To decide which weight-loss surgery is best for you, start first by considering your current health and weight, your goals, the procedures your physician performs and which are covered by your insurance provider.
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There are many different procedures to choose from but they fall into two basic categories:
- One restricts the size of the stomach to reduce the amount of food you can eat.
- The second type restricts the size of the stomach and also bypasses parts of the digestive tract to limit the calories absorbed as food passes through your intestines.
Your physician can help you discuss which approach will help you achieve your individual goals in the safest manner possible.
At UC Irvine Health, we perform the Roux-en-Y gastric bypass, sleeve gastrectomy and gastric banding as surgical options. There are many factors to consider when choosing between these procedures, including the patient’s obesity-related medical problems and eating habits.
Obese individuals are at far greater risk of dying from obesity-related diseases, including coronary artery disease, hypertension (high blood pressure), type 2 diabetes and certain cancers. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), individuals who are obese have a 10 percent to 50 percent increased risk of death from all causes. A healthy weight for most people is defined as a body mass index (BMI) between 18.5 and 24.9.
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Severe obesity, sometimes known as "morbid obesity," is defined as being more than 100 pounds overweight or twice your ideal body weight, according to the Metropolitan Life Insurance Company height and weight table.
More than 35 percent of U.S. adults are obese. Of these, 6.3 percent — or about 15 million adults — are severely obese, according to the National Institutes of Health. Severe obesity is a well-established risk factor for development of coronary artery disease, type 2 diabetes, dyslipidemia, gallbladder disease, hypertension and certain cancers.
The risk of developing these additional medical problems is proportional to the degree of obesity.
Numerous medical approaches to this problem have been advocated, including low-calorie diets, drugs, behavioral modification and exercise therapy. Unfortunately, many patients are unable to maintain reduced body weight. Surgical intervention is a treatment proven to be effective in the long-term management of morbid obesity.
Most insurance carriers cover the laparoscopic gastric bypass procedure and gastric banding if you are eligible. Coverage for laparoscopic sleeve gastrectomy varies depending on your health insurance carrier. If your insurance does not cover these procedures, you may discuss other options with our office.
Our weight-loss surgeons have performed more than 2,000 laparoscopic bariatric operations and managed complex complications associated with weight-loss surgery.
Board-certified gastrointestinal surgeons Dr. Ninh T. Nguyen and Dr. Brian R. Smith also are specialists in minimally invasive laparoscopic techniques for these procedures.
Laparoscopic weight-loss surgery involves making five half- inch incisions and performing the operation by observation through a small camera. The laparoscope, which is connected to a video camera, is inserted through one of the small abdominal incisions, giving the surgeon a magnified view of the patient’s internal abdominal space on a television monitor. The entire operation is performed "inside" the abdomen after gas has been inserted to expand the abdomen and create a working space.
Advantages of the laparoscopic approach include less post-operative pain, a shorter hospital stay, faster return to work and improved appearance. Recovery time also is shorter, absent any operative complications.
Eligibility for a laparoscopic procedure is based on the patient’s BMI at the initial consultation, his or her body build (pear versus apple body type), prior surgical history and whether the patient can tolerate inflation of the abdomen.
The following guidelines for selecting patients for obesity surgery were established in 1991 by the National Institutes of Health Consensus Development Panel. Ideal candidates are individuals who:
- Have suffered from obesity for at least five years
- Have tried losing weight with conservative, nonsurgical methods without success. Documentation of such efforts must be provided at the time of consultation. If unavailable, a medically supervised weight-reduction program may be recommended before bariatric surgery is considered
- Have a BMI of 35 or higher along with an obesity-related medical problem, or 40 or higher without an obesity-related medical problem. Recent FDA approval of gastric banding for patients with BMI greater than 30 with an obesity-related medical comorbidity allows for adjustable band placement in these patients
- Fully understand the importance of the proposed surgical procedure, including all known and unknown risks
- Are prepared to make the necessary lifestyle changes required for long-term success
- Are willing to be observed by a physician for a prolonged period of time.
Once you are deemed eligible for surgery and your procedure is authorized by your insurance carrier, you receive a date for a preoperative history and physical exam. Preoperative laboratory studies are ordered and a date for your surgery is set. Next you receive instructions for two weeks of a liquid diet, as well as bowel preparations for the day before surgery and instructions regarding current medications.
Both laparoscopic and open gastric bypass surgeries last about two hours, although it can take longer if a patient has had previous abdominal surgery or if anatomical conditions make the procedure more difficult. Laparoscopic adjustable gastric banding normally takes about 60 to 90 minutes. A laparoscopic sleeve gastrectomy takes about one hour.
If you have the laparoscopic gastric bypass procedure, you can expect to be in the hospital for two days postoperatively. You may be able to return to most of your usual activities in seven to 10 days.
With the adjustable gastric banding procedure, the hospital stay is typically one day, with most patients able to resume normal activities in seven to 10 days.
Sleeve gastrectomy patients also typically stay one day in the hospital, then are able to resume normal activities in seven to 10 days.
Most gastric bypass patients experience fairly rapid weight loss for three to six months after surgery. Weight loss slows but generally continues for 12 to 18 months after surgery. Patients lose an average of 65 percent to 75 percent of their excess body weight within the first year.
After 18 months, it is critical to adhere to the low-fat, low-sugar diet and exercise recommendations to maintain your weight loss.
With gastric banding, weight loss is generally slower and more gradual, with patients losing about 40 percent to 50 percent of excess body weight. Laparoscopic sleeve gastrectomy patients lose about 60 percent to 65 percent of excess body weight within the first year. Weight loss may continue for up to two years.
Questions? Contact UC Irvine Health Bariatric Surgery Services at 888-717-4463.