Weight Loss Surgery
Weight loss surgery, also known as bariatric surgery, is one of the most effective options available for reversing the dangerous effects of morbid obesity when other conservative methods of reducing weight (diet, exercise and medication) have failed.
Surgical procedures to reduce weight can help patients overcome life-threatening diseases, such as type 2 diabetes, hypertension, high cholesterol, heart disease, obstructive sleep apnea, gallbladder disease, asthma and metabolic disease. When combined with a commitment to lifestyle modifications and diet changes, weight loss surgery can be a patient’s best chance for health and longevity.
The surgeons at Houston Methodist perform the following weight loss surgical procedures: LAP–BAND®, gastric sleeve and roux–en–Y gastric bypass (RYGB). We also address the most common questions in regards to weight loss surgery. Visit our frequently asked questions page for more information.
The LAP-BAND® procedure, sometimes called adjustable gastric banding, can be a safe alternative to gastric bypass surgery for patients with underlying health conditions, which place them in a high-risk category for more invasive surgery. It is among the least invasive weight loss surgeries and is designed to restrict food intake by placing a silicone band around the upper portion of the stomach that creates a small pouch that holds only approximately two ounces of food. This is solely a restrictive procedure and does not involve any stapling or re-routing of the gastrointestinal tract.
During the surgery —normally performed laparoscopically and under general anesthesia — the band is placed around the upper stomach. A tube connected to an access port is placed beneath the skin, which allows the surgeon to modify the size of the ring to ensure successful weight loss.
Following adjustable gastric banding, patients consume a liquid-only diet and gradually resume eating solid foods according to their specific weight management plan. Adjustments to the gastric band are made four to six times in the first year to ensure optimal fit and encourage continued weight loss. Band adjustments are painless and are generally done during a regular office visit. Weight loss associated with the LAP–BAND® is more gradual than with some other weight loss surgeries, with most patients losing about 5 to 10 pounds per month.
Who is a good candidate for the LAP-BAND® procedure?
Patients with a BMI between 35 and 39 may be candidates if they suffer from obesity-related illnesses such as diabetes, high cholesterol or high blood pressure.
What are the complications associated with the LAP-BAND® procedure?
The most common complication associated with adjustable gastric banding are adhesions from previous surgeries, which hinder a laparoscopic procedure. In such cases, your surgeon may need to change to an open procedure. Other complications may include band migration or slippage, access port leakage or kinking, esophageal spasm, gastroesophageal reflux (GERD), and nausea and vomiting.
Gastric Sleeve Procedure
The gastric sleeve, or sleeve gastrectomy, is a minimally invasive laparoscopic surgical procedure that promotes weight loss by permanently removing two-thirds of the stomach, while preserving the valve (called the pylorus) that regulates emptying the stomach so food slowly trickles out. Because the stomach is reduced in size, it only holds approximately two to five ounces of food, promoting a feeling of fullness with smaller amounts, thus reducing overall daily caloric intake.
During the procedure, which is performed under local anesthesia, the large portion of the stomach along the curvature is removed. The open edges are then attached with staples to form a sleeve or tube. The entire surgery takes about an hour and involves approximately five small incisions. Because there is no nasogastric tube or drain, patients return to work and daily activities in about two weeks following the surgery.
Who is a good candidate for the gastric sleeve?
The gastric sleeve is a good weight loss option for patients with less weight to lose. It may also be performed to initiate weight loss and help less stable, morbidly obese patients achieve a healthier state before an extensive procedure can be safely performed.
What are the complications and risks with gastric sleeve?
Patients with a high BMI (40 or higher, or BMI of 35 to 39.9 with a significant obesity-related condition) may require follow-up surgery to reach their weight loss goals. Complications from stomach stapling may occur as well as other conditions, such as deep vein thrombosis, ulcers, gastric leakage and fistula, pulmonary embolus, ulcers and dyspepsia.
Roux-en-Y Gastric Bypass (RYGB)
The roux-en-Y gastric bypass (RYGB) is a surgical procedure that alters the digestion process. The RYGB is a malabsorptive (the inability to absorb certain fats, proteins and sugars) and restrictive procedure, designed to redirect food to a pouch surgically created in the stomach, bypassing part of the small intestine.
