MBL's Ultimate Guide to Weight Loss Surgery!

Scroll to browse the whole guide or click the links on the right to be taken to your preferred section.
NOTE: This guide is just that, a guide and should not be considered medical advice. Consult with your physician to determine which weight loss surgery is right for you.

What is weight loss surgery?

Weight loss surgery, or bariatric surgery, is surgery that involves making changes to the digestive system in order to promote weight loss. Weight loss surgery is often used when diet and exercise have not resulted in the desired weight loss, or the patient has other health conditions related to weight, such as type 2 diabetes or sleep apnea.

There are several different types of weight loss surgery. The right one for you will depend on several factors, such as your current weight, the amount of weight you need to lose, and whether you have any weight-related health conditions.

Scroll down or click on the links below to be taken to that specific weight loss surgery procedure section.

Are you curious about or considering weight loss surgery?

Do you need help losing weight? Has your doctor recommended a type of bariatric surgery to help with weight-related health conditions such as type 2 diabetes-related joint pain and deterioration or obstructive sleep apnea?

Weight loss procedures such as gastric bypass surgery have been helping people lose weight and improve weight-related health conditions for decades. Bariatric surgery can be very effective for patients who have tried other weight-loss surgery options without achieving long-term results. Now, new advances in weight-loss procedures and more clinical trials mean that patients have more options than ever before when it comes to both surgical and non-surgical interventions for weight loss.

Is weight loss surgery right for you?

If you think weight-loss surgery may be the right path for you, it’s important to weigh your options and understand what to expect from this part of your weight-loss journey. This Guide to Weight Loss Surgery answers many common questions about weight loss surgery. We’ll also take a closer look at 6 different bariatric procedures, including how each one works, the advantages and disadvantages of each type, and other considerations that will help you decide if any of these approaches is right for you.

A qualified bariatric surgeon can provide additional information about each procedure and help you develop a plan for meeting your weight-loss and wellness goals.

What are the benefits of weight loss surgery?

Weight loss surgery has helped many people reach and maintain their goal weight. Bariatric surgery typically results in more successful long-term weight loss than diet and exercise alone, especially for patients who are chronically obese and those who also suffer obesity-related disease, such as type 2 diabetes.

While people are often able to lose weight on their own through diet and exercise, keeping the weight off is another story. Cleveland Clinic reports that among people who lose 65 pounds or more, less than 5 percent of them keep the weight off for five years. Most of them gain the weight back within one year.

In addition to successful long-term weight loss, bariatric surgery has also been shown to lead to other benefits, including improved cardiovascular health, remission of type 2 diabetes, depression relief, joint pain relief, and improvements in other health conditions, such as sleep apnea, fertility problems, and more.

Estimate of Bariatric Surgery Numbers, 2011-2018

	2011	2012	2013	2014	2015	2016	2017	2018
Total	158,000	173,000	179,000	193,000	196,000	216,000	228,000	252,000
Sleeve	17.8%	33.0%	42.1%	51.7%	53.6%	58.1%	59.4%	61.4%
RYGB	36.7%	37.5%	34.2%	26.8%	23.0%	18.7%	17.8%	17.0%
Band	35.4%	20.2%	14.0%	9.5%	5.7%	3.4%	2.7%	1.1%
BPD-DS	0.9%	1.0%	1.0%	0.4%	0.6%	0.6%	0.7%	0.8%
Revision	6.0%	6.0%	6.0%	11.5%	13.6%	14.0%	14.1%	15.4%
Other	3.2%	2.3%	2.7%	0.1%	3.2%	2.6%	2.5%	2.3%
Balloons	–	–	–	–	0.3%	2.6%	2.8%	2.0%

Originally published June 2018 The ASMBS total bariatric procedure numbers are based on the best estimation from available data (BOLD,ACS/MBSAQIP, National Inpatient Sample Data and outpatient estimations). *New methodology for estimating outpatient procedures done at non-accredited centers.

Educational Videos: Weight Loss Surgery

Video information + transcriptions below. Tap to open and read along with video.

Video Name: Part 1: Understanding bariatric surgery

Video Channel: UHN Patient Education

Video Description: In Part Video 1, Dr. Timothy Jackson explains the types of weight-loss surgeries performed in the Bariatric Surgery Clinic at Toronto Western Hospital. This includes the Roux-en-Y and Sleeve Gastrectomy.

