What is Bariatric Surgery?

Bariatric surgery, or weight loss surgery, effectively treats obesity in people for whom measures such as diet, exercise and medication alone are not enough. This surgery can improve the patient’s quality of life and may also help resolve conditions that often coincide with obesity — including headaches, reflux, diabetes, liver disease, high blood pressure, joint pain and sleep apnea. After a successful bariatric surgery, studies have shown that patients have lower blood sugar, blood pressure and cholesterol levels as well as decreased workload on the heart.

Our first approach to bariatric surgery, called the laparoscopic sleeve gastrectomy, is the most common procedure among adolescent weight loss patients. This type of surgery reduces the size of the stomach and removes the part of the stomach that produces grehlin (the hunger hormone). Our second approach, the laparoscopic Roux-en-Y gastric bypass, reduces the size of the stomach and re-routes the small intestine to create changes in gut hormones that lead to decreased hunger and weight loss. Rather than doing large-incision surgery, laparoscopic surgery uses specialized miniature instruments that are inserted through small incisions made in the abdominal wall. Our team has been doing this form of bariatric surgery since 2004.

This technique:

• Promotes faster healing and recovery
• Decreases pain
• Decreases the chance of infection

Laparoscopic Sleeve Gastrectomy

In a laparoscopic sleeve gastrectomy, surgeons significantly resize and shrink the stomach. The surgery works in three main ways:

1. Given its reduced size, the stomach cannot hold as much food.
2. The procedure removes many of the cells that produce grehlin, the hormone involved in creating the feeling of hunger.
3. The stomach empties its contents faster, causing the intestine to release GLP-1, a hormone that makes you feel full.

The laparoscopic sleeve gastrectomy provides advantages over other surgical weight loss procedures. Patients are less likely to require further surgery for complications, it does not require the construction of new connections within the bowel, it has a lower risk of malabsorption of nutrients and the surgery can later be converted to the gastric bypass, if needed. Furthermore, adolescents who undergo a sleeve gastrectomy have a similar rate of weight loss and reduction in obesity-related diseases after one year as adolescents who undergo a gastric bypass.

Laparoscopic Roux-en-Y Gastric Bypass

Gastric bypass surgery changes the process of digestion. Like the laparoscopic sleeve gastrectomy, this operation decreases the size of the stomach. But it also causes significant changes in gut hormones like grehlin, GLP-1 and others that result in decreased hunger, rapid feeling of fullness and weight loss. After the surgery, food travels directly into the lower part of the small intestine, bypassing the first two sections of the small intestine. It therefore increases the risk of nutritional deficiencies. While the gastric bypass may have a higher complication rate, it also may result in greater long-term success from surgery and may be the better choice in some adolescents.