Surgical procedures to treat obesity can be classified as malabsorptive or restrictive.  Malabsorptive procedures include the jejuno-ileal bypass and the biliopancreatic diversion/duodenal switch.  The jejuno-ileal bypass has largely been abandoned due to the development of structural liver abnormalities in one-third of patients and clinical cirrhosis in as many as 10%. In the BPD/DS, bile and pancreatic juices draining into the duodenum are diverted to the terminal ileum by a long Roux-en-Y limb, in addition to gastric partitioning. Excellent weight loss results; however, the procedure is not used widely because of the greater nutritional and metabolic risks. 

Restrictive procedures include the vertical banded gastroplasty (VBG) and gastric banding (i.e., Lap-Band®). Both procedures involve creating a small pouch in the stomach, 15 to 30 ml, to limit the amount of food a patient can eat. The Roux-en-Y gastric bypass (RYGB) also involves the creation of a small gastric pouch which is drained by the small intestine. This operation combines gastric restriction with a minimal degree of malabsorption. An added benefit is the limitation on the intake of simple sugars, which cause you to feel ill. Although the Lap-Band procedure has gained popularity since it was approved by the FDA in 2001, the RYGB is still the most commonly performed obesity procedure in the United States.

Dr. David Provost has experience with a variety of bariatric procedures, but prefers the RYGB and the Lap-Band. Both procedures are generally performed laparoscopically in most patients. This means that instead of performing the surgery through a standard incision, typically going from below the breastbone to above the umbilicus, the operation is done through six smaller incisions, less than one inch in length, using cameras and long instruments. More information about the Lap-Band and gastric bypass procedures is available on this site.

The adjustable laparoscopic gastric band (Lap-Band®) was approved by the FDA in June 2001 for the surgical treatment of obesity, although gastric banding procedures have been performed internationally since 1993. The Lap-Band limits the intake of food while decreasing hunger. The Lap-Band is adjustable, permitting gradual weight loss. Average weight loss is initially 10% to 15% less than that observed following a Roux-en-Y gastric bypass, but long-term results appear similar, and most patients realize excellent results. 

Advantages of the Lap-Band include ease of insertion, shorter hospital stay, and rapid recovery from surgery. The risk of major complications from surgery is low with the Lap-Band, as is the operative mortality.  A disadvantage of the Lap-Band is the potential need for re-operation in the future for band replacement or removal, which may be required in up to 5% of patients. Indications for band removal include erosion into the stomach, band slippage with resultant vomiting, and port or tubing leakage. These complications are rarely life-threatening nor emergent, and can be managed laparoscopically. 

We have been very pleased with the results of the Lap-Band, and we believe it is an excellent alternative to the more invasive gastric bypass. Of course, to ensure long-term success, you need to adhere to prescribed eating habits and schedule routine follow-up appointments for band adjustments. For more information about the benefits of the Lap-Band procedure, please contact our office.

The gastric bypass has been performed for more than 35 years. Average initial weight loss exceeds 70% of excess weight, and long term studies have demonstrated that the weight loss is maintained at over 50% in greater than 90% of patients.  Attention to diet and eating habits, exercise, and long-term follow-up with your surgeon contribute to optimal weight reduction. 

In addition to weight loss, many associated medical problems will resolve or improve following gastric bypass.  Adult-onset diabetes mellitus improves in over 90% of patients, with 80% becoming medicine-free, including insulin. Patients can also expect improvements in hypertension and high cholesterol, obstructive sleep apnea, shortness of breath, and other respiratory difficulties, such as asthma. Gastroesophageal reflux (acid reflux) is frequently cured immediately. Although permanent damage to joints that has already occurred is not reversible, patients will often experience significant improvements in mobility and joint pain. Improvement is also frequently observed with leg swelling or venous stasis disease, urinary incontinence, and headaches.

As a surgical procedure, laparoscopic gastric bypass has much lower rates of incisional hernia and wound infection, reduced pain, and a more rapid return to work and normal activities than the traditional open-incision gastric bypass.  Some patients may not be candidates for the laparoscopic approach to gastric bypass due to larger size or large abdominal wall hernias. Prior abdominal operations, such as cholecystectomy (gall-bladder removal), hysterectomy, Caesarean section, and appendectomy do not usually preclude laparoscopic RYGB.

For more information about the benefits of gastric bypass surgery, please contact our office to schedule a free consultation.

Weight loss surgery is considered a highly effective treatment for those who are morbidly obese. However, sometimes, years after weight loss surgery is performed, revision surgery may be necessary due to a number of complications. To qualify for revision surgery, you must experience at least one of the following:
• Unsatisfactory weight loss
• Significant weight regain
• Complications, such as ulcers or malnutrition
• Unresolved co-morbidities

For gastric bypass patients, weight regain or insufficient weight loss can occur when a patient’s pouch (or stoma) begins to stretch. As a result, they no longer feel full as quickly and go back to eating larger portions. To find out if your stoma or pouch has stretched, Dr. Provost will perform a diagnosis test using an endoscope to take measurements.

If your pouch or stoma has stretched, Dr. Provost will likely recommend the StomaphyX procedure. StomaphyX is a simple, 20- to 60-minute operation performed under general anesthesia. During the operation, Dr. Provost will insert an endoscope attached to a StomaphyX device through your mouth and into the stomach, and sections of the stomach tissue are sucked into the StomaphyX device to create folds. Typically Dr. Provost will create 10 to 20 folds and fasten each one with staples to hold it in place. This procedure returns the pouch to its original operative size.

Revision surgery is considered a higher risk surgery compared to the original weight loss surgery you had. Dr. David Provost is one of the country’s leading experts in revision surgery and has helped thousands of patients regain control of their weight loss through the StomaphyX procedure. Although the complexity of your revision surgery will depend on the original surgery you had, Dr. Provost has the experience necessary to help you get back on track.

To find out more about having a weight loss surgery revision procedure and to schedule a consultation, contact our offices.