The information within this video is not intended to replace any advice provided to you by your health care team. For your safety, we ask that you do not act on the information within these videos without first discussing your treatment or healthy living plan with your qualified health care providers.

For more information about UHN Patient & Family Education, visit http://www.uhnpatienteducation.ca.

Video Transcription: As a surgeon at the Toronto Western Hospital Bariatric Clinic I’d like to talk to you about the types of weight loss surgeries that are currently performed in our clinic. The Roux-en-Y Gastric Bypass, also called the Roux-en-Y, and the Sleeve Gastrectomy, also called the Sleeve. Both had been proven to be effective treatments for morbid obesity, each takes a few hours to perform and requires a short hospital stay. Research shows that the Roux-en-Y is the current gold standard, which means it has the best weight loss and health benefits. Let me show you more about the Roux-en-Y surgery that we perform.

To gain access to the abdominal cavity, small incisions are created on the abdomen. Trocars, which serve as passageways for the surgical instruments, are placed into the incisions. The surgical instruments are passed through the trocars to access the abdominal cavity. The surgeon observes the abdominal cavity using a laparoscope, or video camera.

A small stomach pouch is created using a stapling device. The small intestine is separated into two sections. The lower portion of the small intestine is attached to the newly created stomach poach, this allows food to pass directly into the small intestine where digestion continues. The upper portion of the small intestine is reconnected to the lower part of the intestine. The bile and pancreatic fluids from the liver and pancreas allow for food to be completely digested. By altering the anatomy of the gastrointestinal tract, gastric bypass changes signals in the body resulting in decreased hunger and increased feelings of fullness after meals.

As I mentioned before, the Roux-en-Y is considered the gold standard in weight loss surgery. In some cases, there is another surgery we do called The Sleeve. Just like in the Roux-en-Y surgery, trocars are placed to gain access to the abdominal cavity and the abdomen is viewed laparoscopically. The average human stomach can expand to hold around one to one and a half liters of food. While in the stomach, food is mixed with digestive enzymes to help break down the food to a more simple form so that it can be more easily digested and absorbed when it is in the small bowel.

During a Sleeve Gastrectomy, a thin vertical sleeve is created by using a stapling device. This sleeve will typically hold between 50 and Video 150 milliliters, or be about the size of a banana. The excised portion of the stomach is removed. This results in decreased hunger and increased feelings of fullness after meals. The bile and pancreatic fluids from the liver and pancreas mix with the food and allow it to be completely digested and absorbed in the bowel. There is no rerouting of the small bowel needed for the Sleeve Gastrectomy.

As with all weight loss surgery, success depends on making lifelong changes to your eating and exercise habits. All surgery has risk, your weight, age, medical history, and other factors determine your specific risk.

Video Name: Part 2: Benefits and risks of bariatric surgery

Video Channel: UHN Patient Education

Video Description: In Part Video 2, Dr. Timothy Jackson explains the benefits and risks of bariatric surgery. We hear from patients who have gone through the weight-loss surgery about their unique experiences.

The information within this video is not intended to replace any advice provided to you by your health care team. For your safety, we ask that you do not act on the information within these videos without first discussing your treatment or healthy living plan with your qualified health care providers.

For more information about UHN Patient & Family Education, visit our website.

Video Transcription: Welcome back. Let’s continue to part two where I’ll explain the benefits and risks of bariatric surgery. Let’s start with the benefits. After having bariatric surgery, you’ll need to make healthy lifestyle changes to lose weight and to keep the weight off after surgery. Most people see major improvements in their overall health, especially if they’ve had weight related health conditions.

One of the most common health improvements is lower blood pressure. Your doctor may bring down your blood pressure medication doses or even say you don’t need to take them anymore. Having a normal blood pressure will lower your chance of having a heart attack, stroke or heart failure. Another major benefit of bariatric surgery is that it improves or even resolves type two diabetes. Most people need to take less diabetes medication after the surgery. The improvement of diabetes will lower your chance of having damage to your heart, blood vessels, nerves, kidneys, and eyes.

