Treatment Options

Gastric Sleeve

The Sleeve Gastrectomy, also referred to as gastric sleeve surgery, is a very effective operation that can be done laparoscopic with small incisions and allows patients to lose weight and reduce hunger. The weight loss with the Sleeve Gastrectomy has been in the range of 50% to 60% of the excess body weight.

This operation is the only bariatric procedure that has no malabsorption (as the gastric bypass does) and no foreign body (as the gastric banding does). It has a lower risk compared to the gastric bypass, and the relative invasiveness of the procedure is in between the bypass and the banding procedure.

A primary reason people lose weight with the gastric sleeve is because of the significantly smaller stomach size. The reduction of the size of the stomach, to about 60 - 80 cc in volume results in a powerful restrictive weight loss. This is about 7-80% smaller than the normal stomach size. As a result, patients feel full after a very small amount of food, and therefore lose weight because they eat less, and they are happy eating less.

Decreased Hunger

There are also significant effects on the hunger mechanisms that make the weight loss seen with the Sleeve Gastrectomy even better than would be seen just with a small stomach pouch. Hunger is favorably affected because there is a reduced capacity to produce ghrelin, a substance that plays a role in how you feel, and relieves hunger.

Preservation of Pyloric Valve
Another important fact about the sleeve is that it preserves the pylorus, which is the valve that regulates emptying of the stomach. This acts as a "natural band" and allows food to hold up in the stomach for a while, making the person feel full while the food trickles out. Coupled with the fact that there is no rearrangement of the bowel, it also means dumping and marginal ulcers are not a problem. The normal satiety mechanism (feeling of fulless) is enhanced by this mechanism.

Gastric Banding

The gastric band surgery is a safe, effective weight loss solution. Gastric banding is performed laparoscopically (with a camera) using several small incisions rather than one large incision. It requires no stapling or cutting of the stomach and it allows us to easily adjust the amount of food a patient can eat without the need for further surgery. The gastric band avoids irreversible changes to the stomach and bowel anatomy, and if for any reason it needs to be removed, the stomach generally returns to its original form. 

Gastric Bypass

In the gastric bypass procedure - which is more specifically called the Roux-en-Y bypass - stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum (part of the small intestines), thus bypassing some of the intestines that take care of calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

One reason people lose weight with the gastric bypass is because of the significantly smaller stomach size. Only a small portion of your stomach remains in use after the gastric bypass surgery, so patients generally report feeling more full after eating smaller meals.

Malabsorption means that your body does not absorb all the calories that you eat. This happens because a portion of your intestine is bypassed. Since the intestines absorb calories, the food you eat will contribute fewer calories to your body. This is a benefit in losing weight, but also something to be careful about because the body will also absorb fewer nutrients. Taking supplements is necessary after a gastric bypass.

Non Surgical Weight Loss Balloon Procedures

CHI Memorial Bariatric and Metabolic Care offers two balloon procedures - one which requires sedation and one which only requires light sedation. 

The Obalon Balloon System is different than any other weight loss balloon because you do not need to be sedated or have any down time with this option. Patients are given up to 3 Obalon balloons to take up space in their stomach. The balloon is deflated and in a pill that the patient can swallow. Once the pill is in the stomach, the doctor fills the balloon through a very thin tube that's attached to the pill.

One Obalon balloon is placed per visit, and each balloon is placed approximately 2 weeks apart. 6 months from the time your first balloon was placed, all three balloons will be removed.

The Obalon Balloon System is approved for adults over the age of 22, who have a BMI between 30 - 40. To estimate your BMI, you can use this chart. Patients whose BMIs fall into the red area are candidates for the Obalon Balloon System. Certain conditions may prevent Obalon from being an option for you. These conditions include pregnancy, gastrointestinal abnormalities, and certain digestive disorders.

Precaution: Patients should not to undertake scuba diving or travel in an unpressurized airplane cabin as these activities might cause the balloons to deflate.

ReShape Integrated Dual Balloon System
The ReShape balloon has been approved for patients with a BMI between 30 & 40. To estimate your BMI, you can use this chart. Patients whose BMIs fall into the red area are candidates for the ReShape balloon. Candidates must also have one obesity-related health condition such as diabetes or high blood pressure.

This balloon is a non-surgical procedure because it is placed "endoscopically." This means that a tube is inserted down the throat, into the patient's stomach and the balloon is placed with that tube. Placing the balloon generally takes under 10 minutes and is performed under light sedation.

Once placed, the balloon is filled with saline. The ReShape Dual Balloon looks like 2 attached balloons. Approved as a temporary device only, the balloon is removed in a similar procedure, within 6 months of being placed.

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