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Programs and services : Weight-Loss Surgery : FAQ : Surgery

Sanford Weight-Loss Surgery


What is Roux-en-Y gastric bypass surgery?

Gastric bypass surgery is considered the gold standard of weight loss.  In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach with surgical staples. The smaller stomach is connected directly to the upper portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. A second connection of the small intestine to itself completes the operation.  This reduces the amount of food the new pouch can hold to a very small volume so that you will feel full with very small portions.  It will significantly decrease hunger and will make foods that are high in sugar and fat less pleasurable.  These effects will improve your health and help you lose weight. Refer to the image below.

Roux-en-Y gastric bypass

How small is the stomach pouch after surgery?

The pouch is usually about one ounce which will hold one to two tablespoons or 2-3 small bites of food at one time.

Can the pouch stretch?

After surgery the pouch is very stiff but over time the pouch will get softer or more pliable so that larger amounts of food can be eaten at a meal.  However, even in the long term the volume of food that you can eat at a meal will be much less than before surgery. Learning to not drink with your meals, permanently will help you stay satisfied with a smaller portion at mealtime.

What happens to the stomach that's bypassed?

It remains attached to the neighboring organs and has a blood supply. The acid and fluid secretions are significantly decreased. It doesn't have a function in processing your food, but remains in the body. If it is needed for any reason in the future it is still in your body.

What is the success rate of Roux-en-Y surgery?

Success of surgery is measured by improving your health and not just by how much weight is lost. Type 2 diabetes goes away or improves in 90% of patients and the results are seen very quickly after surgery. High blood pressure, sleep apnea, gastric reflux, arthritis related pain and many other health conditions improve or are resolved in most patients as weight loss occurs.

How much weight should I expect to lose?

The average patient loses 70-80% of their extra body weight or about 38% of their total body weight by 18-24 months after gastric bypass surgery. At 5-10 years after surgery, patients usually have kept off 67% of their extra weight. The amount of weight that is regained is determined by how well you are using the tools of surgery.  For patients eating appropriately maintaining the 70-80% weight loss or more is very likely. For patients who are not eating appropriately loosing less than 70-80% of weight would be expected with further weight gain over time.

What are possible complications after surgery?

Leakage of the staple line or one of the connections is a serious complication which is rare but may require a second operation. If this occurs it will be seen in the first week or two after surgery.
With the cutting and reconnection of the intestine, spaces are formed. The intestine can move through these spaces and become blocked.   Most of these spaces are closed.  This is also a rare complication called an internal hernia that can happen years after the gastric bypass surgery.

With any abdominal surgery, bands of fibrous scar tissue called adhesions can form. These adhesions can block the intestine.  This may happen years after the surgery.

Narrowing, called strictures, or ulcers may form where the stomach and intestines are joined together.  This happens much more often when patients restart smoking or are taking anti-inflammatory drugs like Ibuprofen or Aleve.

Vitamin deficiency may occur.  All patients who have gastric bypass will need to take a multivitamin, Vitamin B12 and Calcium Citrate.  If these supplements are taken, you are unlikely to have a vitamin deficiency. 

What is the mortality rate?

Recent statistics on national averages of mortality at Centers of Excellence (which we have this recognition) is 0.14% or less than one and a half death per 1000 patients in the first 30 days after surgery. The most common causes are pulmonary embolism (blood clot in the lungs) or leakage at one of the intestinal connections.

What is sleeve gastrectomy?

Sleeve gastrectomy is a newer bariatric surgery that permanently removes a large part of the upper stomach making the lesser curve of the stomach into a long tube. This part of the stomach is not a stretchy as the part of stomach removed.  This will cause you to be full with a small portion of food. It also causes a decrease in hunger hormones which make you less hungry after surgery. Refer to image below.

How small is the stomach after surgery?

75-80% of the stomach is removed with sleeve gastrectomy.  The stomach is larger than the gastric pouch after bypass but the valve the lets food into the small intestine is still in place so that patients feel full after surgery.

Can the stomach stretch?

Studies have shown that the sleeve can stretch with time causing some weight gain but the stomach will never reach its original size. Not drinking with your meal permanently will help you stay satisfied with smaller portions at mealtime.

Is Sleeve Gastrectomy reversible?

No. The portion of the stomach separated from the sleeve is permanently removed from the body at the time of surgery

What is the success rate of Sleeve gastrectomy?

Success as with bypass surgery is measured by improving your health and not just by how much weight is lost.  Sleeve gastrectomy also has an immediate effect on Type 2 Diabetes but the effect is not as great as what is seen with gastric bypass. High blood pressure, sleep apnea, arthritis related pain and many other health conditions improve or are resolved aw weight loss decreases in most patients.

