Gastric Bypass Surgery In Los Angeles, Ca.
Morbid obesity is treated with gastric bypass surgery because of the serious risks related to this degree of obesity, the relative low risk of operative treatment, and the ineffectiveness of medical and dietary interventions. The conservative management of morbid obesity (diet, exercise, drugs, behavioral modification, etc.) has been ineffective in the long term. More than 95 percent of subjects regain their lost weight within a few years after conservative treatment. Morbid obesity surgery for our Orange County and Los Angeles patients is the number one method that has resulted in long-term maintenance of weight loss and a dramatic reduction in the associated diseases.
This guide has been written for individuals considering gastric bypass surgery at our Arcadia offices as a means for weight loss. Its purpose is to educate the reader on the available options and operative information regarding morbid obesity surgery.
Below is a link to the “60 Minutes” story that ran on Sunday, April 20th. It is a pro-gastric bypass story that focuses on Type 2 Diabetes remission, sleep apnea, the link between weight loss and a 50% reduction in cancer risk, and patients coming off all their medications.
Click here for more information
Further information on morbid obesity and gastric bypass surgery for weight loss can be obtained from the American Society of Bariatric Surgery.
American Society of Bariatric Surgery (ASBS)
140 NW 75th Dr., Suite C
Gainesville, FL 32607
Tel: (352) 331-4900
Morbid obesity surgery can be thought of as either malabsorptive or restrictive. The malabsorptive procedures bypass a large segment of intestine, and weight loss is achieved by creating nutritional inefficiency. Restrictive procedures take advantage of inherent efficiency, and weight loss occurs as a result of lowered caloric intake.
Anatomical changes or arrangements that help surgical procedures achieve weight loss are as follows:
- decreased gastric volume (pouch)
- controlled outlet of the pouch
- length of small bowel in contact with food alone (alimentary channel)
- length of small bowel in contact with food and digestive juices (common channel)
Small pouch size with a controlled outlet provides restriction of intake. The shorter the common channel, the greater the degree of malabsorption. Pouch size and the length of the common channel are strongly interdependent.
The Roux-en-Y gastric bypass surgery achieves weight loss with an effective combination of restriction and malabsorption. The restrictive component is afforded by a 20 to 30 cc gastric pouch. The malabsorption component is achieved with the “bypass” of the stomach and the first part of the small intestine or duodenum. This combination has afforded good weight loss, minimal nutritional risks, and a high quality of life postoperatively. If you would like to find out who is a good candidate for gastric bypass surgery at our Arcadia office, contact the California Bariatric and General Surgery Associates today.
The Malabsorptive Procedures
This older procedure severely shortened the amount of small intestine that was in contact with food. Weight loss was satisfactory, but metabolic complications were too high. Approximately 50 percent of patients developed some type of late metabolic complication. The operation was performed between 1963 and 1980. The morbid obesity surgery is no longer in use.
This operation consists of removing a part of the stomach, leaving a 200 to 500 cc pouch, and shortening the small intestine conduit to 250 cm, leaving a 50 cc common channel in which bile and pancreatic juices mix prior to entering the colon. Weight loss has been satisfactory, but malabsorptive complications have lead most surgeons in the United States away from this approach to morbid obesity surgery.
This procedure is similar to the biliopancreatic diversion but alters the stomach configuration to produce less dumping and diarrhea. The outer margin of the stomach is resected. A sleeve of stomach, the pylorus, and the beginning of the duodenum are preserved. The duodenum is divided so that pancreatic and bile drainage are bypassed. The ingested food meets the bile and pancreatic juice near the end of the small intestinal adaptation. Over time, bowel movements decrease to an average of three per day. Side effects of foul smelling stools and abdominal bloating are common. Weight loss is satisfactory and patients are able to eat larger meals than patients with pure gastric restriction or standard Roux-en-Y gastric bypass surgery.
Vertical Banded Gastroplasty:
Known commonly as the “Gastric Stapling” procedure. This procedure creates a small stomach pouch (30 to 60 cc) along the inner curvature of the stomach. The size of the opening is controlled by a plastic band. This is the most “physiologic” of the bariatric procedures. Weight loss is not as predictable as with the Roux-en-Y gastric bypass surgery, which is available in Arcadia at our facilities.
The Inflatable Gastric Band:
A silicon band is placed around the top of the stomach. This band effectively restricts oral intake. This device has recently completed FDA trials. The procedure was approved for the treatment of obesity in late 2001. The results of the U.S. trials are disappointing compared with published results from Europe and Australia. In view of the results of these trials, most gastric bypass surgeons in the U.S. have not adopted this procedure.
Primarily Restrictive, Small Component of Malabsorption
Laparoscopic and Traditional Roux-en-Y Gastric Bypass Surgery:
The Roux-en-Y gastric bypass surgery performed in Arcadia is our procedure of choice. A very small (20 cc) gastric pouch is created. The pouch is divided from the main body of the stomach. A portion of the small intestine is passed in front of the main body of the “bypassed” stomach and connected to the small pouch. Food therefore bypasses most of the stomach and duodenum and empties directly into the small intestine. Gastric juices, bile, and pancreatic juices join the food approximately 100 to 150 cm downstream. The gastric bypass surgery procedure is primarily restrictive; however, a small component of malabsorption results. The number of calories that one can take in is limited by the size of the stomach pouch. A small amount of food will give the feeling of “fullness.”
The major long-term nutritional consequences are due to decreased iron, calcium, and vitamin B12 absorption. These deficiencies can almost always be overcome with oral supplements.
The open Roux-en-Y gastric bypass surgery is the procedure of choice of most bariatric surgeons for patients. We are now able to offer the Roux-en-Y gastric bypass surgery at our Arcadia offices via a minimally invasive (laparoscopic) technique.
Advantages of the laparoscopic procedure over traditional surgery include less pain, faster recovery, less chance of hernia formation, and incisions that are more cosmetic.
The Laparoscopic Roux-en-Y gastric bypass surgery is performed through five half-inch incisions. The average hospital stay is one to two days. You can expect to return to work in one to three weeks following gastric bypass surgery.
The majority of our procedures for weight loss are now performed via the laparoscopic technique. Not all individuals are candidates for this method. You can discuss your individual case with your surgeon. If you suffer from morbid obesity and live in the Los Angeles or Orange County areas, contact us to learn about gastric bypass surgery at our Arcadia location.
Conversion or Revision of Previous Weight Loss Procedures:
Many of the morbid obesity surgery procedures for weight loss can be converted successfully to a Roux-en-Y gastric bypass surgery. At present, our revision procedures are performed through a standard open technique.