During the surgery, a small pouch in the stomach is created and then the larger part of the stomach is separated from this pouch. The area just below the first section of the small intestine (duodenum) is divided; the second section of the small intestine (jejunum) is then brought up and connected to the newly created pouch, and the duodenum is reconnected to the new intestinal limb – forming a "Y" shape. Bypassing the duodenum prevents the absorption of calories and nutrients, which results in weight loss.
This surgical procedure normally produces approximately two-thirds of excess weight loss within two years.
Who is a candidate for the RYGB procedure?
Patients who have a BMI greater than 40 or who suffer from life-threatening obesity-related disease are considered good candidates for the RYGB procedure if they are physically able to withstand the surgery.
What are the complications and risks with the RYGB procedure?
Some of the complications associated with RYGB may include leaks between the two surgical structures, dumping syndrome, stomach distension and bowel obstruction. Patients are also at risk for nutritional deficiencies such as iron, vitamin B12, vitamin D and calcium, which may result in anemia, osteoporosis and metabolic bone disease. It will be necessary for patients undergoing this procedure to follow a lifelong nutritional plan that includes supplements, outlined by your surgeon and weight management team.
For detailed information about how all of these procedures work, the risks involved, how to select a surgeon, what you need to know for your pre-surgery visit, what to expect after surgery, insurance issues and more, visit our frequently asked questions page.
General Information for Weight Loss Procedures
Candidates for weight loss surgery must meet the following criteria.
- BMI of 40 or higher, or BMI of 35 to 39.9 with a significant obesity-related condition such as diabetes, high blood pressure, heart problems, sleep apnea or reflux disease
- Demonstrated prior attempts at weight loss such as diets, exercise, behavior modification or medications
- A thorough understanding of the possible risks, benefits and side effects of the procedure
- Absence of medical or psychiatric conditions in which surgery would be advised against
- Commitment and motivation with realistic expectations after surgery
- Absence of any addictive behaviors, such as smoking, drinking and drug abuse
- Completion of both a psychological and nutritional evaluation prior to approval
Benefits of weight loss surgery
Medical studies show that a new healthier life is waiting for the vast majority of people who decide to have weight loss surgery.
- Heart disease decreases by 47 percent for women and 67 percent for men
- Risk of colon, breast, endometrial, kidney and esophageal cancers is lowered by 25 to 30 percent (when surgery is combined with regular physical activity)
- Risk of diabetes decreases by up to 80 percent
- The ability to become pregnant increases by 43 percent
- Risk of developing osteoarthritis, which can lead to joint replacements, is lowered; every two-pound loss decreases risks 9 to 13 percent
- Risk of sleep apnea decreases
- Risk of GERD (gastroesophageal reflux disease) decreases
- Depression risk is lessened
- Reduces the amount of money spent on medications by 77 percent, as well as the potentially harmful side effects associated with some medications
- Reduces the need for health care services by 36 percent
Bariatric Surgery Registry
The bariatric surgery registry is a data system required by the Metabolic & Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) that collects, manages and analyzes data on individuals who have had weight loss surgery. The purpose of the registry is to identify trends in populations, demographics, treatment outcomes and survival rates to improve surgical care for bariatric patients.
Information is collected for several reasons.
- It is required by the MBSAQIP – Houston Methodist has undergone an independent, voluntary and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards. With the expanded range of facilities now engaged in bariatric surgery — from full service inpatient hospitals to outpatient facilities — the MBSAQIP Accreditation Program symbolizes institutional commitment and accountability for safe, high-quality surgical care, as evidenced by the documentation of performance indicators and the measurement of outcomes. Bariatric surgery accreditation promotes uniform standard benchmarks and supports continuous quality improvement.
- The information assists with education – Statistical reports of bariatric registry data enable physicians to evaluate the success of specific treatment modalities as measured by the quality of life and level of successful weight loss.
- Assists with lifetime patient follow-up – The bariatric surgery registry can serve as an automatic reminder to patients to schedule regular medical examinations, and it provides continuing surveillance of bariatric patients to assist with outcome measurements.
- Research – The data collected and maintained in the bariatric registry can serve as a valuable resource for physicians and others interested in clinical research.
In all circumstances, HIPAA guidelines are adhered to and confidentiality of patient identity is strictly maintained.
Our physicians specialize in weight loss surgery at the following convenient locations: