Complications can include leaks at the connection sites of the pouch and small bowel; infection; small bowel obstruction; internal hernia; pulmonary embolus and even death. Patients can avoid vitamin and mineral deficiencies with proper supplementation, and our staff is there to ensure that nutritional levels are regularly monitored.
Adjustable Gastric Banding or Lap Band® System
This procedure is designed to restrict and reduce your food intake without interfering with the body's normal digestive process.
A silastic band is placed around the upper part of the stomach, creating a small pouch. The pouch restricts food intake, and the narrow passage between the pouch and the lower stomach slows the emptying of food into the rest of the stomach, causing you to feel fuller, longer.
The diameter of the band can be adjusted to increase or decrease restriction. This is done by inflating or deflating the band with a saline solution introduced through an access port that is placed under the skin during surgery.
Adjustable gastric banding is performed laparoscopically as outpatient surgery so patients can go home the same day.
Adjustable gastric banding is safe and effective, with advantages that include:
- Proven success. Patients lose about 40 percent of their excess body weight within two years.
- Reversibility. Under the care of our exceptional medical staff surgeons, the surgery can be reversed.
- Normal digestion and absorption. The procedure does not affect how the body digests food and absorbs vitamins, minerals and other nutrients.
- Less impact on the anatomy. Adjustable gastric banding does not require the opening or removal of any part of the stomach or intestines.
Among the potential complications associated with adjustable gastric banding are tearing in the stomach or gastric perforation, which could require additional surgery; leakage or twisting of the access port; nausea and vomiting; slippage of the band; obstruction of the passage between the pouch and the stomach; enlargement of the pouch; and mechanical failure of the band implant.
Gastric Bypass Roux-en-Y Revisions
Sometimes, an initial procedure may need to be revised. Reasons for revision include:
- Mechanical failure of surgery
- Regaining original weight lost
- Intractable nausea & vomiting
Our surgeons have performed hundreds of revisional surgeries, giving our patients wonderful and successful outcomes. Many times, a revision is exactly what a patient needs in order to be successful in their weight loss goals.
Pre-operative Diagnostic Tests may include:
- Upper GI with Marshmallow Test
- Endoscopy
- Bloodwork
Gastric Bypass Roux-en-Y Reversals
Our surgeons are literally on “the cutting edge” in the field of bariatrics, having performed more gastric bypass reversals than any other program in the United States and abroad. Our patients come from all over the United States, and while a reversal is rarely needed, it is something that can be done. Reasons for complete reversal include:
- Intractable nausea & vomiting or excessive diarrhea resistant to medical management
- Excessive weight loss
- Emotional and/or psychological problems with required lifestyle adjustments
It should be noted that these conditions are very rare.
Pre-operative Diagnostic Tests may include:
- Upper GI with Marshmallow Test
- Endoscopy
- Bloodwork
Both revisions and reversals can be performed either open or laparoscopically – depending on the patient's surgical history – and take about 1 to 1 ½ hours each.
Vertical Banded Gastroplasty (VBG) Revisions
The VBG procedure was very popular a few years back, and while it was a good attempt to offer patients a solution to permanent weight loss through surgery at the time, we have found that this surgery has a high rate of mechanical failure.
Because the surgery relies on patients throwing up when they overeat, the pressure put on the pouch from vomiting eventually causes the staple line to disrupt or the band to erode.
Many patients find that they can eat more because (1) their pouch has stretched due to the pressure exerted on it from vomiting, (2) their staple line disrupted, allowing food to enter the larger stomach and thus allowing greater food consumption, or (3) the band has eroded, causing pain and possible severe complications.
Many options for revisions are available; however, we recommend that most patients convert their VBG procedure to a gastric bypass Roux-en-Y to optimize their weight loss.
Vertical Banded Gastroplasty (VBG) Reversals
Like most bariatric procedures, our surgeons can completely reverse a vertical banded gastroplasty if that's what the patient desires.
Both revisions and reversals can be performed either open or laparoscopically – depending on the patient's surgical history – and take about 1 to 1 ½ hours each.
Duodenal Switch (DS)
This procedure is considered more radical because it combines malabsorptive elements to achieve weight loss. The duodenal switch is offered as a revision, and as an initial surgical procedure in appropriate candidates.
The DS procedure includes a partial gastrectomy, which reduces the stomach along the greater curvature, effectively restricting its capacity while maintaining its normal functionality. This means that part of the stomach is permanently removed. Unlike the gastric bypass Roux-en-Y (RNY), which uses a gastric “pouch” and bypasses the pyloric valve, the DS procedure keeps the pyloric valve intact. This eliminates the possibility of dumping syndrome, marginal ulcers, stoma closures and blockages, all of which can occur after other gastric bypass procedures.
In addition, the DS procedure keeps a portion of the duodenum in the food stream. The preservation of the pylorus/duodenum pathway means that food is digested normally in the stomach before being excreted by the pylorus into the small intestine. As a result, the DS procedure enables “more normal absorption” of many nutrients (including protein, calcium, iron, and vitamin B12) than is seen with the gastric bypass Roux-en-Y procedure.
The malabsorptive component of the DS rearranges the small intestine to separate the flow of food from the flow of bile and pancreatic juices. This inhibits the absorption of calories and some nutrients. Further down the digestive tract, these divided intestinal paths are rejoined and food and digestive juices then begin to mix, and limited fat absorption occurs in the “common tract” as food continues on toward the large intestine.
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