Common Examples of Restrictive Weight-Loss Procedures

Common Examples of Restrictive Weight-Loss Procedures

For anyone who is considering weight loss surgery, it is important to learn what you can about the different kinds of procedures and the risks involved so you can make an informed decision. Here are examples of a restrictive weight-loss procedure.

Adjustable Gastric Band

The Adjustable Band, often referred to by the trademarked name Lap-Band, is a silicone rubber collar that is placed around the top of the stomach. The inner lining of this collar is actually a small balloon that the surgeon inflates by injecting saline solution into an access port that is buried under the skin of the abdominal wall. Tubing connects the access port to the Band. Every couple of weeks, the patient receives an injection of saline solution into the port until you hit the ‘sweet spot’. The sweet spot refers to just the right amount of saline injected to allow for weight loss while still being able to eat and drink comfortably.

Although having a needle stuck in your abdomen every couple of weeks is definitely one of the drawbacks of the procedure, it remains popular because it is minimally invasive and easily reversible or revisable, not to mention it is one of the least expensive of the weight loss procedures. With the Adjustable Gastric Band, patients can expect to lose between 30 to 60% of excess weight.

There are some negative aspects of the Adjustable Gastric Band. First, because there is a foreign body permanently implanted in your abdomen, there is a risk of band slippage or erosion requiring re-operation. Patients frequently complain of chronic reflux and vomiting because of the partial obstruction caused by the Band. Another downside of the Band is the ability to beat the system. If you are considering the Adjustable Gastric Band, you should approach it with the understanding that you will need lifetime follow-up and careful dietary coaching and monitoring to maximize your results

Gastric Sleeve

Due to some clinical situations that prompted surgeons to forgo the bypass portion of the Duodenal Switch procedure, they found that patients lost significant amounts of weight with the restrictive portion alone. Since 2001, the laparoscopic approach to the Gastric Sleeve has made it one of the more popular restrictive-only procedures of today.

The Gastric Sleeve is accomplished by removing and discarding up to 90% of the stomach. This results in a long tubular stomach. Early results with the Gastric Sleeve revealed weight loss in the range of 50 to 65% of excess weight lost. Since there is no bypass, there is less chance for vitamin and mineral deficiencies and there is no risk of the classic marginal ulcers seen with the bypass procedures. Since the hunger hormone Ghrelin is produced in the stomach, and the majority of the stomach is removed, Ghrelin levels fall after this surgery resulting in a decrease in appetite. Diabetes and hypertension generally improve or resolve after the Gastric Sleeve procedure. Although the Gastric Sleeve is a relatively safe and effective operation, it is absolutely irreversible, so if you are considering this procedure as an option for you, you should keep that in mind.

The Gastric Sleeve is not without its problems. Leaks, which can be very serious and even life threatening, have been reported in up to 6% of cases. Narrowing of the tube, known as a stricture, can occur in up to 5% of cases. When a stricture develops, the patient has difficulty swallowing food and even liquids. This can typically be corrected by passing a specialized balloon down the throat, into the stomach, and dilating it in much the same way a balloon angioplasty of the heart vessels is performed. Occasionally, surgical revision is necessary.

Gastric reflux is another problem that occurs in about one third of patients undergoing the Gastric Sleeve, particularly if they had pre-existing gastric reflux prior to surgery. Chronic reflux can damage the esophagus and predispose you to esophageal cancer. More time and studies are needed to see if this risk becomes a reality.

Weight regain after the 5th year has been reported with the gastric sleeve. Along with the regaining of weight, the recurrence of diabetes and other diseases may occur. A second stage operation whereby a bypass is added to the sleeve will sometimes help to kick start weight loss again.

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