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.  Read the full story

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.  Read the full story

Revision surgery after a weight loss surgery procedure is not uncommon. Approximately 10-25% of all bariatric patients will require a revisional procedure due to weight regain or surgical complications (such as vomiting, reflux, stricture or blockage, fistula, marginal ulcer, or excessive weight loss/malnutrition) or a device malfunction (such as band erosion, band prolapse/ chronic pouch dilation). In fact, nearly half of all patients Dr. Provost sees are requesting a revisional procedure, having experienced some form of complications from a previous weight loss surgery or due to significant weight regain. Read the full story

Gastric sleeve surgery (also called Vertical Sleeve Gastrectomy, VSG, gastric sleeve, or “Sleeve”) is a surgical weight-loss procedure in which the stomach is reduced to about 25% of its original size, through surgical removal of a large portion of the stomach. The open edges are surgically stapled together to form a sleeve or tube with a banana shape. The procedure, performed laparoscopically, permanently reduces the size of the stomach and is irreversible. Read the full story