities according to their postoperative guidelines. Patients typically return to work within 2-3 weeks and normal activities within 6 weeks, with surgeon approval.

Gastric sleeve patients take a multi-vitamin supplement for the rest of their lives and follow a diet and exercise program that combines moderation and nutritional balance.

Our program’s approach is to re-educate the patient in order to adapt to the new post-surgery lifestyle. Food budgeting, exercise, vitamins, portion control, speed at which one eats, and behavior modifications will be important lessons and topics during your visits and support sessions.

Long considered the gold standard in bariatric surgery, the gastric bypass offers the greatest excess weight loss and obesity related disease resolution potential of any of the procedures we offer. The bypass works by both limiting the amount of food the patient can eat (restriction) and limiting the number of calories absorbed through the small intestine (malabsorption). It can be particularly useful for those suffering from uncontrolled type-2 diabetes or acid reflux.

About the Procedure

Gastric bypass is generally performed in a minimally invasive (laparoscopic) manner. This means that specially-made surgical tools, including a high definition camera, are passed through tiny incisions in the abdomen.

During surgery, your surgeon creates a small gastric pouch by dividing the stomach. This new pouch limits food intake (portion control). The surgeon then attaches a section of the small intestine (jejunum) directly to the new pouch. This allows food to bypass a portion of the small intestine (duodenum), which normally absorbs calories and nutrients. Having the smaller stomach pouch causes patients to feel full sooner and ultimately eat less food; bypassing a portion of the small intestine means the patient’s body absorbs fewer calories.

Unlike the gastric sleeve, the larger portion of the stomach is not removed from the abdomen. Rather, it remains, without accepting food, but continuing to produce digestive enzymes that are delivered to the intestine. As you eat less food and absorb fewer calories, your body may stop storing excess calories and start using its fat supply for energy.

Results of the Gastric Bypass

The gastric bypass is a very effective weight loss tool with potential excess body weight loss of typically upwards of 80%. The bypass is also effective in eliminating or improving many of the diseases associated with morbid obesity. The gastric bypass is particularly effective for those suffering from type-2 diabetes, which in many cases, will go into remission within days or weeks of surgery. The mechanism by which the gastric bypass improved diabetes so quickly, even without appreciable weight loss, was largely unknown. However, researchers now believe that the modifications to the small intestine may rebalance the patient’s gut bacteria.

Patients with severe and uncontrolled acid reflux may benefit as well.

Typical Benefits of the Gastric Bypass Include:

• Patients report an early sense of fullness and satisfaction that reduces the desire to eat.
• Patients generally lose more weight sooner than patients who undergo purely a restrictive procedure.
• Obesity related disease resolution rates are excellent.
• It can be performed laparoscopically, which means less pain, less blood loss, and shorter hospital stay.
• Built in negative feedback reinforcement with Dumping Syndrome, which produces rapid movement of food through the small intestine leaving the patient uncomfortable. This provides warnings signs that too much sugar and fat is being consumed, thus reinforcing healthy food choices.

Considerations and Risks of the Gastric Bypass

The Gastric Bypass is still a major surgery and comes with a degree of surgical risk which may be exacerbated by a patient’s poor health due to obesity.

• If any staple line begins to leak, the results could be bleeding or infection in the abdomen, which requires emergency care and surgery.
• The Gastric Bypass is treated as a permanent approach and is not adjustable. However, the procedure can be revised if it does not produce the desired results.
• There will be a hospital stay with this procedure.
• There are potential risks of anastomotic leaks; fistulas; intestinal irritation and ulcers; Dumping Syndrome; vitamin and mineral deficiencies such as iron, chronic anemia, vitamin B12 and calcium. This will require lifelong vitamin supplementation. It may also present lifelong difficulty in visualizing the lower stomach and segments of the small intestine when using endoscopy.

After Gastric Bypass Surgery

The typical hospital recovery time after a gastric bypass requires one to two days. Once home, patients will practice appropriate wound care and limit strenuous activities according to their postoperative guidelines. Most patients return to work within 2 weeks and normal activities can be resumed within 6 weeks, with surgeon approval.

Like other bariatric surgeries, gastric bypass patients will take a multi-vitamin supplement for the rest of their lives. Patients will likely take additional supplements because of the limited absorption of nutrients in the small intestine. These may include Vitamin D, Calcium, Vitamin B12, Iron and more. Periodic blood tests will ensure that any nutritional deficiencies are found and addressed appropriately. As with any bariatric post-op program, patients will follow a diet and exercise program that combines moderation and nutritional balance.

Our program’s approach to food budgeting, exercise, vitamins, portion control, speed at which one eats, and behavior modification such as refraining from drinking while eating is exactly the same regardless which procedure is chosen.

