Gastric Banding

LGB
  • Least invasive among the other bariatric procedures
  • Technically a reversible procedure ( Removal of band causes weight gain)
  • Good % of excess weight loss (EWL) (40-50 %)
  • Does not create any major disturbance in anatomy as in other bariatric procedures
  • Ideal for young patient who does not want to undergo a Major (Malabsortive) procedure and is ready to exercise.
  • Definite improvements in associated co-morbities
LGB LGB

Precautions:

  • To be done with caution in patients who have bread, pasta, refined flour as in Maida.
  • High liquid calorie consumption Alcohols and colas.
  • Older patients unwilling to exercise.
  • Gastric outlet obstruction
  • Large hiatus hernia
  • Manometry studies showing esophageal dysmotility

Roux En Y Gastric Bypass

LRYGBP
  • An excellent procedure for patients with higher BMI, type II diabetes and other morbidities, excellent results in the low BMI type II diabetics.
  • A good procedure for sweet eaters, low volume eaters
  • Procedure of choice for patients with hiatus hernias
  • A good procedure for band failures and VBG and sleeve with inadequate weight loss.
  • Excess Weight loss up to 70-80 %
LRYGBP

Precautions:

  • Smokers – Risk of ulceration of Gastro-jejunal anastomosis
  • Patients with inability to take lifelong multivitamin supplements.
  • To be avoided in patients with small bowel conditions like Crohn`s disease

Sleeve Gastrectomy

LSG

A good effective procedure as a sole choice of procedure in patients who are

  • Volume eaters
  • Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts.
  • Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
  • No dumping syndrome because the pylorus is preserved.
  • Minimizes the chance of an ulcer occurring.
LSG
  • By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated.
  • Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2).
  • Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2).
  • Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
  • Can be done laparoscopically in patients weighing more than 500 pounds
LSG

Absolute Contraindications:

  • Gastric outlet obstruction
  • Large Hiatus Hernia
  • Manometry showing a lax esophageal sphincter

Disadvantages Of LSG

  • Potential for inadequate weight loss or weight regain. While true for all procedures, it is theoretically more possible with procedures without intestinal bypass.
  • Higher BMI patients will may need to have a second stage procedure later to help lose all of their excess weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons.
  • Soft calories from ice cream, milk shakes, etc., can be absorbed and may slow weight loss.
  • This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
  • Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.
  • Considered investigational by some surgeons and insurance companies.

Mini Gastric Bypass

  • Mini Gastric Bypass was originally performed by Dr. Robert Rutledge in North Carolina, USA in 1997.
  • It involves making the stomach smaller like a sleeve and connecting it to the small intestine at about 6 to 8 feet from the starting point of the intestine.
  • This gives restriction and decreased absorption at the same time.
  • Mini Gastric Bypass show that it is either equivalent to or better than the traditional gastric bypass.
  • MGB is a relatively safer procedure amongst all the available bariatric surgeries at present.
  • Mini Gastric Bypass is now becoming more and more popular in different corners of the world.

Intra-gastric Balloon:

LTG
  • As a one stage procedure for a weight loss of 5-10 kgs in low BMI with or without co-morbidities in patients not warranting any other bariatric surgery.
  • As an initial procedure in the super super obese category BMI>60 to gain weight loss of 20-40kgs before planning definitive surgery.
  • As an initial procedure for patients unfit for anesthesia to loose weight.