South Bay Metabolic and Weight Loss Institute

South Bay Metabolic and Weight Loss Institute

Our Surgical Weight Loss Team

At the South Bay Metabolic and Weight Loss Institute we have harnessed the collaborative power of multiple specialists and subspecialists into one comprehensive team of expert surgeons.

For more than 25 years, we’ve provided quality care for our patients while paving the way for future medical innovations. Our expert surgeons have performed countless weight loss procedures such as the gastric bypass and sleeve gastrectomy. We have pioneered the use of minimally-invasive techniques and key-hole surgery. Patients benefit by experiencing less pain, have very small scars, and recover faster.

Check out the information below.

Bariatric Surgery Specialists

Bariatric (weight loss) surgery can be extremely helpful not in just weight loss but in regaining better health and wellness. For example, bariatric surgery has been medically proven to improve your quality of life and INCREASE your lifespan. Let us help you live better, healthier, and longer!

Bariatric Surgery Q & A

Laparoscopic Bariatric Surgery

Laparoscopic surgery utilizes a camera and long slender instruments placed within the abdomen to perform the operation. This is in contrast to the traditional open incision, which is a large incision made on the abdomen.

Because of the smaller incisions used with laparoscopic surgery, pain after surgery is less and the recovery is faster. In addition, with the smaller incisions, the body perceives less injury and less stress hormones are released that can be detrimental to healing.

Mortality and complication rates are the same or better with laparoscopic surgery compared to traditional surgery. The incidence of wound infections and hernias after laparoscopic surgery is negligible. This is in comparison to open surgery with hernia rates as high as 20% and wound infections of 13%. There is also a decrease in scar tissue formation with less risk of bowel obstruction in the future.

Laparoscopic weight loss surgery provides comparable weight loss and similar resolution of co-morbidities to the traditional open surgery (the same operation is done). The surgical “leak” rate (< 1%) and risk of blood clots (0.5-1%) are equivalent. Whenever an operation is attempted laparoscopically there is always a risk of not being able to complete laparoscopically and an open incision may need to be made. The risk of conversion to the open method is very low.

Diabetes and Bariatric Surgery

The Next Step

Once your decision has been made to pursue surgical intervention for long-term weight loss and your medical doctors have deemed it safe you will need to be evaluated by the Bariatric team. A detailed and extensive medical and diet history as well as physical examination will be performed. There may be several tests that will need to be done in order to assess your surgical risks for complications. These may include but are not limited to Echocardiography, Stress tests, pulmonary function studies, sleep apnea studies, and endoscopy. A psychological evaluation and dietary consultation is required of all surgical candidates. In addition, you will meet with your surgeon for a comprehensive discussion of which surgery would be most appropriate for you. There will also be classes and support group meetings to attend in preparation for surgery.

BMI

Calculate Your Body Mass Index

Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.

  • Enter your weight and height using standard or metric measures.
  • Select "Compute BMI" and your BMI will appear below.
Your Height



Your Weight:

 

Categories: Underweight

  • Underweight = <18.5
  • Normal weight = 18.5 ‐ 24.9
  • Overweight = 25 ‐ 29.9
  • Obesity = BMI of 30 or greater
 

What Are the Surgical Options?

There are several types of restrictive and malabsorptive operations. Each one carries its own benefits and risks.

Restrictive Operations

Restrictive operations serve only to restrict food intake and do not interfere with the normal digestive process. To perform the surgery, doctors create a small pouch at the top of the stomach where food enters from the esophagus. Initially, the pouch holds about 1 ounce of food and later expands to 2-3 ounces. The lower outlet of the pouch usually has a diameter of only about 3/4 inch. This small outlet delays the emptying of food from the pouch and causes a feeling of fullness.

As a result of this surgery, most people lose the ability to eat large amounts of food at one time. After an operation, the person usually can eat only 3/4 to 1 cup of food without discomfort or nausea. Also, food has to be well chewed.

Restrictive operations for obesity include laparoscopic adjustable gastric banding (LAGB) and vertical banded gastroplasty (VBG).

Sleeve Gastrectomy

The Sleeve Gastrectomy is considered a restrictive and metabolic procedure. Performed laparoscopically, two-thirds of the stomach is cut away and removed, leaving a narrow, banana-shaped stomach. The new smaller stomach provides restriction and aids in portion control. The portion of the stomach removed releases a hormone called ghrelin, which is an appetite stimulant. By removing that part of the stomach, there is less ghrelin production. In addition, the portion removed is very distensible-it can stretch very easily and may also contribute to our ability to eat large portions.

The sleeve gastrectomy is not reversible, but with time and if a person frequently overeats, they may stretch their sleeve resulting in less restriction. It will never stretch back to the original size, but may stretch enough to lose your restrictive control.

Although the sleeve gastrectomy is a newer procedure, it has been performed for many decades in combination with the biliopancreatic diversion (BPD). The BPD is a malabsorptive operation where most of the intestine is bypassed. The weight loss is dependent on not absorbing the food eaten and may result in severe nutritional deficiencies. This operation is often reserved for people who need to lose several hundreds of pounds, but these are also the same people who are very high risk for complications because of their larger BMIs. In order to minimize the complication rates, the biliopancreatic diversion was done in stages. The first stage was the sleeve gastrectomy. After the patient lost one hundred pounds, they then went onto the second stage which was most often the biliopancreatic diversion or less frequently, the gastric bypass. What was discovered was that several patients lost a significant amount of weight with the sleeve gastrectomy alone, and did not need to have the second stage of the surgery performed. That is how we have come to do the sleeve gastrectomy by itself. For those patients that do not lose enough weight with the sleeve alone, it would still be possible to perform the gastric bypass (which provides enough malabsorption without excessive malnutrition).

