Laparoscopic Gastric Banding
A laparoscopic adjustable gastric band, commonly called a lap-band, A band, or LAGB, is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to slow consumption of food and thus reduce the amount of food consumed.
- Least invasive among the other bariatric procedures
- Technically a reversible procedure ( Removal of band causes weight gain)
- Good % of excess weight loss (EWL) (40-50 %)
- Does not create any major disturbance in anatomy as in other bariatric procedures
- Ideal for young patient who does not want to undergo a Major (Malabsortive) procedure and is ready to exercise
- Definite improvements in associated co-morbities
- To be done with caution in patients who have bread, pasta, refined flour as in Maida
- High liquid calorie consumption Alcohols and colas
- Older patients unwilling to exercise
- Gastric outlet obstruction
- Large hiatus hernia
- Manometry studies showing esophageal dysmotility
Laparoscopic Roux En Y Gastric Bypass
Gastric bypass surgery refers to a surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch and then the small intestine is rearranged to connect to both.
- An excellent procedure for patients with higher BMI, type II diabetes and other morbidities, excellent results in the low BMI type II diabetics
- A good procedure for sweet eaters, low volume eaters
- Procedure of choice for patients with hiatus hernias
- A good procedure for band failures and VBG and sleeve with inadequate weight loss
- Excess Weight loss up to 70-80 %
- Smokers - Risk of ulceration of Gastro - jejunal anastomosis
- Patients with inability to take lifelong multivitamin supplements
- To be avoided in patients with small bowel conditions like Crohn's disease
Laparoscopic Sleeve Gastrectomy
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 10-20% of its original size, by surgical removal of a large portion of the stomach along the greater curvature.
A good effective procedure as a sole choice of procedure in patients who are
- Volume eaters
- Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts
- Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin)
- No dumping syndrome because the pylorus is preserved
- Minimizes the chance of an ulcer occurring
- By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated
- Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2)
- Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2)
- Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures
- Can be done laparoscopically in patients weighing more than 500 pounds
- Gastric outlet obstruction
- Large Hiatus Hernia
- Manometry showing a lax esophageal sphincter
Disadvantages Of LSG
- Potential for inadequate weight loss or weight regain. While true for all procedures, it is theoretically more possible with procedures without intestinal bypass
- Higher BMI patients will may need to have a second stage procedure later to help lose all of their excess weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons
- Soft calories from ice cream, milk shakes, etc., can be absorbed and may slow weight loss
- This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur
- Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure
- Considered investigational by some surgeons and insurance companies
The Intra Gastric Balloon is a non-surgical procedure available for weight loss. A soft, expandable, silicone balloon is placed inside the stomach via a camera that enters through the mouth. Once inserted into the stomach, the empty balloon is filled with sterile saline, occupying a large part of the stomach, creating a feeling of fullness.
Placement of the intragastric balloon takes approximately 20 minutes. Because the balloon is inserted and removed in a day clinic and does not involve surgery, it is considered to be a minimally invasive procedure.
The Intra Gastric Balloon is completely reversible, and effective in temporarily reducing hunger, controlling food intake, initiating behavioural change, and achieving target weight loss of 5 to 30 kg.
The Intra Gastric Balloon remains in the stomach for a six-month period, where it is then removed the same way it was placed.
- As a one stage procedure for a weight loss of 5-30 kgs in low BMI with or without co-morbidities in patients not warranting any other bariatric surgery
- As an initial procedure in the super super obese category BMI > 60 to gain weight loss of 20-40 kgs before planning definitive surgery
- As an initial procedure for patients unfit for anesthesia to loose weight
- Laparoscopic Foregut surgeries Like Fundoplication, Cardiomyotomy
- Laparoscopic Colorectal Surgeries Like Anterior Resection, APR etc.
- Laparoscopic Hernia surgeries Like TEP, TAPP, Ventral Hernia repair
- Laparoscopic Gynecology surgeries Like TLH etc.
- Basic Laparoscopic surgeries like Appendectomy, Cholecystectomy, Diagnostic laparoscopy