Our preferred laparascopic approach has many benefits. Less invasive, with less pain and a lower risk of scarring, laparascopic surgery also leads to a shorter hospital stay and recovery time.

Each bariatric procedure offers unique benefits and risks to the patient. Patient age, health status and preferences factor into the decision of which procedure is appropriate.

It is important that you understand the benefits, as well as the risks associated with the procedure you choose. As always, we encourage you to discuss your questions and concerns with your bariatric team.

Laparoscopic Gastric Bypass – ROUX-EN-Y Gastric Bypass

Benefits

  • High rate of remission for Type 2 Diabetes
  • Most patients lose weight rapidly and continue to lose for 18-24 months post-operatively.
  • Can offer significant and sustained weight loss
  • Offers restriction and malabsorption to aid in weight loss
  • Overall weight loss tends to be greater compared to restrictive procedures such as the LAP-BAND or Sleeve Gastrectomy. For this reason, patients with a BMI greater than 50 may see better results with this procedure compared to others.
  • Many patients regain a small percentage of their weight after 24 months. Few patients regain all their weight.
  • Improves or eliminates most obesity-related conditions such as type 2 diabetes and hypertension
  • Blood sugar levels for most patients with type 2 diabetes can improve almost immediately after surgery and may normalize within a year after surgery
  • Long-term experience and outcome data makes this type the current gold standard for bariatric procedures
  • It may become more difficult to “cheat” due to the Dumping Syndrome. This occurs when high sugar foods are eaten. The undigested high-sugar food contents of the stomach are emptied, or “dumped,” into your small intestine too rapidly. Common symptoms include abdominal cramps, sweating, fast heart rate and nausea, which are negative reminders when eating foods high in sugar.

Possible Risks

The complications of gastric bypass are much less severe than those of intestinal bypass, and most large studies report complications in two phases: those which occur shortly after surgery, and those which take a longer time to develop.

  • The most serious acute complications include leaks at the junction of the stomach and small intestine. This dangerous complication usually requires the patient to be returned to surgery on an urgent basis, as does the rare acute gastric dilation, which may arise spontaneously or secondary to a blockage occurring at the Y-shaped anastomosis (jejunostomy).
  • There are certain complications to which any patient having surgery is prone, including degrees of lung collapse (atelectasis) which occur because it is hard for the patient to breathe deeply post-operatively. Consequently, a great deal of attention is paid in the post-operative period to encourage deep breathing, including use of an incentive spirometer and patient activity, to minimize the problem.
  • Blood clots affecting the legs are more common in obese patients, carrying with them the risk of breaking off and traveling to the lungs as a pulmonary embolus. This is the reason we follow a clinical pathway to help prevent blood clots, including early ambulation after surgery, use of PAS (compression) boots during the procedure and hospital stay, use of Lovenox (blood thinner), anti-embolic exercises and having patients quit smoking and remain smoke-free for at least six months.
  • Later, patients may experience the narrowing of the stoma (the junction between the stomach pouch and intestine), resulting from scar tissue development. This opening has been made smaller, and even a little scarring will squeeze the opening down to a degree that affects the patient’s eating. Vomiting, which comes on between the fourth and twelfth weeks, may be the cause. The problem can be dealt with by stretching the opening to the correct size through the use of endoscopic balloon dilation, usually done in a single procedure.
  • Intestinal obstruction occurs in approximately two percent of patients, an occurrence rate similar to that following any abdominal procedure.
  • Anemia is fairly common after gastric bypass, particularly in menstruating women. Since the stomach is involved in iron and vitamin B12 absorption, these may not be absorbed adequately following bypass. As a result, anemia may develop, leading the patient to feel tired and listless, with blood tests showing low levels of hematocrit, hemoglobin, iron and vitamin B12. The condition can be prevented and treated, if necessary, by taking extra iron and vitamin B12. Since the food stream bypasses the duodenum, the primary site of calcium absorption, there is a possibility of calcium and vitamin D deficiency. All patients must take supplemental vitamin and mineral products as recommended by their program dietitians.
  • "Dumping" is often included among complications of gastric bypass, but it’s really a side effect of the procedure, caused by the way the intestine is attached. "Dumping" occurs when the patient eats refined sugar following gastric bypass and experiences rapid heartbeat, nausea, tremors, faintness and, sometimes, diarrhea.
  • Age, excess weight and certain diseases can increase these risks. There are also risks associated with medications and methods used in the procedure.

Possible Complications

Early:

  • Anastomotic leak
  • Acute stricture at anastomosis
  • Dehydration (can lead to water-soluble vitamin deficiencies)
  • Roux-en-Y obstruction
  • Atelectasis
  • Wound infection (typically the left upper quadrant site)
  • Hemorrhage
  • Herniation
  • Blood clot: pulmonary embolism or deep vein thrombosis

Late:

  • Stomal stenosis
  • Anemia
  • Vitamin and/or mineral deficiency
  • Bowel obstruction/twisting (volvulus)

LAP-BAND (Laparoscopic Adjustable Gastric Band)

Benefits

  • This procedure is considered less invasive compared to other weight loss procedures. Because of this, patients may have fewer operative complications, less post-operative pain and a faster recovery.
  • The LAP-BAND can be adjusted.
  • The procedure can be reversed if necessary.
  • This procedure requires a shorter hospital stay and faster recovery time. Most LAP-BAND procedures are performed on an outpatient basis, though they require an overnight stay. Most patients are back to work within one or two weeks.
  • Because the LAP-BAND is restrictive only, there is less risk of vitamin/mineral deficiency. However, they can still occur and patients are required to take supplements post-operatively and have routine lab surveillance and lifelong follow-up with the program.

