Two of the most common bariatric procedures are gastric sleeve surgery and gastric bypass surgery. This article will take a closer look at both surgeries and what they entail, including their pros and cons, and when to consider one over the other.
Both gastric sleeve surgery and gastric bypass reduce your stomach from its regular size to a small pouch. This causes weight loss in two ways:. With gastric sleeve surgery , the surgeon permanently removes about 80 percent of your stomach. The bypassed part of the stomach is attached further down the small intestine, so it still provides the acid and digestive enzymes produced there. With this procedure, a small stomach pouch is created by placing an inflatable band around part of your stomach.
The size of the opening between the pouch and the rest of your stomach affects the amount of weight you lose. Gastric band surgery can be easily reversed by removing the band. Gastric bypass is more complicated than gastric sleeve surgery. This is because gastric bypass is a two-step procedure, while gastric sleeve only involves one step.
Both gastric sleeve surgery and gastric bypass are usually done laparoscopically. This involves inserting a lighted scope with a camera called a laparoscope and other tools through several small incisions in your abdomen to perform the surgery.
This requires a much larger incision in your abdomen. This type of incision takes longer to heal than the small laparoscopic incisions. This often means 4 or 5 days in the hospital. According to the American Society for Metabolic and Bariatric Surgery , the risk of a major complication is about 4 percent. This is much lower than the risk of developing serious obesity-related health complications. The main difference in postoperative diet is the size of your stomach pouch, which affects how much you can eat.
A portion of the small intestine leading from the stomach pouch is also cut, and the intestine below this area is connected to the new stomach pouch. As a result, your body takes in only a fraction of the calories it once did. Instead, the surgeon simply removes a portion of the stomach lengthwise , leaving you with a small, banana-shaped, but otherwise perfectly functional stomach.
Here, too, you take in a much smaller amount of food, giving your body fewer calories to store. Both gastric bypass and gastric sleeve surgeries get the job done , but which one you choose will depend on such factors as:. To learn more about these procedures, costs, post-op dieting and more, reach out to us at Olde Del Mar Surgical.
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Meet The Team. As a complication of gastric bypass surgery, hypoglycemia often occurs because of excessive dumping after the surgery. Medications will usually manage conditions; however, surgical removal of a portion of the pancreas may be required in more extreme situations.
The risk for this condition is around one percent. Thirty percent of individuals who have gastric bypass surgery develop nutritional deficiencies. These deficiencies include osteoporosis, anemia, and metabolic bone disease. These deficiencies may be prevented with vitamin and mineral supplementation.
The possibility of getting gallstones increases dramatically when an individual experiences extreme weight loss. Prevention of gallstones may be achieved with bile salts. Some surgeons may remove the gallbladder during surgery in order to deal with this condition. This dangerous condition involves the intestine becoming obstructed. A hernia is an opening that occurs when an internal organ or body part protrudes through a surgical incision; it occurs inside the abdomen or through the abdominal wall muscles.
An internal hernia may result from surgery and rearrangement of the bowel. An incisional hernia is an incision that does not heal in a correct manner.
Abdominal wall hernia is more likely to occur with open procedures than with laparoscopic procedures and usually occurs several months after surgery. Incisions may be infected because of bacteria released from the bowel during the operation.
This may also happen to the inside of the abdomen; however, bladder and kidney infections may also occur. Antibiotics, respiratory therapy, and physical activity after surgery can lower these risks. These types of infections are far more common with open surgery than with laparoscopic techniques. Marginal ulcers are the most common in the newly created stomach pouch after gastric bypass surgery.
They can usually be avoided by following the correct dietary guidelines. These ulcers are often accompanied by a burning pain in the stomach, and their presence can be confirmed with an endoscopy a scope inserted into the mouth and down the esophagus. They are usually treated with antacids. Although this condition occurs with gastric sleeve surgery, it is most common in gastric bypass surgery and results from a build-up of scar tissue. Strictures can be either acute or chronic very quick onset or an ongoing issue after surgery.
