Your surgeon will determine if you are a good candidate for minimally invasive bariatric surgery. Your surgeon will decide how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference.
Surgical approaches to restrictive bariatric procedures
A restrictive procedure helps you lose weight by reducing the size of your stomach and the amount of food you can eat. Procedures include:
- Adjustable gastric banding (AGB, Lap-Band surgery, gastric band surgery) involves attaching an inflatable band (called a gastric band) around the top portion of the stomach. The surgeon tightens the band like a belt to form a smaller stomach. Your physician adjusts the size of the stomach by adding or removing saline (salt water) to the band through a port. The port is inserted in the tissue just under your skin in your abdominal wall.
- Vertical sleeve gastrectomy (VSG, gastric sleeve surgery, gastric sleeve resection, tube gastrectomy) involves removing part of the stomach and using staples to create a smaller tube-shaped stomach. It is the first step of a two-step surgery. The second surgery is a Roux-en-Y gastric bypass (RYGB) or less commonly, a biliopancreatic diversion with a duodenal switch (BPD). The second surgery is performed after the patient has lost sufficient weight to be healthy enough to undergo this more complex procedure. In some cases, VSG by itself has been shown to be effective in achieving significant and fast weight loss.
Surgical approaches to malabsorptive/restrictive bariatric procedures
A malabsorptive/restrictive procedure helps you lose weight by reducing the size of your stomach and the amount of food you can eat. It also changes the normal digestion process. This reduces the amount of calories and nutrients that are absorbed into the body. Procedures include:
- Biliopancreatic diversion with a duodenal switch (BPD-DS, duodenal switch) is performed by removing part of the stomach and using staples to create a smaller tube-shaped stomach (vertical sleeve gastrectomy). In another surgery, the stomach is attached to the middle of the small intestine. Food then bypasses a large part of the small intestine, reducing the amount of calories and nutrients that are absorbed into the body. Bile and other digestive juices are also diverted to further reduce digestion. This is a high-risk surgery that is less commonly performed due to many of the potential long-term health risks.
- Roux-en-Y gastric bypass (RYGB) involves stapling the stomach to create a small pouch that holds less food. The new stomach pouch is attached directly to the middle of the small intestine. This allows food to bypass much of the stomach and the first section of the small intestines. This reduces the amount of calories and nutrients that are absorbed into the body.
Types of anesthesia that may be used
General anesthesia is used for bariatric surgery. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain.
What to expect the day of your bariatric surgery
The day of your surgery, you can generally expect to:
- Talk with a nurse who will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
- Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
- Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
- A surgical team member will start an IV.
- You may be given an injection of blood thinner to reduce the risks of blood clots during surgery
- The anesthesiologist or nurse anesthetist will start your anesthesia.
- A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
- The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and during recovery until you are alert, breathing effectively, and your vital signs are stable.
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