Because surgical solutions for obesity have been practiced for decades, there are a number of procedures that have been and are being developed to improve the options for obese individuals. Below are very brief summaries of historical weight loss surgery procedures provided to educate our patients. In addition, we have highlighted a new procedure being developed and touched upon how best to address the need for weight loss surgery revision.
Gastric Pacing New Techonology!
Gastric pacing is a technologically new option that is undergoing clinical trial and not yet widely available. This treatment for obesity applies low-level shocks to specific nerves within the stomach the will suppress hunger sensations. The small shocks are delivered via electric leads that are surgically placed in the wall of the stomach through a minimally invasive procedure with low surgical risk. Shown to provide better results than treatment with medication, gastric pacing may become an option for those who need to lose smaller amounts of weight or for morbidly obese individuals who need to lose weight in preparation for gastric bypass surgery.
Revision Gastric Bypass **
Because each individual is different and has undergone different types of weight loss surgeries, there is no simple answer to offer people who need to undergo a revision surgery. This issue is best answered by having a dialog with your physician to discuss what options are available based on your individual need.
Biliopancreatic Diversion (BPD or BPD-DS)
Italian physician, Dr. Nicola Scopinaro originated the Biliopancreatic Diversion (BPD) procedure which was later modified to include the duodenal switch (BPD-DS) as pictured to the right. The procedure promotes weight loss through a method called malabsorption, a process through nutrient absorption is impaired. The actual surgery involves removal of all but about 1/3 of the stomach and repositioning of the small intestine to create a shorter section where food is digested. Although the BPD and BPD-DS do offer enticing weight loss results for the morbidly obese, the rate of malnutrition associated with the procedures is high.
"Long Limb" Gastric Bypass
In an effort to avoid the malnutrition associated with BPD procedures, some physicians are transitioning to a version of weight loss surgery also called the Long Limb Gastric Bypass. The procedure involves the small intestine being connected further down the line, thus providing a shorter distance for digestive juices to interact with food. Some studies have shown this surgery results in higher weight loss than standard gastric bypass surgery, but there is still a larger percentage of nutritional complications associated with the procedure that can result in severe effects to the nutritional balance of electrolytes and other nutrients within the body.
Fobi modification of the Gastric Bypass
Only about 15 percent of patients experience inadequate weight loss following gastric bypass surgery. One surgeon, Dr. Mathias Fobi, developed a highly controversial method to address this problem, which is called the Fobi modification of gastric bypass surgery. The procedure involves synthetic material being placed around the stomach pouch to continually restrict food intake throughout the patient’s life. There is very little data available on this procedure to determine its viability as a long-term solution for our patients.
Vertical Banded Gastroplasty (VBG)
As a developer of the original gastric bypass surgery, Dr. Edward Mason continued his search for the safest, most effective surgical method to aid the morbidly obese. Dr. Mason expanded upon his original idea to create the Vertical Banded Gastroplasty. The procedure controls the amount of food an individual can eat by making a small stomach pouch that empties into the lower stomach via a narrow, fixed stomach passage that is held in place by a permanent ring. Although the procedure was once the most popular weight loss surgeries in the U.S., it is no longer widely practiced because study data indicates the long-term solution is not as successful as Roux-en-Y gastric bypass. Another factor in the demise of VBG is its frequent need for revision surgery.
Jejuno-Ileal Bypass (JIB)
Developed in the 1950’s and popularized in the 1970’s, the Jejuno-Ileal Bypass (JIB) was a technically easy surgical procedure that produced large amounts of weight loss for the morbidly obese with little effort required from the patient. Although this procedure is no longer performed, for most physicians who disapprove of the practice of weight loss surgery, this is the surgery that comes to their mind. The weight loss associated with the JIB were accomplished by surgically bypassing the majority of the small intestine’s area that absorbs nutrients. The unfortunate result of the procedure for many patients, years after the operation, was kidney or liver disease and even death. Any individual who has undergone a JIB should schedule regular follow-up visits with a physician.
**A WeightWise surgeon would be happy to meet with you and discuss the options available if you are in need of a surgical revision.