Weight Loss Treatment Options

There are many options available, both medical and surgical, for the treatment
of morbid obesity.  However, the success rate among the options varies considerable. Most non-surgical weight loss programs are based on some combination of diet/behavior modification and regular exercise.  Unfortunately, these programs have not been effective in producing or sustaining a significant weight loss, especially in the morbidly obese population.  Weight loss surgery, however, has been the only method that has resulted in sustained weight loss in
the morbidly obese.

Types of Weight Loss Surgery our clinic performs:

We currently offer two types of Bariatric surgery, the Roux-en-Y
gastric bypass and the Lap-Band adjustable gastric banding. 

Roux-en-Y gastric bypass
The Roux-en-Y Gastric Bypass is considered a combined restrictive and malabsorptive procedure.  It is the most commonly performed weight loss surgery in the United States.  A small (15-30cc) pouch is created by stapling and dividing the stomach.  The outlet of the pouch empties directly into the lower portion of the jejunum, bypassing the duodenum and reducing calorie absorption.  This is done by dividing the small intestine just beyond the duodenum and construction a connection with the new, smaller pouch.  The bypassed portion of intestine is then reconnected to the jejunum.

Advantages

• Faster and typically greater weight loss than purely restrictive procedures.
• Studies have demonstrated long-term weight loss maintained after 10-14 years.
• Dumping syndrome may help patients avoid high-calorie sweets.

Risks

• Leakages or surgical connections, though uncommon, may occur.
• Because the duodenum is bypassed, lower absorption of the minerals iron and calcium can occur.  The absorption of certain B-vitamins may also be affected.  This can lead to deficiencies of these nutrients, which in turn can predispose patients to medical problems such as anemia and osteoporosis.
• Dumping syndrome can result in unpleasant side effects.
• The lower part of the stomach can no longer be easily visualized after surgery.

Results

• 75% - 80% success rate.
• Average weight loss: 70% EWL
• 1/3 of patients reach IBW

Hospital Course
Gastric Bypass patients typically have a 3-4 day hospital stay.  Patients receive fluids through I.V. lines and are allowed only small amounts of ice chips by mouth.  Most patients will have a drain inserted into the abdomen, which is removed before you go home.  Usually on the third day after surgery, you will have an x-ray
procedure done to test for leaks.  If this test is satisfactory and you are tolerating liquids, you are discharged from the hospital.

Lap-Band adjustable gastric banding
An Adjustable Gastric Band is a purely restrictive procedure in which a band is placed around the upper most part of the stomach creating a functional small pouch.  There is a balloon on the inner surface of the band that can be adjusted through a port attached to the abdominal muscle layer.  Food passes through the band area into the larger portion of the stomach and is digested in the normal manner.

Advantages

• No stapling or cutting of digestive system.
• Normal digestion.
• More reversible.
• Band can be adjusted to increase or decrease restriction
• Very low mortality rate

Risks

• Band slippage.
• Band erosion into stomach wall.
• Band, tubing or port malfunction, which causes balloon to deflate.
• Vomiting or acid reflux
• Pouch dilatation

Results

• 75% - 80% success rate
• Average weight loss: 50-65% EWL over two years

Hospital Course
The Lap-Band procedure requires an overnight stay after surgery.  The next morning patients undergo an x-ray procedure to ensure proper positioning of the band and the absence of a blockage.  Patients are then discharged from the hospital.

The Weight Loss Clinic
4315 Londonderry Road
Harrisburg, PA 17109

The Weight Loss Clinic
at Robinwood
1110 Professional Court
Suite 201
Hagerstown, MD 21740