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Types of Weight Loss Surgery 

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There are several different types of surgical procedures for weight loss available at Sentara Northern Virginia Medical Center. These procedures are broken into two main categories; Restrictive and Malabsorptive/Restrictive surgeries.

A majority of the weight loss procedures Sentara offers are Restrictive Weight Loss Surgeries. These types of surgeries limit the ability of the stomach to store food. Additionally, the Roux-en-Y procedure is also a Malabsorptive Surgery, which works by altering digestion.

Restrictive/ Minimally Invasive Weight Loss Surgery

Our weight loss surgeons typically perform weight loss surgery by laparoscopic ("keyhole") techniques, which include some of the most common types:

 Laparoscopic Roux-en-Y gastric bypass

 Laparoscopic sleeve gastrectomy

 Laparoscopic adjustable gastric banding (LAP-BAND® and Realize® Band)

Roux-en-Y gastric bypass, sleeve gastrectomy and gastric banding have been shown to be safe and effective for weight loss.

During laparoscopic surgery, the operation is performed by placing thin, long instruments and a small, lighted telescope through several small incisions (each less than half (.5) an inch) in the abdomen. In select patients, the mini-incision open surgery is performed through a single four-inch incision at the upper abdomen.

Compared with the traditional long abdominal incision, these smaller incisions are less painful, faster to heal, and have lower risk of infection and hernia formation.

Types of Minimally Invasive Weight Loss Surgery

Roux-en-Y Gastric Bypass

Illustration of gastric bypass surgeryDuring gastric bypass, the stomach is completely divided into two sections - a small working section called the "pouch" measuring approximately 20 to 30 cc (the size of a hard-boiled egg) and a larger, excluded (bypassed) portion of the stomach.

Over time, the larger, excluded portion of the stomach will shrink slightly but will not cause any problem. Although not receiving food, the larger stomach is still producing acids and other digestive juices along with channeling bile and pancreatic enzymes down the intestine for digestion.

The working pouch is so small that it can hold only one to two ounces of food. When food is consumed, the pouch fills quickly creating the feeling of fullness, even though the remaining stomach is empty.

The small intestine is also divided. One end, the Roux segment, is connected to the pouch so the food can pass from the pouch into the small intestine for digestion, thus bypassing the stomach. The other end, the biliopancreatic segment (the continuation of the duodenum), is connected further down the small intestine for drainage of bile and digestive enzymes.
The outlet between the pouch and the intestine is deliberately made small in order to delay the time it takes for food to pass through it. With the small pouch and slow transit time, a small amount of food can make you feel full for a long time.

Surgery takes about one-and-a-half to two hours and patients typically stay in the hospital two to three days. Most patients are able to return to work after two to three weeks. 

Illustration of sleeve gastrectomy

Sleeve Gastrectomy

In sleeve gastrectomy, approximately 75 percent of the stomach is removed permanently, leaving a cylindrical or sleeve-shaped stomach. The outlet valve and the nerves to the stomach remain intact.

While the stomach is drastically reduced in size, its function is preserved. Sleeve Gastrectomy surgery takes about two hours and patients typically stay in the hospital for two days. Most patients are able to return to work after two weeks. 

Laparoscopic Adjustable Gastric Banding (LAP-BAND® or REALIZE BAND™)

Illustration of lap-band weight loss surgeryOur weight loss surgeons offer placement of the adjustable gastric band (LAP-BAND® and Realize™ Band. In the gastric banding procedure, a silicone elastic band is placed around the upper part of the stomach -- forming a small pouch above, a narrow channel, and the larger stomach below.

The band is connected to an elastic tube, which is then connected to an access port placed deep under the skin of the abdomen. No division or stapling of the stomach or intestine is necessary.

When food is consumed, the small pouch fills quickly and then empties slowly creating a sustained feeling of fullness. The food gradually passes through the narrow channel to the lower stomach and into the intestine for digestion.

The tightness of the band, or the size of the narrow channel, can be adjusted by injecting or withdrawing fluid (saline) from the access port under the skin. The adjustment is made if the band is too loose and you are not losing adequate weight or if it is too tight causing you to vomit. The adjustment can only be performed at your surgeon's office.

The gastric band is normally left in place for the rest of the person's life. Removal requires another surgery and is only performed if there are severe side effects or complications. Weight gain is expected if the band is removed.

Weight loss in gastric banding patients is generally slower compared to gastric bypass patients. Tightening of the band is only performed when you are following the dietary guidelines and are still not losing adequate weight or when you are not feeling adequate restriction. On the average, most patients will need three to four adjustments in the first year to attain acceptable weight loss.

Laparoscopic Adjustable Gastric Banding surgery generally takes about one hour and patients typically stay in the hospital overnight. However, some have been able to go home the same day. Most patients are able to return to work after one week.

Weight Loss Revision Surgery

Our weight loss surgeons also offer revisional weight loss surgery. These operations are generally reserved for those who have had prior weight loss surgery but failed to lose adequate weight or have regained significant weight. Revisional surgery is generally more complex with higher operative risks. Gastric pouch enlargement from overeating is one of the most common causes of weight regain.

If you have any questions, or would like to schedule a consultation with a weight loss surgeon, please call 1-800-SENTARA.

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