Understanding Surgical Options

Better Choices. More Victories.

Bariatric surgery or weight loss surgery is designed to help patients lose weight quickly and safely. There are three procedures commonly performed, the gastric bypass, the adjustable gastric band and the sleeve gastrectomy. All can be performed using minimally invasive laparoscopic surgical techniques if the patient meets certain criteria.

GASTRIC BYPASS

The most common and successful surgical weight loss procedure is the Roux-en-Y gastric bypass. Not only does gastric bypass generate weight loss, it has also been recognized to resolve type 2 diabetes long before any weight loss even takes place. During surgery, a small stomach pouch is created to restrict food intake. Afterward, a Y-shaped section of the small intestine is re-routed and attached to the new pouch. This allows food to bypass the lower stomach and the upper parts of the small intestine, reducing the amount of calories and nutrients the body absorbs. The small stomach pouch created during surgery can hold only about two to four tablespoons (three ounces), drastically reducing the amount of food that can be eaten at one time. A gastric bypass patient will typically lose 75% of their excess body weight in the first 18 months which is maintained long-term.

In most cases, the Roux-en-Y gastric bypass procedure can be achieved through minimally-invasive laparoscopic methods. Dr. Robert T. Marema, M.D., F.A.C.S., was a pioneer in the development of laparoscopic techniques in bariatric surgery.

As with any laparoscopic procedure, the recovery time, patient discomfort and risks are reduced when compared to open surgery. However, not all patients are candidates for laparoscopic procedures. Gastric bypass surgery carries the same risks as any other major abdominal surgery.

Shortly after surgery patients are back in their hospital room. Sitting up in a chair or walking around is encouraged. Patients are usually discharged approx. 2 days post surgery. Gradually, physical activity will increase, with near-normal or normal activity resuming a few weeks after surgery.

SLEEVE GASTRECTOMY

Dr. Marema was the first surgeon in Florida and second in the world to perform a single-incision vertical sleeve gastrectomy using the SPIDER® Surgical System. He has since trained physicians from around the globe on this procedure.

'>'>Click here to watch Dr. Marema explain sleeve gastrectomy

Vertical sleeve gastrectomy is the latest and fastest growing type of surgical weight loss procedure, which dramatically minimizes the size of a patient's stomach. Without using SPIDER, surgeons typically rely on conventional laparoscopic equipment that requires five separate small incisions in a patient's abdomen - rather than just one.

"The SPIDER minimizes physical stress on patients while also providing cosmetic benefits," commented Marema. "I simply make one small incision that's hidden in the patient's belly button and insert the SPIDER. I then expand the internal portion of the device, similar to expanding an umbrella. This allows me to clearly see the anatomy and accurately perform the operation. When I'm finished, I close the system and remove it through the small incision, leaving almost no visible scar."

SPIDER's proprietary expansion technology is unique - it is not available in any other surgical device today. In addition, SPIDER contains four working channels through which the surgeon inserts a camera and instruments. Two of the channels are flexible, providing surgeons with true left and true right instrumentation, a marked contrast to other single-port instruments that force a surgeon to cross his hands to operate.

"As an individual who has been involved with the evolution of bariatric surgery since its earliest beginnings, I am continuously seeking new ways to improve the experience and outcomes for my patients," added Marema. "The SPIDER definitely provides several advantages that I am happy to offer as part of our program."

In Sleeve Gastrectomy, the stomach is divided lengthwise and a narrow, banana-shaped tube (sleeve) is created by removing 80% or more of the stomach. The gastric tube is much smaller than the stomach's natural size, thus restricting the amount of food that can be eaten at a given time. The remainder of the stomach is removed and, since no bypass is created, absorption of nutrients remains normal. The procedure takes about 30 minutes and has been reported to produce a loss of 50% or more of excess weight.

ADJUSTABLE GASTRIC BANDING

Adjustable Gastric Banding promotes weight loss by reducing the capacity of the stomach through a band fastened around the upper stomach to create a new, smaller pouch. As a result, patients experience a greater sense of fullness and are satisfied with smaller amounts of food.

The current FDA-approved product is known as the LAP-BAND. The adjustable band has an inflatable inner surface and is connected to an access port below the skin by thin, kink-resistant silicone tubing. The port allows the surgeon to adjust the band, impacting the amount and consumption rate of food. This affects the patient's rate of weight loss. Adjustments to the band are performed on an outpatient basis and are determined by the patient's weight.

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