If you suffer from sleep apnea, your symptoms such as insomnia, daytime sleepiness, anxiety, irritability, and headaches may greatly improve after bariatric surgery. Your sleep apnea may even go away completely. Bariatric surgery is also shown to lower cholesterol. This means healthier arteries and a much lower chance of having heart disease and heart attack. Many people are able to take fewer cholesterol medications or even none at all.

Losing weight after bear trick surgery places much less stress on your joints. You’ll be able to move more easily. Also, you’ll feel less strain while exercising and joint pain will no longer be a roadblock to leading a more active life. There are many benefits of bariatric surgery. Besides lowering major health risks, almost all patients tell us that their overall quality of life greatly improves, but you don’t have to take my word for it. Let’s introduce you to some patients who have had bariatric surgery and want to share their stories with you.

I struggled with my weight for about Video 20 years and I just sort of felt like my ability to enjoy life and do the things I wanted to do was being minimized.

I didn’t want to be in public and I didn’t want to go and do things and I didn’t want to put my face forward.

I didn’t really have much of a life because I couldn’t walk very far. A couple of blocks and I would be in pain and every time I wanted to go somewhere was, “Can I get there and get back.” I had a lot of issues. I had diabetes, high blood pressure and I felt that if I didn’t do this, I was shortening my life.

I tried my best, I went to the gym, I tried to eat healthy, nothing seemed to work for me.

PatI no longer has diabetes. I no longer have high blood pressure. My cholesterol medication has been cut in half. I walk everywhere. I love walking. I still have arthritis because I’ve done in my joints over the years. That can’t be reversed but it’s nowhere near what it was like before.

Just this Monday, I went to my sleep study doctor and I got the results of my sleep study and I put my sleep apnea machine in the basement because I don’t ever need to use it again as long as I don’t gain any weight.

Life is kind of easier in a way. It’s much harder in other ways, but I can move around and do things and I’m not afraid to go and do something.

Before my surgery, I was taking three blood pressure medications and they weren’t really doing the job and I have high cholesterol. And the high blood pressure is gone, the cholesterol is gone.

The cholesterol and the gout, actually within three months, I was off all my medication and all my blood levels had returned to normal, which they’d never been.

ColleenI feel that I’ve regained a whole new life.

This isn’t a quick fix. I think that it is a tool that can help people who are struggling with weight. I’ve used this tool now to achieve my goal. It’s a lifelong goal and it will continue throughout my life and it’s certainly not easy. And it’s just a journey that I’m on and it’s hard, but it’s good.

Now that you’ve heard about the many benefits of surgery. Let’s talk about some of the risks and complications or problems which can happen with both the Roux-en Y and sleeve surgeries. Risk refers to something that can go wrong after the surgery. One of the more common risks after having bariatric surgery is developing an ulcer. An ulcer is an area where the protective lining in the stomach has eroded away and the layer underneath is sensitive to stomach acid. People may feel nausea and pain just below the ribs. Usually with medication, these ulcers will heal in a few months. Who is at risk for developing an ulcer? People who smoke, drink too much alcohol or take ibuprofen or other antiinflammatory medications. The chance of getting an ulcer doesn’t decrease over time, so you’ll have to quit smoking, avoid taking antiinflammatory medications and drink less alcohol for the rest of your life.

Another possible risk of bariatric surgery is known as a stricture. A stricture happens when the passageway that connects the new stomach pouch to the small intestine becomes too narrow. This makes it difficult for food or water to pass through. People usually feel it’s hard to swallow or get their food down. Sometimes they vomit. When this happens, a short procedure can be done to make the area wider.

A gastric leak is another possible complication. It happens when stomach contents leak into the abdomen. This rare but serious complication happens most often within the first two weeks after surgery. If it does happen, you may have a fever and stomach pain. Sometimes you may need another operation to close the leak. Having bariatric surgery will change the way you need to eat and how you absorb your food. You could get vitamin and mineral deficiencies to prevent serious complications such as weak bones, low iron or vision loss, you will need to take supplements every day for the rest of your life.

Losing a large amount of weight can cause loose skin. The amount of loose skin is different for everyone and there’s no way to know how much you may have. Unfortunately, exercise will not help reduce this. Some people don’t see it as a big problem, but for others, it can be quite upsetting. You can have excess skin removed, but this procedure is not covered by OHIP.

