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Laparoscopic adjustable gastric banding (LAGB) or Laparascopic Gastric banding is one of the least invasive weight loss treatments available for obesity. It's done with a few tiny abdominal cuts, instead of with one large cut. The surgeon puts instruments through the cuts. One of those instruments is a laparoscope, a tool with a tiny camera. Using this, a silastic band is placed around the stomach just below the junction of esophagus (food pipe). This forms a small pouch thus creating an hour-glass effect. The silicon ring passes around the stomach, thus giving a small outlet, that allows only as much food as the size of an eraser, to enter the distal stomach. The reservoir is placed under the skin in the midline just below the chest such that it can easily be felt while lying down. A needle can be injected through the skin into the reservoir and to add or remove fluid to adjust the size of the stomach outlet.
The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time. The small pouch ensures that the patient feels full after eating only small amounts of food. This causes weight loss. As its name suggests, this is an adjustable gastric band Scheduled follow-up visits will be at 6 weeks, monthly for the first six months and yearly thereafter or as and when medically required.
LAGB is used to treat severe obesity, which is linked to high blood pressure, high cholesterol, type 2 diabetes, sleep apnea, and arthritis. It is recommended for people who have tried other weight loss plans without long-term success. Once you lose a significant amount of weight, your risk falls for these weight-related health problems. Adjustable gastric banding may help you live longer if you can't lose weight in other ways.
The sleeve gastrectomy originated as the restrictive part of the duodenal switch operation. In the last several years, it has also been used as a staging procedure prior to a gastric bypass or duodenal switch in very high risk patients. It has also been used as a primary, stand-alone procedure.
Most sleeve gastrectomies performed today are performed laparoscopically. This involves making five or six small incisions in the abdomen and performing the procedure using a video camera (laparoscope) and long instruments that are placed through these small incisions.
Sleeve gastrectomy is a restrictive form of operation in which approximately 2/3rd of the left side of the stomach is removed laparoscopically using endoscopic staplers. The stomach thus takes the shape of a hockey stick or sleeve. It can be performed as either first stage of a two-stage procedure for super obese (BMI >60) where it can be followed with malabsorptive surgery or as a single stage procedure by itself.
The capacity of the stomach ranges between 60 - 100 cc. Unlike many other forms of bariatric surgery, the outlet valve and the nerves of the stomach remains intact while only the stomach size is drastically reduced. Though a non-reversible procedure, the part of the stomach that contains Ghrelin, the hormone for hunger is removed; it drastically reduces your appetite and hormones that controls diabetes.
Gastric bypass, aka Roux-en-y gastric bypass surgery, involves creation of a small stomach pouch with the help of staples, which restricts the food intake. In addition, the initial segment of the small intestine is bypassed and a direct Y shaped connection is made from the remaining part of the jejunum to the new stomach pouch for malabsorption.
Roux-en-Y gastric bypass (RYGB) reduces the size of the stomach to a small pouch - about the size of an egg. It does this by stapling off a section of it. This therefore drastically reduces the amount of food intake. The surgeon then attaches this pouch directly to the small intestine, bypassing most of the rest of the stomach and the upper part of the small intestine. This reduces the amount of fat and calories absorbed from the foods taken and this causes even more weight loss.
Gastric bypass surgery can be done as an open surgery, with a large cut (incision) on the abdomen to reach your stomach. Or it can be done as a laparoscopic RYGB. Laparoscopic RYGB procedure means you don't stay in the hospital as long and recover more quickly. You also may have less pain, smaller scars, and less risk of getting a hernia or infection.
A biliopancreatic diversion is a weight loss surgery where the normal process of digestion is changed by making the stomach smaller. By this procedure, food bypasses part of the small intestine so that you absorb fewer calories. This surgery is for people who are more than severely obese. Super obesity means that BMI (body mass index) is 50 or higher.
After surgery, the patient will feel full more quickly than when the stomach was its original size. This reduces the amount of food the patient will want to eat. Bypassing part of the intestine also means that fewer calories are absorbed. This leads to weight loss.
There are two biliopancreatic diversion surgeries: a biliopancreatic diversion and a biliopancreatic diversion with duodenal switch. Most surgeons will not perform duodenal switch surgery except in super obesity.
These procedures can be done by making a large cut in the belly (an open procedure) or by making a small cut and using small tools and a camera to guide the surgery (laparoscopy).
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