Reflux which is improved with gastric bypass can get worse with sleeve gastrectomy because acid is produced in the lower stomach.  With the intact pylorus the valve at the end of the stomach, the system is a higher pressure system which can worsen reflux in some patients.

How much weight should I expect to lose?

The average patient loses 66-68% of extra body weight 3 years after surgery.  This drops to 53% of extra body weight at 5 years.  As with gastric bypass the amount of weight you lose or regain is determined by how well you are using the tools of surgery.

What are possible complications after surgery?

Leakage of the staple line is a rare but serious complication that can result in the need for additional surgery. Unlike the gastric bypass, this surgery causes higher pressure in the stomach which was described above.  When there is a leak, it often harder to heal because of the greater pressure.  This complication can be seen shortly after surgery or a few months later.

The stomach sleeve can fold or twist causing a blockage and vomiting if severe additional surgery may be needed.

Reflux or heartburn can be made worse or can occur after sleeve gastrectomy.  Most often gastric bypass will help reflux.  If you have severe reflux symptoms, sleeve gastrectomy may not be the right surgery for you.

Ulcers can occur in the sleeve gastrectomy. Smoking and anti-inflammatory drugs such as Ibuprofen or Aleve will increase this risk.

Vitamin deficiencies can occur but are less likely than gastric bypass.

What is the mortality rate?

As with gastric bypass mortality rates are very low when surgery is done at a Center of Excellence like ours.  30 day post-surgical mortality rate with sleeve gastrectomy is 0.08% which is less than 1 patient per thousand dying of a complication of surgery.

What is Lap Band Surgery?

This operation involves placing a silicone band around the upper portion of the stomach.  The band separates the stomach into two parts: a tiny upper pouch and a larger lower pouch.  The band is connected by tubing, to a port that sits below the skin of abdominal wall.  The port cannot be seen from the outside.  You may or may not be able to feel it.  The band is a reservoir that can be filled by injecting fluid through the port via a needle passed through your skin. 

This surgery, which is almost exclusively a laparoscopic procedure, is a restrictive weight-loss operation.  This means that it works by limiting the amount of calories a person can take in.  You will feel full on a reduced amount of food as the band is filled, it slows the passage of food from the upper pouch into the lower portion of the stomach.  The pressure of the Lap Band on your stomach will result in decreased appetite.  As the band is filled, the patient will feel full with smaller amounts of food.

What is the success rate of Lap Band surgery?

Lap Band patients if successful can have significant improvement in their weight related medical problems.  These improvements are related to degree of weight loss.  General experience has shown that about 1/3 of patients have weight loss results close to what is seen with gastric bypass, 1/3 of patient has significant but less weight loss seen with gastric bypass and 1/3 of patients have poor results.  Improvements in diabetes are less dramatic than that seen with gastric bypass or sleeve gastrectomy and more gradual and directly related to weight loss rather than the hormonal effects the other two procedures provide.  Medications to treat conditions such as high blood pressure, and high cholesterol can be reduced as well with weight loss.  Improvement or resolution of sleep apnea can also occur with significant weight loss.

How much weight should I expect to lose?

Weight loss with the Lap Band is typically slow and steady if patients follow the dietary recommendations.  Patients generally lose one to two pounds per week during the first year after the band is placed.  Weight loss can be seen for two to three years after surgery, if eating patterns are appropriate, and average excess body weight loss is approximately 45% and total body weight loss of 20%. 

What are the possible complications of surgery?

Band slip will cause the band to move out of its normal position and cause increased vomiting and food intolerance.  If this occurs the band will need to be deflated.  In severe cases an additional operation to reposition or remove the band may be needed.
In 2-3% of band patients the band will erode or work its way through the stomach causing infection.  With erosion the band will need to be removed.  Band erosion may result in an infection at the port site.

The band, tubing and port are mechanical devices that can leak or have other mechanical problems. These problems could require additional surgery.

If the band is too tight for an extended period of time, the esophagus the tube that runs from the mouth to the stomach can stretch permanently. If this occurs the band will need to be removed.

Long term studies have shown that 30% of bands placed will be removed because of one of these complications or for poor weight loss results.

What are the mortality rates?

30 day post procedure mortality for Lap Bands is 0.03%, or 3 deaths for every 10,000 operations performed.

Why are less Lap Band procedures being performed?

Long term result seen in Australia, Europe and the United States have shown inconsistent results with this procedure.  While some patients can do quite well with a Lap Band many patients do not.  Much more consistent results have been seen with Gastric bypass and Sleeve Gastrectomy.  Another problem has been the large number of patients who have needed their band removed either because of complication or poor weight loss results.  Long term studies have shown that 30% of Lap Bands placed will be removed.


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