Having bariatric surgery can be quite stressful and may trigger some mental health difficulties, especially for people who have had similar challenges before, such as depression or anxiety. People who have bariatric surgery are also at risk of developing addictions, this includes both alcohol and other drugs. This is one of the reasons we recommend drinking less alcohol.

Now that we’ve covered the most common benefits and risks of bariatric surgery, let’s check in again with some patients who would like to share some of the challenges they have had to overcome.

I didn’t have any complications during surgery at all. It went as textbook planned.

It’s been a big success for me. But you have to know that there are complications for some people and know what they are.

I had a major complication where I was bleeding internally. I had this surgery in the morning and by midnight that evening I was losing lots of blood. And my surgeon who performed the surgery was there. They clamped it, fixed it all up. But that was certainly an issue and I mean there’s risks with everything.

First I had was the leak. My heart rose to extreme highness. So it was a very scary thing for my family.

Video 10 minutes or whatever after whatever I ate or drank, I would throw it up. I had absolutely no pain. I just couldn’t keep anything down. If I wouldn’t be throwing up, I wouldn’t have known. They kept me overnight and they did a scope and they said they found an ulcer. I had a three month follow up, everything was fine. I didn’t need any of the medication again. And I’m great.

CatherineI had difficulty with the diet basically. So they opened the stricture, they opened up the tubes so that I could get more food down. It was wonderful. I could eat.

well, remembering to do them and being faithful to doing the vitamin and mineral treatment post op, it’s a constant new habit to build, but it’s a small price to pay for what you get.

It’s very common right after the surgery to have some depression and buyer’s remorse is one of the ways it’s put. I felt a little bit of that, but I got over it fast. I think that’s just part of the fact that you’ve just had major surgery.

I mean for me, I lost my weight very quickly and so there was the sort of this one day looking in the mirror and kind of going, “Oh my God, who am I?” It was such a shock. I sort of didn’t really recognize myself and sort of had to reacquaint myself with this new body and that took some adjusting.

Throughout the weight loss, I mean it appeared that there was going to be more loose skin and that type of thing, just because of the drastic weight loss.

I try to hide it as much as I can, but that’s going to be an issue because I’m still losing weight. And I know it’ll be an issue and I’ll probably have to have some surgery to correct it.

I look okay with clothes on and I’ll take my clothes off in front of anybody who doesn’t already love me to bits. So there you go.

Like everything, I think it goes through a phase where you kind of look at it like, okay, but I’m healthier and I’m happier and I’m able to do so much more.

The outcome today, looking back was worth every complication. I would rather have gone through all the loss of blood and the scary times and the procedures and the ulcers to be where I am today.

As you can probably tell from those who have shared their stories, surgery was just one step in their weight loss journey. It is important to remember that every person’s experience with surgery is unique. Together, we will need to consider your specific situation and review your benefits and risks. This is the end of part two. Again, if you have any questions about the benefits and risks of bariatric surgery, make sure to write them down and ask the bariatric team.

Video Name: Part 3: Preparing for life after bariatric surgery

Video Channel: UHN Patient Education

Video Description: Nurse Practitioner, Sandra Robinson, discusses life after bariatric surgery, and the importance of starting to make lifestyle changes even before surgery. Patients who have had weight-loss surgery share their experiences, challenges, and suggestions for establishing healthy habits. The information within this video is not intended to replace any advice provided to you by your health care team. For your safety, we ask that you do not act on the information within these videos without first discussing your treatment or healthy living plan with your qualified health care providers. For more information about UHN Patient & Family Education, visit our website.

Video Transcription:

Sandra Robinson:

Now we’re going to talk about some of the lifestyle changes that you can start working on today. To increase your chances of success, healthy eating, exercise, and lifestyle changes should begin even before surgery. By making these changes now, you’ll find it is easier to adapt to life after surgery. After bariatric surgery, your stomach will be much smaller and you won’t be able to eat a large amount of food. It will be important to eat breakfast and a meal or snack every three or four hours. You will also need to know what’s in your food. The best way to do this is by cooking most of your meals at home. Here’s the example of what a typical meal might look like once you’ve had bariatric surgery. It includes lean protein, healthy vegetables, and carbohydrates. And here’s an example of a healthy snack. Remember, you’ll need to eat every three or four hours throughout the day, so you want to plan your snacks ahead of time.

