1. LAGB (Gastric banding)
Gastric banding involves creating a gastric pouch by encircling the stomach with
some type of material such as dacron, silicone (Figure 1a), etc. in order to create
a pouch and it is connected by tubing to a reservoir implanted and secured to the
abdominal fascia in the patient’s upper abdomen which can be accessed via a needle
to inflate or deflate the band device. Weight loss after gastric banding is predominantly
due to the restriction of nutrient intake that is created by the small gastric pouch
and the narrow outlet. It is considered one of the safest procedures performed today
with a mortality rate of 0.05%.
2. LSG (Sleeve Gastrectomy)
Sleeve Gastrectomy (Fig. 2) includes removal of sleeve of stomach so that it can
hold up to 50 to 150 ml of fluid depending on use of bougie size.
Sleeve gastrectomy is an irreversible procedure. The advantages of sleeve are that
it removes the portion of stomach that produces hormone that stimulates hunger (Ghrelin).
Dumping syndrome is less likely due to the preservation of the pylorus. By avoiding
the intestinal bypass, the chance of intestinal obstruction (blockage), anemia,
osteoporosis, protein deficiency and vitamin deficiency are significantly reduced.
Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2)
and limited results have shown promising as a single stage procedure for low BMI
patients (BMI 35–45 kg/m2).
3. LRYGB (Gastric bypass)
Laparoscopic Roux-en-Y gastric bypass (Figure 3) has mixed restrictive and malabsorptive
component. It consists of forming a 25 to 30 cc pouch and bypass of 70 to 100 cm
biliopancreatic limb and 100 to 130 cm of alimentary limb. The advantage of gastric
bypass is better weight loss and control of diabetes but it is associated with dumping
syndrome, nutritional deficiencies, and others. The patients need to take life long
multivitamins and minerals.
The advantage of gastric bypass is better weight loss and control of diabetes but
it is associated with dumping syndrome, nutritional deficiencies, and others. The
patients need to take life long multivitamins and minerals.
4. Laparoscopic Mini Gastric bypass (LMGB)
If we compare the four procedures, the sleeve gastrectomy has advantages and disadvantages.
It carries lesser risk than the bypasses, and has a faster weight loss.
Please carefully weigh the advantages and disadvantages of each of the available
bariatric procedures before you decide which you feel is the one for you. If I feel
that a particular procedure has advantages for you, I will recommend that during
our consultation.
SILS (Scarless) Bariatric surgery
Now a day’s single incision surgery is gaining popularity and bariatric is no exception.
Single incision bariatric surgery can be performed in selected subgroup of patients,
young females with height less than 180 cm and no previous umbilical surgery.