Surgical Options

There are four main surgical weight loss procedures performed in Australia: adjustable gastric band; sleeve gastrectomy; one anastomosis gastric bypass (or mini gastric bypass) and the Roux-en-Y gastric bypass. The surgeries vary in the way they aid weight loss, but they all assist in reducing hunger, thus allowing less food to be eaten and making you feel full for longer.

Laparoscopic Adjustable Gastric Band

The laparoscopic adjustable gastric band is the most non-invasive procedure. It is adjustable and reversible. It is a hollow band – like a ring or belt – that is placed around the upper part of your stomach.

It is designed to place a precise level of pressure on the nerves around the upper part of your stomach so they send signals to your brain that you are not hungry. Because the band also constricts the upper portion of your stomach, you will eat less food at one time and still feel satisfied.

The lap band system includes a small access port that is safely placed under your skin. The port is not visible and it is unlikely that anyone will know you have the band, unless you tell them. The band is adjusted by adding or removing fluid through this access port with a small needle to ensure it continues providing optimum weight loss results.

As the procedure is done laparoscopically there is less scarring, less time in hospital and a quicker recovery time. The lap band is adjustable - as you lose weight, fluid can be added or removed from the band to ensure your continued weight loss success. The band can also be loosened to accommodate changes during pregnancy and tightened after delivery to help you return to your healthy goal weight.

Unlike other weight loss procedures, the lap band procedure is reversible. It does not involve removing or stapling parts of the stomach and does not reroute the digestive tract.

How does the band help to lose weight?

The lap band is a tool to assist with weight loss by encouraging a feeling of fullness. Learning to eat with a lap band is a key to success and requires patients to eat slowly and wait 40 seconds between each mouthful of food. Most patients lose around 40% of excess weight over a 12-24 month period. Adjustments are required at regular follow up visits so this weight loss can be maintained long-term.

How is the surgery performed?

The procedure is performed laparoscopically (keyhole surgery), with some blood tests taken prior to the surgery. All patients are required to go on the Optifast meal replacement program three weeks before surgery. This helps to lose some weight and most importantly helps to reduce the size of the liver making the surgery safer and easier for you and the surgeon.

There can be a major complication in 1 in 2,500 procedures.

The procedure takes approximately two hours and an overnight stay in hospital is required.

Potential problems

There can be potential problems with a lap band such as erosion, leakage, slippage of the band. The port may flip, dislodge, leak, dislocate or become infected. There may be difficulty swallowing certain foods and intolerance to certain foods. There may be nausea and vomiting. There may be gall stones associated with the band, reflux, hiatus hernia and pouch dilation.

Gastric Sleeve

A sleeve gastrectomy is performed using a laparoscopic (keyhole) technique to reduce the amount of food the stomach holds. The stomach is cut vertically and stapled so there is a thin sleeve remaining. About 80% of the stomach is removed. Normally a stomach holds about 2-3 litres. With a sleeve gastrectomy this capacity is reduced to approximately 100-150mls.

How does the gastric sleeve help you to lose weight

The sleeve allows you to lose weight while still being able to eat the foods you enjoy by:

• Portion control – because the stomach is smaller you can still eat your normal food but with much smaller portions.
• Food choices changes – it changes the way your stomach handles fatty and sweet foods causing a reduced desire for these foods.
• Hunger reduction – you feel less hungry between meals.
• Metabolism – it changes the blood levels of metabolically active stomach hormones and changes the biochemical pathways regulating appetite and metabolism.

Patients can lose between 50-60% of their excess body weight over approximately 12-24 months. The procedure is not reversible.

The gastric sleeve operation can be performed for weight loss and also for those patients who are no longer able to tolerate or have complications with the lap band. All patients need to be on the Optifast meal replacement program for three weeks prior to surgery.

There is usually a stay of 3-5 days in hospital and the operation takes approximately two hours. Patients undergoing this procedure are followed up in 1, 3 and 12 month visits.

Potential problems

The surgery carries greater associated risks than the lap band surgery which include bleeding, staple line leakage, twisting of the stomach, reflux, fistula developement, diarrhoea and dumping. 

One Astomosis Gastric Bypass (Mini Gastric Bypass)

The mini gastric bypass is minimally invasive and is performed laparoscopically. The stomach is reduced by creating a tube which is then joined to the small intestine. Up to two metres of the small intestine may be bypassed. This differs from the Roux-en-Y which has two joins and the mini bypass has one join. The operating time is shorter than the Roux-en-Y bypass. This procedure is reversible.

See Roux-en-Y Gastric Bypass to see how the mini bypass works to assist in weight loss.

Roux-en-Y Gastric Bypass

The gastric bypass operation is where a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine).

This complex operation is similar to a gastric sleeve in the way it allows control of your diet. Patients can lose approximately 80% of their excess body weight. Patients need to be on the Optifast meal replacement plan for three weeks before surgery.

How does the gastric bypass help you to lose weight

The gastric bypass allows you to lose weight while still being able to eat the foods you enjoy by:

• Portion control – because your stomach is smaller you can still eat your normal food but with much smaller portions and it prevents overeating.
• Food choices change – it changes the way your stomach handles fatty and sweet foods causing a reduced desire for these foods.
• Hunger reduction – you feel less hungry between meals it alters your appetite.
• Metabolism – it changes the blood levels of metabolically active stomach hormones and changes the biochemical pathways regulating appetite and metabolism.
• Absorption – the bypass component reduces the amount of calories and nutrients absorbed from food. 

Potential problems

This procedure carries a higher risk of post-operative complications and long term nutritional deficiencies. If vitamin supplements are not taken, diarrhoea and dumping can occur with foods containing excess sugar or starch. 

Surgical complications include anastomotic leaks and internal bowel hernias. All surgical procedures carry a risk and the risk of mortality varies between 1 in 2500 for gastric bands and 1 in 1000 for the gastric sleeve and bypass.