Weight loss with sleeve is gradual, but still at a faster rate than with the adjustable gastric band. Expected excess weight loss is about 60 % at 1 year. Although 5-year data supporting the sleeve is good, the long term data is not yet available.

Laparoscopic Adjustable Gastric Banding (Lap-band)

The laparoscopic adjustable gastric band is a purely restrictive procedure. It involves placing a silastic (plastic) band around the top portion of the stomach so that the stomach acts as if it has been reduced in size. After eating a small amount of food, this smaller stomach becomes distended and the patient feels full. Also, the food passes slower into the remainder of the stomach so that fullness last longer than before surgery. The goal is portion control. The band “tightness” around the stomach is adjustable by adding or removing fluid from a balloon on the inside of the band. This is done utilizing a “port” that is connected to the balloon. The port lies on the abdominal wall, under the skin. The adjustments are performed in the bariatric office, and do not require another operation to perform. No part of the stomach or intestines are cut or divided in order to place the band.

Combined Procedures (Restrictive & Malabsorptive Operations)

Malabsorptive operations are the most common gastrointestinal surgeries for weight loss. They restrict both food intake and the amount of calories and nutrients the body absorbs.

Roux-en-Y Gastric Bypass (RYGB)

The Roux-en Y gastric bypass is a combined RESTRICTIVE and MALABSORPTIVE procedure. The restriction in this operation is accomplished either by forming a smaller functional stomach with staples (“short limb”), or taking out about 66% of the stomach. In either case, the remaining portion of the stomach is at about 1-4 ounces in size. The size of this new stomach will start out at about the size of a golf ball (short limb Roux Y gastric bypass), or small juice glass (long limb Roux Y gastric bypass). Expect some increase in size as time goes by. We do not put any bands or rings (foreign materials) around the stomach to make it empty more slowly.

Recall the total length of the intestine varies from 15 to 30 ft. The malabsorptive component of the operation is achieved by separating the food from the digestive juices. The “Roux limb” carries the food (~ 2-3 ft) and the digestive juices are carried in the “Biliopancreatic limb” (~ 1ft). When the two limbs are rejoined, the food is able to mix with the digestive juices, allowing the breakdown and absorption of food in the remainder of the intestine called the “common channel.”

Biliopancreatic Diversion (BPD)

In this more complicated malabsorptive operation, portions of the stomach are removed (see figure 4). The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure successfully promotes weight loss, it is less frequently used than other types of surgery because of the high risk for nutritional deficiencies. A variation of BPD includes a “duodenal switch” (see figure 5), which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway.

Malabsorptive operations produce more weight loss than restrictive operations, and are more effective in reversing the health problems associated with severe obesity. Patients who have malabsorptive operations generally lose two-thirds of their excess weight within 2 years.

In addition to the risks of restrictive surgeries, malabsorptive operations also carry greater risk for nutritional deficiencies. This is because the procedure causes food to bypass the duodenum and jejunum, where most iron and calcium are absorbed. Menstruating women may develop anemia because not enough vitamin B12 and iron are absorbed. Decreased absorption of calcium may also bring on osteoporosis and metabolic bone disease. Patients are required to take nutritional supplements that usually prevent these deficiencies. Patients who have the biliopancreatic diversion surgery must also take fat-soluble (dissolved by fat) vitamins A, D, E, and K supplements.

RYGB Weight Loss Related To:

Surgery Factors Patient Factors
Meal size restriction Caloric intake
Some malabsorption
Decreased appetite
Caloric expenditure

In review, following gastric bypass surgery, when you eat food, it will go into the smaller stomach (gastric pouch). The food then enters the route of intestine referred to as the “Roux limb.” (The Roux limb is also called the “alimentary limb” because it carries the food). The portion of bowel that is not carrying food (biliopancreatic limb) carries bile and digestive juices from the liver and pancreas. Full digestion will take place in the “common channel” where the digestive juice and bile mix with food. “Short” versus “long” limb gastric bypasses refer to the length of the bypassed bowel, with the long limb bypassing a greater length of bowel, and thus providing more malabsorption.

Patient Testimonials

*All opinions expressed are the sole viewpoint of the individual patient, and as such should not be treated as medical advice. Results will vary for every individual.*

More Success Stories

Frequently Asked Questions

Explore Benefits and Risks

Surgery to produce weight loss is a serious undertaking. Anyone thinking about surgery should understand what the operation involves. Patients and physicians should carefully consider the following benefits and risks:

* Disclaimer: The testimonials, statements, and opinions presented on our website are only applicable to the individuals depicted, and may not be representative of the experience of others. The testimonials are provided voluntarily and are not paid, nor were they provided with free services, or any benefits in exchange for said statements. The testimonials are not indicative of future results or success of any other individuals. Association of South Bay Surgeons a Medical Group, Inc cannot and does not guarantee the medical outcome or the results of individuals utilizing the services provided by us.*

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