Restrictive Banding Procedures
About a third of people who undergo these procedures achieve normal weight and 80% experience some weigh loss. They are less successful than the bypass procedures but cause a lower risk for nutritional deficiencies.
Vertical Banded Gastroplasty. Vertical banded gastroplasty (VBG) was the most common restrictive procedures. It involves creating a hole through both stomach walls and sealing the edges with a staple. This narrows the stomach, similar to a funnel, and allows only small amounts of food to pass through.
Laparoscopic Gastric Banding. Laparoscopic gastric banding (the Lap-Band) usually does not require a major incision and avoids some of the major complications of gastric bypass:
- It employs an adjustable silicone band that is placed around the upper part of the stomach.
- A small balloon-like reservoir attached to the band under the abdominal skin contains saline, which can be added or removed to tighten or loosen the band.
- The procedure restricts the amount of food a person can eat and gives the feeling of fullness.
The band is removable, if necessary. Studies to date indicate that the intestinal tract returns to normal afterward. Some studies have reported significant weight loss and improved quality of life with the procedure, including in the elderly. A 2001 analysis of eight U.S. centers where it was performed, however, reported a very high failure rate after 2 years. Experts concluded that it is not, at this time, an effective procedure for severe obesity. Nevertheless, increasing surgical experience could improve these results.
Malabsorptive Bypass Procedures
Malabsorptive procedures produce greater weight loss than restrictive procedures. They generally achieve about two-thirds of their weight loss within 2 years. Furthermore, in a 2003 study, after standard bypass surgery, 83% of patients with type 2 diabetes experienced normal blood glucose levels and the rest had significant reductions.
Roux-en-Y Gastric Bypass Procedure. This is the most common and successful malabsorptive surgery in the United States. It involves creating a small stomach pouch that serves as a reservoir and restricts food intake. The pouch eventually holds up to 3 ounces of food and has a small outlet that delays emptying and causes a feeling of fullness. Then the surgeon creates a Y-shaped section in the small intestine that attaches to pouch and allows food to bypass the lower stomach and upper part of the intestine. One 2003 study reported that it was associated with significant weight loss, and furthermore 80% of patients with type 2 diabetes were able to reduce their medications. A more recent study, published in the March 14, 2006 Archives of Surgery, found that gastric bypass surgery also helps lower the blood pressure of very obese patients.
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