Sandra Robinson:

Remember, your digestive system will change after surgery. You’ll no longer be able to eat a large amount of food or foods that are high in sugar or fat. If you do, you may experience what is called dumping syndrome. This can include stomach cramps, a racing heart, nausea, vomiting or diarrhea. These symptoms may last for several hours. Also, you won’t be able to drink a large amount of fluids in one sitting. To stay hydrated, you’ll need to sip small amounts of fluids throughout the day. Let’s hear from some bariatric patients who can share their experiences about eating after they’ve had surgery.

Pat:

It’s totally different way of eating and you have to know that going into this.

Shane:

In the beginning, it was very structured and I’m happy for the structure that the hospital provided right after surgery because it is basically learning to eat all over again. So what to eat held, how much to take, and kind of timing it all out and how much you should actually be getting in, in a day.

Barbara:

I eat six or seven times a day, little meals. I always eat protein. I don’t eat anything unless protein is part of the meal.

Pat:

You have to be able to keep yourself healthy by choosing foods that work for you. The other thing that will happen is that some foods that you ate before surgery you may not be able to eat after.

Laura:

For me hamburgers, I used to love hamburgers. I’m afraid to have one now because I don’t want to get back into old habits. Chips and cheesies and hamburgers and fries and I have to cut that stuff out.

Barbara:

And I do recommend to anybody who has the surgery to really… The closer you can stick to the postop care, the better.

Pat:

If you follow the guidelines, Toronto Western has been awesome about the amount of guidelines they give and the amount of support they give. If you follow that, you’ll be fine.

Sandra Robinson:

As you can probably tell from these patients, they think about food very differently. While eating healthy will be important, another key to success is becoming more active. Once you start losing weight, you’ll find you’re able to do so much more. This can include fun activities like biking, walking and playing with your children or grandchildren. Any activities that will cause you to sweat a little bit and breathe a bit harder are going to make you feel good and improve your health. Try to be active at least Video 30 minutes a day, four or five days a week. Once you find some physical activities you enjoy, it will be easy to make them a part of your new lifestyle. Start imagining the activities you want to do and make them a goal to work towards. Let’s hear from some patients and see what their experience has been with physical activity and exercise after surgery.

Pat:

You’re so overweight that just going for a walk down the street becomes a major issue. Now you can do it without thinking. I have so much energy all the time.

Laura:

My physical activity before was zero. Now I’m going to the gym about five times a week at least.

Cory:

At work, I work on the fourth floor. I can go walk up the stairs now and not feel like I’m going to die at the end of it. If the elevators aren’t working, that doesn’t scare me anymore.

Joe:

I used to go drive the missus to the store, I’d wait in the truck til the grocery is done and get out and we get together and get it all back into the vehicle. Now I go grocery shopping. I have no problem walking around.

Shane:

It’s all, I think, mental. And I mean, the physical comes with whatever you’re doing, but it’s the mental and being able to. I feel great doing this and I’m able to do it without a struggle or people commenting on the way you look to hang out or whatever the case may be.

Cory:

Before I would be… I might be on the couch and think, “Oh, I should go out and I should….” I didn’t. Now it’s, “Well, yeah. Of course. Let’s go down here. Let’s go see something. Let’s go do something. Why not? Have some fun.”

Laura:

A year ago, I wouldn’t have been able to handle Video 10 minutes on the dance floor at my firm’s Christmas party. The last Christmas party, I was on the dance floor for an hour and a half.

Pat:

At nine months after surgery, I did a Video 30 mile bike ride for multiple sclerosis. Again, something I would never have done when I was overweight.

Joe:

Then I went through the surgery, I said the one thing I am going to do is I’m going to be playing baseball last summer. I said, “When I get it this summer, I’m going to play baseball.” And they said, “Well, you need to be able to run.” I said, “I will be able to run.” Since then, I just never turned back. I played baseball, play horseshoes, ride a bike, even bought a sports car that I can get into it now and I’m rebuilding it, so these are all things I couldn’t do before for Video 15 years.

Laura:

I feel that much better. My energy level is crazy. I can… I’m sprinting on the treadmill. The adrenaline rush that I’ve got, I feel like I could run another mile or something, but it’s like night and day.

