MedStar Health Bariatric and General Surgery at MedStar Washington Hospital Center

The laparoscopic sleeve gastrectomy, often called the “sleeve,” is performed by removing approximately 80 percent of the stomach. The portion of the stomach that remains is the size and shape of a banana.

How it Works

The procedure limits the stomach’s ability to hold food and liquid, helping reduce the amount of food (and calories) that are consumed. By removing the portion of the stomach that produces most of the “hunger hormone,” the surgery effects metabolism. It decreases hunger, increases fullness, and allows the body to reach and maintain a healthy weight, as well as control blood sugar. The potential for complications in the small intestine is minimal.

Advantages

1. Technically simple procedure requiring only a short amount of time in the operating room
2. Can be performed for certain patients with high-risk medical conditions
3. May be performed as the first step for patients with severe obesity
4. May be used as a bridge to gastric bypass
5. Effective weight loss and improvement of obesity related conditions

Disadvantages

1. Non-reversible procedure
2. May worsen or cause new onset reflux and heart burn
3. Less impact on metabolism compared to bypass procedures

The Roux-en-Y Gastric Bypass, often called the “gastric bypass,” has been performed for more than 50 years, and the laparoscopic approach was refined in 1993. It is one of the most common operations and is very effective in treating obesity and obesity-related diseases. The name is a French term meaning “in the form of a Y.”

The Procedure

1. First, the stomach is divided into a smaller top portion (pouch) which is about the size of an egg. The larger part of the stomach is bypassed and will not be able to store or digest food following the surgery.
2. The small intestine is also divided and connected to the new stomach pouch to allow food to pass. The small bowel segment, which empties the bypassed or larger stomach, is connected into the small bowel approximately 3-4 feet downstream, resulting in a bowel connection resembling the shape of the letter Y.
3. Eventually, the stomach acids and digestive enzymes from the bypassed stomach and first portion of the small intestine will mix with food that is consumed.

How it Works

Like many bariatric procedures, the newly-created stomach pouch is smaller and able to hold less food, which means fewer calories are consumed. Additionally, the food does not come into contact with the first portion of the small bowel and this results in decreased absorption. Most importantly, the modification of the food routed through the gastrointestinal tract has a profound effect to decrease hunger, increase fullness, and allow the body to reach and maintain a healthy weight. The impact on hormones and metabolic health often results in improvement of adult-onset diabetes even before any weight loss occurs. The operation also helps patients with reflux (heart burn) and often the symptoms quickly improve. Along with making appropriate food choices, patients must avoid tobacco products and non-steroidal anti-inflammatory drugs.

Advantages

1. Reliable and long-lasting weight loss approach
2. Effective for remission of obesity-associated conditions
3. Refined and standardized technique

Disadvantages

1. Technically more complex compared to sleeve gastrectomy or gastric band procedures
2. More vitamin and mineral deficiencies than sleeve gastrectomy or gastric banding
3. There is a risk for small bowel complications and obstruction
4. There is a risk of developing ulcers, especially for non-steroidal and anti-inflammatory drug user, and/or tobacco uses
5. May cause “dumping syndrome” (a feeling of sickness after eating or drinking, especially sweets)

We offer revision, conversion, and staged procedures to address complications, weight regain, or insufficient weight loss.