Symptoms include food intolerance, dysphagia, nausea, and vomiting. Strictures found immediately after surgery may be treated with bowel rest not consuming food by mouth and rehydration with intravenous fluids. These strictures will usually heal, and if they do not, then endoscopic dilation is performed in order to restore the opening. This condition occurs when a connection made during surgery leaks digestive contents into the abdomen. This situation may produce infections and can often be fixed if it is found quickly enough.
By blowing air into the connection and using a dye, a surgeon can see if the connection is secure. Common symptoms of postoperative bleeding include hematemesis vomiting of blood or melena stools bloody stools. There are two types of hemorrhages: intraluminal and extraluminal. Intraluminal bleeding is often managed by using large bore intravenous lines for fluid resuscitation, administration of packed red blood cells, measurement of urine with a Foley catheter, and performing an urgent gastroscopy.
Common sources for extraluminal bleeding include the gastric staple line, spleen, liver or abdominal wall. Urgent laparoscopy allows for the evacuation of the clot and control of the bleeding source.
Hemorrhages can also be treated by replenishing bodily fluids, discontinuing the use of anticoagulation drugs, and by transfusion or operation. The risk of hemorrhage after gastric bypass surgery is 3. The coagulation of the blood is increased whenever the body is injured or undergoes a surgical procedure. Sometimes, a clot in the veins of the leg will form, break free, and then float to the lungs. This type of clot is called a pulmonary embolus, and it can be life threatening. In order to combat this problem, blood thinners are administered immediately before the surgical procedure is to begin.
The risk of deep vein thrombosis or pulmonary embolism is around one percent. For a thorough explanation of gastric sleeve complications, this article is recommended. Gastroesophageal reflux disease GERD is a long-term complication that is very common with gastric sleeve patients. It is characterized by periodic episodes of gastroesophageal reflux and usually accompanied by heartburn.
It often leads to histopathologic changes, which are microscopic structural changes in the esophagus. It may also lead to esophagitis, which is an inflammation of the esophagus. It is usually treated with proton pump inhibitors.
If symptoms persist, a gastroscopy which is an examination of the esophagus, stomach, and duodenum using an endoscope is performed. Like gastric bypass surgery, complications relating to malnutrition are also possible. This is especially true if the prescribed nutrient supplementations are not taken.
While most nutritional deficiencies are more common with gastric bypass surgery, there is an increased risk of folate deficiency with gastric sleeve surgery; therefore, folate levels of post-op gastric sleeve patients are often closely monitored.
Chronic strictures generally require endoscopic or surgical treatments. Treatment options depend on the length of narrowed portion.
If the narrowing is short, endoscopic dilatation is used. However, if the narrowing is long and endoscopic dilation fails, then surgery is often necessary.
Some patients have even required a gastric bypass in order to alleviate this condition. Gallstones are also developed in individuals who have gastric sleeve surgery. This is because the overall chance of getting them increases whenever anyone experiences an enormous amount of weight loss. In the same manner as patients who have had gastric bypass surgery, prevention of gallstones is usually achieved with bile salts.
This condition most commonly occurs with gastric bypass surgery; however, it is sometimes seen in patients who have undergone gastric sleeve surgery. Like strictures found in gastric bypass patients, treatment is accomplished by not consuming food orally and by rehydration with IV fluids. Endoscopic dilation is also performed occasionally on gastric sleeve patients with this condition. The risk for stricture including chronic stricture is 3. Although the risk of this condition is much greater for gastric bypass patients, it occurs to a lesser degree with gastric sleeve patients.
The risk of deep vein thrombosis or pulmonary embolism with gastric sleeve patients is below one percent. One of the more immediate concerns of gastric sleeve surgery, this aspect of the procedure is given special attention by surgeons, who spend a lot of extra time and effort in order to make sure that the newly created barrier performs correctly.
When the staple line does fail, the patient will often experience an increase in heart rate. If the leak occurs a few days after surgery, laparoscopy may be attempted in order to find and repair the leak.
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