There are two types of surgeries to control obesity: restrictive (decreasing intake of food) and malabsorptive (causing food to be poorly digested and incompletely absorbed). There are also procedures which are a combination of the two mentioned above. The following is a list of the procedures done across the country as well as those performed here at The Nebraska Medical Center.

Gastric Restrictive Procedures

The surgical restrictive bariatric procedures work by decreasing the amount of food one is able to consume at a given point through out the day.

Adjustable Gastric Banding

A band made of synthetic material is placed around the stomach near the upper end to make a small pouch and narrow passage into the rest of the stomach. The advantage of this is that normal anatomy is maintained so food and vitamin absorption is maintained. The size of the band can be adjusted as needed. Most patients need approximately (5) five adjustments in the first year; 1-2 each year for the next 2 years. The adjustments are an additional cost. With most patients you will lose weight for 3 years after this procedure.

Restrictive procedures depend on a small pouch (1 to 2 tablespoons) and small outlet to reduce food intake and help you to stay feeling full longer. If a patient overeats, they will get sick and vomit. This is a form of behavior modification. Over time, overeating can stretch the pouch and allow regain of weight. As with all of the operations for morbid obesity, readmission to the hospital may be required for fluid replacement or nutritional support if there is excessive vomiting and adequate intake cannot be maintained. Life long vitamin supplements and monitoring by a physician who understands your procedure is required.

The REALIZE Band is made of strong, flexible silicone and has a soft balloon that fits around the stomach. The amount of saline in the balloon controls the tightness around the stomach.

Malabsorptive Procedures

Roux-en-y Gastric Bypass

This procedure provides gastric restriction as well as some malabsorption. It is the most widely accepted form of obesity surgery in the United States. The stapling is positioned vertically at the top of the stomach. The stomach is completely stapled shut and a new outlet is created. This is done by dividing the small bowel just beyond the duodenum and brining it up to the pouch to create the new outlet. The other open end of the bowel is sewn back into the side of the Roux limb of intestine, completing a Y-shape which gives the procedure its name. The length of either segment of bowel can be increased to produce more malabsorption which in turn produces more weight loss. This also increases risks and side effects. There is the risk of staple line disruption as well as staple line leaks.

Photo provided by LapBand System