Non-Surgical Procedures for Weight Loss
At Cayuga Center for Healthy Living, we provide education, guidance, and support in helping you make the changes you need. We offer individual and group counseling sessions with a medical team led by our medical director to help you improve your lifestyle. Our team includes nurse practitioners, nurses, dietitians, and physical therapists. Our goal is to help you successfully maintain the lifestyle changes you have adopted.
Surgical Procedures for Weight Loss
There are three types of bariatric surgery performed at Cayuga Medical Center: Laparoscopic Adjustable Gastric Banding (LAGB), Laparoscopic Sleeve Gastrectomy (LSG), and Roux-en-Y Gastric Bypass (RYGB). Together with your surgeon, you will decide which procedure is right for you.
Click on the link for a description of each procedure:
Laparoscopic Adjustable Gastric Banding (LAGB) Procedure
During LAGB surgery, the surgeon places a silicone band with a balloon inside around the top of the stomach. This procedure is usually done with minimally invasive (laparoscopic) surgery. A small stomach pouch is left above the band. The band limits the passage of food, which causes the stomach to feel full after small amounts of food are eaten. This is commonly referred to as “restriction.” The tightness of the band can be adjusted during office visits.
Once the band has been properly adjusted, patients should not feel hungry for hours after eating a small meal. Overeating, eating too fast, eating improper foods, or not chewing well may result in discomfort and vomiting.
Weight loss is expected to be gradual – ideally one to two pounds per week. With weight loss, patients experience improvement in weight-related illnesses, such as diabetes, high blood pressure, and joint pain.
Patients are expected to follow up regularly, as often as once a month, in order to track their progress and evaluate the need for a band adjustment. As time progresses, follow-up may be less frequent but still remains important.
Laparoscopic Sleeve Gastrectomy (LSG)
Laparoscopic sleeve gastrectomy (vertical sleeve gastrectomy or gastric sleeve surgery) is performed using minimally invasive (laparoscopic) surgery and reduces the amount of food that can be eaten at one time. During this procedure the stomach is cut and stapled along its long axis removing a “sleeve” like portion and leaving only a small tube-like stomach. The part of the stomach that has been cut away is permanently removed. As a result, patients experience fullness with small amounts of foods. This is commonly referred to as “restriction.”
LSG surgery decreases hunger and limits the patient’s eating to small meals. Overeating, eating too fast, eating improper foods, or not chewing well may result in discomfort or vomiting. Similar to LAGB surgery, there is no re-arrangement of the intestine, so that absorption of nutrients remains normal. However, there is no need for adjustments to be made and follow-up visits are less frequent than with LAGB surgery.
Weight loss is more rapid than with LAGB surgery and approaches that of gastric bypass surgery at one year. Patients often experience improvement or resolution of major weight-related illnesses including diabetes, high blood pressure and sleep apnea.
Patients should follow up regularly after surgery in order to track their progress and be evaluated for possible complications. As time progresses, follow-up may be less frequent but still remains important.
Roux-en-Y Gastric Bypass (RYGB) Procedure
During Roux-en-Y gastric bypass surgery, the majority of the stomach is divided from the top of the stomach, leaving a smaller “new” stomach. The intestine is re-routed to the new stomach to bypass the majority of the stomach and part of the small intestine. This is usually done using minimally invasive (laparoscopic) surgery. The small stomach feels full after small amounts of food are eaten. This is commonly referred to as “restriction.” The bypass of the stomach and small intestine also alters absorption of nutrients and is referred to as “malabsorption.” Additionally, changes in the body’s metabolism occur as a result of the surgery.
Gastric bypass decreases hunger and limits the patient’s eating to small meals. Overeating, eating too fast, eating improper foods, or not chewing well may result in discomfort and vomiting. In addition many patients experience “dumping syndrome,” which typically occurs after eating sweets (refined sugars). The symptoms of dumping include sweating, faintness, heart palpitations, and nausea.
Weight loss is expected to be rapid in the first few months (three to five pounds per week), but will taper off as time progresses. Maximal weight loss is usually reached within one to two years. Gastric bypass surgery patients often experience improvement in weight-related illnesses, such as diabetes and high blood pressure, and are often able to stop medications just days after the surgery.
Patients should follow up regularly after surgery in order to track their progress and be evaluated for possible complications. Because of the changes in nutrient absorption, patients require lifelong vitamin and mineral supplementation and careful attention to eating protein-rich foods. As time progresses, follow-up may be less frequent but still remains important.
Benefits of Surgery
Most obesity-related conditions such as diabetes and high blood pressure often improve, and may no longer require medication for treatment.
Many patients maintain long-term weight loss if they are able to make the necessary lifestyle changes and are committed to following their nutrition plan and activity routine.
Risks of Surgery
What are some of the risks involved in weight loss surgery?
As with any major surgery, bariatric surgery carries risks such as bleeding, infection, and an adverse reaction to the anesthesia. Possible risks specific to this surgery include:
- Blood clots in the legs. In some cases, these travel to the lungs and lodge in arteries, causing a pulmonary embolism – a serious condition that damages lung tissue and can lead to death. Walking and using leg wraps that apply intermittent pressure to the leg can help reduce this risk of blood clots in the legs. Smoking has been shown to increase the risk of clotting. Quitting smoking is required.
- Incision hernia. An incision hernia is a weakness in the incision. This is more likely to occur with an open procedure and a large abdominal incision, rather than with the laparoscopic approach.
- Narrowing of the opening (stricture) between the stomach and small intestine. This infrequent complication typically requires an outpatient procedure in which a tube is passed through the mouth to widen (dilate) the narrowed opening. Corrective surgery is rarely required.
Other potential complications of weight loss surgery include:
- Bleeding stomach ulcer
- Intolerance to certain foods
- Kidney stones
- Low blood sugar (hypoglycemia)
Patients need to meet criteria set by the surgeon and their insurance company in order to qualify for surgery. Newer indications now include:
- A body mass index (BMI) of greater than or equal to 30 with two major co-morbidities such as sleep apnea, hypertension or diabetes, or a BMI of greater than or equal to 40 without the presence of co-morbidities.
- Age 18+
- A history of obesity for at least 5 years.
- No recent history of drug or alcohol abuse.
- No tobacco use.
- A trial of several attempts at weight loss.
- No liver, kidney, or gastrointestinal disease.
- No untreated mental illness.
- No untreated glandular problems, such as thyroid or adrenal disease, which cause obesity.
- Patients must be willing to participate in follow up care for several years.
- Patients must have a clear understanding of the surgery and its risks.
- Patient must be able to walk.
Frequently Asked Questions
What is Body Mass Index (BMI)?
Body mass index (BMI) is a measure of body size based on height and weight that applies both to adult men and women. A BMI equal to or greater than 30 indicates obesity.
What is a co-morbid condition?
A co-morbid condition refers to one or more diseases or conditions that occur together with a primary condition, like obesity.
Will my insurance cover the cost of my operation?
The surgical treatment of morbid obesity is a covered benefit under many insurance policies. Coverage depends on what type of policy you have and the terms within the policy. Insurance policies can vary greatly, even when issued by the same company. Your employer dictates the coverage in your policy.
How long does the pre-operative process take?
This depends on your insurance provider and the criteria they require, as well as the tests and requirements our team finds necessary.
How do I decide which procedure is best for me?
Having weight loss surgery is a life-changing decision, and seeking advice from a medical professional such as your primary care physician is recommended. Your doctor and surgeon will be able to provide advice to help determine whether gastric bypass or LAGB surgery is right for you. You should also consider the benefits provided from each surgery versus the risks of complications during and following bariatric surgery.