Bariatric specialists have developed a dozen bariatric procedures, some more commonly used than others. Despite the differences, they nearly all work by one of two principles: restriction of space or reduced nutrient absorption. A given procedure may encompass both ideas.
The reasons those two ideas work are simple. Pick any type of diet, the basic weight loss equation still holds: fewer calories retained than burned produces weight loss. Physical activity and physiology (influenced by genetics) have the largest influence on your burn rate (though which foods consumed plays a role). That leaves only half the equation: calories retained. There are two basic ways to alter that. You can consume fewer calories or absorb fewer.
Bariatric surgeons may staple the stomach near the top (a procedure called gastroplasty). That alters its effective volume. A smaller stomach has many effects, but the major one is to produce a sense of fullness right away. Patients want less food, reducing their calorie intake.
Roux-en-Y GB and other gastric bypass techniques create two unequal stomach compartments. The net effect is to reduce the available ‘storage space’ for food by about 95%. Food enters this tiny stomach, but quickly empties into the upper intestine.
Biliopancreatic Diversion or BPD is a similar technique (and much less common today). Here, half the intestine is bypassed by being sliced and rejoined to the ileum (near the end of the small intestine), a couple of feet above the colon (large intestine).
That reduces absorption of ingested food inside the intestine. The downside is that it can lead to nutrient deficiency, so it’s being phased out in favor of less risky procedures with fewer side effects. A variation actually removes a section of the intestine, a procedure known as the Duodenal Switch, creating a more cylindrical stomach. Sometimes, the two techniques are combined.
The Gastric Band
There are other, less drastic ways to reduce the volume of the gastrointestinal system. One that’s becoming much more popular ó for reasons of safety, convenience, and effectiveness ó is generically referred to as the gastric band. Allergan’s LAP-BANDÆ, right now the market leader, is an inflatable (or deflatable) device that’s surgically wrapped around the stomach/intestine.
It’s cleverly designed to avoid being rejected by the body’s immune system. Patients undergo periodic adjustments (usually four over 1-2 years) as the stomach shrinks and the patient loses weight. A physician tightens the band by injecting saline into it through a tiny port just under the skin.
Lap Band patients normally lose less weight less rapidly than with other procedures. Still, “less” may be in the range of 150 lbs lost and “less rapid” often results in 50% (or more) reduction over a 1-2 years period.
Lap Bands are relatively safer because there’s less chance of nutrient malabsorption and no cuts are made to the gastrointestinal tract. The small outer incision is negligible, and carries only a low risk of post-surgical infection. Patients easily avoid or deal with that through proper self-care and antibiotics.
Lap Band surgeons use a method called laparoscopic surgery (a type of MIS, minimally invasive surgery). The surgeon cuts a small incision, then inserts a small tube incorporating a camera and light. Images projected on a monitor allow the doctor to see to operate. A smaller incision creates less trauma and offers more rapid post-surgery recovery. It also reduces the odds of excess bleeding, infection and other risks.
To decide which procedure is best for you requires a series of consultations with a bariatric specialist.