Laparoscopic adjustable gastric banding
This surgery is seen less these days but still has its popularity among certain patients. I mention it here because there are patients who currently have the band and it is important to know how it works and they still need to follow up regularly with their surgeon to avoid future complications. Consists in the creation of a new small reservoir in the superior part of the stomach , we place a prosthesis that acts like a belt, that allows passage to the rest of the stomach thru a 1cm diameter opening approximately. The band only allows you to feel restriction, so you feel satisfied and full quicker. It does not allow the metabolic changes seen with the other surgeries. Patients with an adjustable band need to be followed up at least once every 1-3 months to ensure adequate weight loss. For the band to give you more or less restriction it is important to put or aspirate fluid from the reservoir implanted in your abdomen. Follow up with your surgeon or nutritionist is important to evaluate progression.
Advantages
- It´s reversible
- No modification of anatomy
- No resection of intestines
Disadvantages
- Placement of a foreign body
- Frequent nausea and vomiting if the band is too tight
- Probable weight regain, once band is removed
- It does not have the hormonal changes seen with the other surgeries and is not as effective for the improvement of medical problems (diabetes)
Risks
- Infection
- Slippage/prolapse
- Erosion into the stomach
Recovery time
- Ambulatory procedure or short term hospitalization
- Can return to work immediately
Biliopancreatic diversion and biliopancreatic diversion with duodenal switch
Both are surgeries that cause weight loss. With this surgery the anatomy of the digestive tract is modified so the body does not absorb as well the fat and nutrients.
With these malabsorptive techniques we can obtain good results in weight reduction, but it is necessary to have a strict follow up of the patient because a good alimentary regimen needs to be maintained and the patient need to take vitamin supplementation to avoid deficiencies and digestive problems . These are aggressive surgeries, difficult to revert if it were necessary.
These surgeries may be indicated in cases where we think that less aggressive surgeries like the sleeve and bypass will not suffice to obtain significant weight loss to benefit the patient.
Disadvantages
- Causes garetear malabsorption
- Can cause a lot of diarrhea
- Can cause greater vitamin loss
Risks
- Malnutrition
- Severe anemias
Gastric Plication
This procedure was developed in the last couple of years, there is a pleating/imbrication of the stomach over itself, and this reduces the volume of food that can enter the stomach. It has become popular because it does not involve any resection of the stomach, there are no intestinal anastomoses/unions. It is considered experimental by the American Society of Metabolic Surgery and their position is that it should be done under investigation protocols. I do not perform this in my practice.
Disadvantages
- Results of weight reduction are inferior to other surgeries
- Unknown results with long-term follow up
- Does not provide the hormonal changes seen with the sleeve and bypass.
Risks
- Gastric distention
- Tear of the suture line
- Bleeding
- Gastric perforation
Intragastric balloon
A removable prosthesis is implanted inside the stomach that is then filled up with fluid till it occupies a volume of 600 cm3. This is a procedure that is purely endoscopic. The objective of the prosthesis is to occupy space inside the stomach to reduce the amount of food that is ingested generating a sensation of fullness reducing the appetite. After a determined period of time, when the patient has achieved the desired weight loss, the balloon must be removed. The use of this device is not approved in the United States, and we must emphasize that it does not cause the hormonal changes that are seen with the other surgeries. You are at risk of regaining all the weight back rapidly once the balloon is removed. I do not perform this in my practice.
Disadvantages
- Sensation of gastric fullness even when not eating
- Nausea
- Probable weight regain once device is removed
Risks
- Erosion
- Rupture of the prosthesis