Bariatric Surgery for Obesity

Sleeve gastrectomy is a surgical approach that helps a person to feel full after eating a small amount of food.

In this procedure, the surgeon removes 75 to 80 percent of the stomach, leaving a narrow “sleeve” of gastric tissue. The stomach, usually the size of a football, is now the shape and size of a thin banana.

The remaining stomach fills up quickly when you eat. Removing most of the stomach also decreases the production of a hormone called ghrelin, which sends hunger signals to the brain.

Surgery is usually completed in about an hour. Most people remain in the hospital overnight so they can be monitored for complications. Your doctor may recommend a liquid diet for a few weeks after the procedure. You can then begin to gradually eat solid foods, starting with pureed foods, to allow the stomach to heal.

Postsurgical follow-up is recommended every three months for the first year and then annually.

Gastric bypass surgery is more complex, but often it is more effective than other procedures in achieving and maintaining significant weight loss.

Gastric bypass is also the most effective surgical option for people who have had type 2 diabetes for more than seven years. That’s because over time, type 2 diabetes causes changes in hormones made in the intestines, PYY and GLP-1, which help regulate insulin, blood sugar, and feelings of hunger and fullness. These changes make it harder to lose weight.

During the procedure, a surgeon creates a small pouch by dividing the upper portion of the stomach from the lower portion. This pouch, which becomes the “new” stomach, cannot hold as much food as the “old” stomach, limiting the amount of food you can consume. The doctor then connects the new stomach to the upper part of the small intestine, so that food passes directly into the small intestine. This reduces the body’s ability to absorb nutrients and calories from food.

Gastric bypass surgery is typically completed in two hours, and patients stay overnight  in the hospital. Most people can return to normal activities within two weeks. To allow the bypass to heal after the procedure, your diet begins with 10 days of liquids before progressing to solid food.

Postsurgical follow-up is recommended every three months for the first year, and then annually. Because of the small amount of food that is consumed after the procedure, it is essential to take multivitamins and follow up with your doctor to prevent vitamin deficiencies.

The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) procedure is a relatively new procedure but is showing exceptional weight loss results as well as remission of type 2 diabetes. Like the gastric bypass, the SADI-S procedure is both restrictive and malabsorptive in nature.

The SADI-S procedure starts with performing a sleeve gastrectomy procedure making a small banana shaped stomach. This portion of the operation restricts the quantity of food a person can consume. Next, the first portion of the small intestine is cut just below the stomach valve (pylorus). Then the lower small intestine is connected to the stomach resulting in greater malabsorption than seen with the gastric bypass procedure.

SADI-S surgery is typically completed in two to three hours, and patients stay overnight one night in the hospital. Most people can return to normal activities within two weeks. To allow the SADI-S to heal after the procedure, the doctor may recommend a liquid diet for a short time after the procedure. As the stomach begins to heal, solid foods are gradually introduced.

Postsurgical follow-up is recommended every three months for the first year, and then annually. Because of the small amount of food that is consumed after the procedure as well as the significant degree of malabsorption that occurs after surgery, it is essential to take multivitamins daily and follow up with your doctor to prevent vitamin deficiencies.

Laparoscopic adjustable gastric banding, commonly known as Lap-Band surgery, reduces hunger and the amount of food you can consume. The band also puts pressure on the vagus nerve, which wraps around the stomach. This pressure signals the brain that you are full—even after you have eaten only a small amount of food.

Please note: the Weight Management Program at NYU Langone Hospital—Long Island does not offer the Lap-Band procedure.

During Lap-Band surgery, the surgeon places an adjustable silicone band around the upper part of the stomach. The procedure usually takes about 45 minutes.

A long tube attaches the gastric band to a small, quarter-sized port, which is located just under the surface of the skin of your abdomen. This allows your doctor to tighten or loosen the gastric band to ensure that you feel full after eating as you continue to lose weight. To do this, saline, meaning salt water, is either injected or withdrawn through the port. Your doctor adjusts the gastric band during monthly follow-up visits in the first 6 to 12 months after surgery. Follow-up appointments take place every 3 months during the second year and every 6 to 12 months thereafter.

Our doctors perform an X-ray test called an esophagram once a year to monitor the position of the band. Before this test, you swallow a liquid contrast material called barium. The barium coats the inside of your gastrointestinal tract, revealing the location of the band on an X-ray.

Additional surgery may be needed if the band is placed too tightly around the stomach, making it difficult to eat and drink, or if the band slips out of place, pushing the stomach upward and causing acid reflux, vomiting, or pain. After surgery, band slippage can occur when people eat too quickly or if they don’t stop when they’re full. This results in chronic regurgitation, which can dislodge the band.

Lap-Band surgery is recommended only for people who are able to return for monthly follow-up visits.

Bariatric surgery can be a lifesaver for people with severe obesity who have related health problems. But like all surgery, complications can occur.

After any type of bariatric surgery, you may notice a dramatic reduction in your appetite, especially between meals. Because your stomach is unable to hold as much food, you may become full more quickly than before. It is essential to eat slowly and chew food well to prevent acid reflux and vomiting that can occur from eating too quickly.

Additionally, it is important to maintain a healthy diet and exercise daily. This will help maximize the weight you are able to lose with these procedures. Also, it can help maintain your healthy weight in the long term.

Your NYU Langone doctor and registered dietitian can offer advice about foods you should eat to optimize weight loss and decrease side effects after bariatric surgery. People who adopt permanent changes in their diet are most likely to maintain weight loss and reduce the risk of obesity-related conditions.