As is possible with any surgical procedure, bariatric surgery does not always turn out as planned. While complication and mortality rates have steadily decreased over the years, on average, it is important to remember that these procedures are complex and serious, and for one reason or another, may fail at some point in the future.

When a patient expresses to us that they are unsatisfied with the results of their past bariatric procedure, we begin by analyzing their diet and exercise regimen. Post-surgery lifestyle changes are a key component of success after bariatric surgery and some patients may not have been ready to undertake critical lifestyle changes such as modified eating and improved workout habits. If this is the case, then revision surgery will not be performed. Rather, we will work with the patient to analyze possible problem areas and develop a comprehensive plan to address them.

In some cases, the primary procedure may have failed due to gastrointestinal anatomical problems or a case where the surgery was not appropriate for that particular patient. In situations like these, the most important next step is to figure out why the procedure failed. Upon learning the underlying reason, and then approving a patient for revision surgery, we must then evaluate the options available to them.

When to Call Us

Just as in a patient’s pre-bariatric lifestyle, weight will fluctuate. These fluctuations may be caused by temporary dietary changes, menstrual cycles and a multitude of other factors. However, when the ups and downs become rapid and significant, this may warrant a call to our office. We suggest that all our patients keep a journal of their diet and exercise regimens. Another useful factor to journal is mood. Stress, anxiety, sadness and even happiness can all contribute to weight gain, as we often use food both to medicate and celebrate. The bottom line? Discuss your challenges in a support group or call our office if you believe something is not right. We’re here to help.

The Most Common Bariatric Surgery Revisions

Gastric bypass revisions are most often employed to correct stretching of the gastric pouch or stoma. This can happen slowly over time as the stomach is a very adaptable organ. There are several remedies to address this issue that can include minimally invasive and endoscopic (no incision) procedures. Patients should be aware that after they reach their goal weight, they may gain back 5-10% of their excess body weight loss – this is natural and does not require a revision.

The sleeve gastrectomy, or gastric sleeve, removes a significant portion of the stomach pouch, but can be revised by converting into a gastric bypass. In doing so, we add a malabsorptive (restriction of the absorption of nutrients in the intestine) component to the sleeve. This combination can offer the jump-start a patient needs to get back on track.

The gastric band can be revised to virtually any other procedure, assuming that the patient qualifies. Remember, some patients can qualify for a Lap-Band with a BMI of as low as 30 – it is important to remember that these patients may not qualify for a stapled procedure. Since the band does not permanently alter any part of the digestive tract, the original band can be replaced or the band can be removed and a stapled procedure such as a gastric bypass or gastric sleeve can be performed.

Revision surgery should not be taken lightly. These surgical procedures are still major surgery and come with all the risks associated with any other bariatric procedure. In fact, the risks of the revision procedure are actually heightened due to the fact that the patient will have already had abdominal surgery. Risks of complications may also be greater. While we do not encourage patients to revise their primary bariatric procedure in every case, we do understand that it is important and necessary in some. We will help you determine if your case qualifies for a revisional bariatric procedure and discuss solutions according to your specific need.

This effective weight loss procedure is additional to the sleeve gastrectomy. The lower intestine is divided much further downstream than a gastric bypass to the point of the duodenal. This operation can be performed in two stages: sleeve gastrectomy first, followed 9-12 months later by the intestinal bypass.

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Duodenal Switch Surgery -- Texas Health Flower Mound

Advantages of Duodenal Switch Procedure:

• Greater weight loss than all other bariatric procedures
• Preferred for patients with BMI>45
• 60 - 70% excess weight loss
• Patients eventually eat normal-sized meals
• Reduces fat absorption by 70 percent
• Gut hormones changed to reduce appetite and improve satiety
• Most effective against diabetes and hypertension
• Offers solutions for people who have regained weight after lap band, gastric bypass or sleeve surgeries have not worked for them

The Biliopancreatic Diversion with Duodenal Switch is a surgical procedure with two components. Similar to the sleeve gastrectomy, a large portion of the stomach is removed leaving a small, tubular pouch. Next, the duodenum or entrance to the small intestine is split and redirected to the base so food bypasses most of the organ.

The divided small intestine is then joined at the bottom allowing maximum digestive juices to mix with food for a much shorter period but long enough for some fat absorption to take place.

The restrictive component of the Duodenal Switch is achieved by partial gastrectomy which reduces the size of the stomach.

The malabsorptive component of the Duodenal Switch is achieved by rearranging the small intestine to separate the flow of food from the area of bile and pancreatic digestive juices. Food bypasses most of the area where chemical breakdown and calorie absorption normally occurs.