Possible Risks

  • There is a risk of gastric perforation—a tear in the stomach wall—during or after the procedure that may require additional surgery. In a clinical study, this happened in one percent of patients.
  • There are certain complications to which any obese patient having surgery is prone, including degrees of lung collapse (atelectasis) which occur because it is hard for the patient to breathe deeply when in pain. Consequently, a great deal of attention is paid in the post-operative period to encourage deep breathing, including use of an incentive spirometer and patient activity, to minimize the problem.
  • Blood clots affecting the legs are more common in overweight patients, carrying with them the risk of breaking off and traveling to the lungs as a pulmonary embolus. This is the reason we follow a clinical pathway to help prevent blood clots, including early ambulation after surgery, use of PAS (compression) boots during the procedure and hospital stay, use of Lovenox (blood thinner), anti-embolic exercises and having patients quit smoking and remain smoke-free for at least six months.
  • Obstruction of the stoma can occur, and may be followed by food, swelling, improper placement of the band, an over-inflated band, band slippage, stomach pouch twisting or stomach pouch enlargement.
  • Esophageal dilation or stretching could occur and may be caused by improper positioning of the band, too tight of a band, stoma obstruction, binge eating or excessive vomiting.

Possible Complications

Early:

  • Nausea and vomiting (with improper band positioning or maladaptive eating techniques)
  • Dehydration
  • Lung problems
  • Blood clot: pulmonary embolism or deep vein thrombosis
  • Perforation of the stomach or esophagus during surgery

Late:

  • Ulceration
  • Gastroesophageal reflux (regurgitation)
  • Heartburn
  • Band slippage/pouch dilation
  • Stoma obstruction (stomach-band outlet blockage)
  • Access port site leakage
  • Wound/port site infection
  • Band erosion
  • Esophagitis
  • Nutritional deficiencies

Laparoscopic Vertical Sleeve Gastrectomy

Benefits

  • It does not require the implantation of a foreign body such as gastric banding.
  • The procedure mechanically decreases both the size of the stomach and the hormone ghrelin, which results in the feeling of satiety (fullness) sooner.
  • The procedure offers the benefit of initially decreasing body weight in the severely obese patient to prepare for a staged procedure or other surgery at a later time.
  • Can offer significant and sustained weight loss, similar to gastric bypass
  • No internal hernias compared to gastric bypass
  • No dumping syndrome or malabsorption
  • Can improve weight-related co-morbidities
  • Less invasive compared to gastric bypass and is technically easier to perform, with no anastomosis (sewing/connecting of the two parts)

Possible Risks

  • Because there is a large staple line, there is a risk of developing a leak or bleeding at the site.
  • No long-term data showing durability beyond five years
  • There are certain complications to which any obese patient having surgery is prone, including degrees of lung collapse (atelectasis) which occur because it is hard for the patient to breathe deeply when in pain. Consequently, a great deal of attention is paid in the post-operative period to encourage deep breathing, including use of an incentive spirometer and patient activity, to minimize the problem.
  • Blood clots affecting the legs are more common in overweight patients, carrying with them the risk of breaking off and traveling to the lungs as a pulmonary embolus. This is the reason we follow a clinical pathway to help prevent blood clots, including early ambulation after surgery, use of PAS (compression) boots during the procedure and hospital stay, use of Lovenox (blood thinner), anti-embolic exercises and having patients quit smoking and remain smoke-free for at least six months.
  • Age, excess weight and certain diseases can increase these risks. There are also risks associated with medications and methods used in the procedure.

Possible Complications

Early:

  • Leak
  • Dehydration (can lead to water-soluble vitamin deficiencies)
  • Obstruction from a narrow sleeve
  • Atelectasis
  • Wound infection (typically the left upper quadrant site)
  • Hemorrhage
  • Blood clot: pulmonary embolism or deep vein thrombosis

Late:

  • Anemia
  • Vitamin and/or mineral deficiency
  • Bowel obstruction/twisting (volvulus)

Body Contouring

What is Body Contouring?

Bariatric surgery leads to dramatic weight loss, which contributes to better health and a more active lifestyle. Unfortunately, the skin does not always maintain its elasticity (ability to stretch and retract back into shape after weight loss) resulting in loose, hanging skin. This excess skin can cause irritation, pain and infection. Some patients also notice that their weight loss is not evenly distributed throughout the body, leaving them with pockets of fat tissue, which can contribute to dissatisfaction with body appearance. For some, body contouring surgery can help.

Can exercise prevent these problems?

No. Exercise and healthy eating, while critical to attaining and maintaining weight loss, have no effect on the development of uneven body contours, bulges or loose skin after dramatic weight loss. The amount of overall weight loss is the number one contributor to the development of these problems. Heredity and age also play a role.

What body areas are affected?

Areas most often affected include the face, neck, upper arms, breasts, abdomen, thighs and buttocks. The type of procedures and body area addressed vary from patient to patient. The patient’s preferences, as well as realistic expectations, must be considered.

What happens during a consultation with a plastic surgeon?

During a body contouring consultation, patients learn about the risks, benefits and alternatives to consider. The consultation involves a physical exam to determine your overall health and readiness to undergo a plastic surgery procedure, as well as an evaluation of your needs, preferences and expectations.