Sandra Robinson:

As you can see, physical activities, both a key to success and one of the most rewarding parts of life after surgery. Now that you understand the changes you’ll be making related to eating and physical activity, let’s talk about how to prepare for surgery itself. You will meet with several members of the bariatric team to make sure that you are well enough to have the surgery. These visits are very important and will assess your physical, emotional, financial, and social wellbeing. Remember, you must quit smoking and drink less alcohol. We’ll also encourage you to plan for the lifelong costs of buying vitamin supplements and making healthy food choices. Above all, we want to make sure that your surgery is safe and that you are set on the path to success in your life after surgery.

Cory:

The assessment process is, I felt was to make sure that I was serious, that I didn’t think that this was just going to be some wonderful thing that I would get the surgery and I wouldn’t have to change my life. You have to change your life.

Pat:

When I was leading up to the surgery, I thought, “Oh, but this never happened. Can I speed this up? Can I get the process going faster?” I now realized that I needed that year. You need to make some changes and you need to be prepared to make those changes and that year is a good time to start.

Shane:

Physically, I was ready to do it. It was always the mental aspect of it that it was kind of, “Am I ready to do this?”

Barb:

Whatever is in here that made you eat, it’s not going to go away with the surgery.

Pat:

Most people who are obese have eating disorders in one way or another. They’ve eaten for a reason. Start to deal with that. Realize that you do have a problem. Start to deal with that to begin with, because that’s not going to go away. They’re going to operate on your stomach, not your mind.

Cory:

So you have to be smoke free for three months. So it basically took me another year. I went to my doctor, I said, “I quit. I want to be recommended.” He said, “We’re going to wait three months this time.” So in three months, I went back. And then I started the process.

Pat:

Every professional that I met made it abundantly clear, whether it was the social worker, or the psychologist, or the nutritionist, or the surgeon, this is a decision you get to make and own that decision.

Cory:

The extra time really made… It gave me more time to research. It gave me more time to watch videos. It just basically, in my mind, made me well aware of the process and I felt good about where I was going. So once I got to the doctor and the psychiatrist and the social worker, once I got to that phase, I was just like, “All right, let’s go. Let’s move this along because I’m ready.”

Sandra Robinson:

As you can probably tell, we need your full commitment before and after surgery. Ask yourself, “Am I mentally, emotionally and physically ready to make these changes?” We recommend you talk about these personal questions with a friend or family member who can support you. Also, throughout the assessment process, the bariatric team will be here to help and guide you. This is the end of part three. Again, make sure to write down any questions you may have and the bariatric team will be happy to answer them in person.

Video Name:Part 4: Making your bariatric surgery a success.

Video Channel: UHN Patient Education

Video Description: In Part Video 4, Sandra Robinson offers tips for success and changes you can expect in your life after surgery. The information within this video is not intended to replace any advice provided to you by your health care team. For your safety, we ask that you do not act on the information within these videos without first discussing your treatment or healthy living plan with your qualified health care providers. For more information about UHN Patient & Family Education, visit our website

Video Transcription: Sandra Robinson:

Welcome back. Now we’re going to talk about some tips for success and the changes you can expect in your life after surgery. The [inaudible 00:00:Video 17] and sleeve surgeries both require the same eating habits, vitamin supplements, physical activity, and lifestyle changes that we talked about in part three. You will lose the most weight in the first year after surgery. Don’t get discouraged if your weight loss stalls or if you experience a few bumps along the road. You may continue to lose weight more slowly in the second year after surgery. According to research, most people gain back a small amount of weight about two years after surgery. This is normal. However, it is also possible to regain all the weight you lost if you don’t eat healthy and live a physically active life. As mentioned earlier, bariatric surgery is only a tool. Going to your followup appointments will help you to stay on track. Another important tip for success is to remember that support from your family and friends play a very important role in your weight loss journey.

Laura:

Having that support group and other support members in your life is so important because if you don’t have that, I don’t know if you could do that on your own. You need people who want this for you just as much as you want it for yourself.

Catherine:

It’s very, very important that we have people to back us up. People to say “it’s okay, we’ll get you through this.” To go to support groups and hear people struggling with the same things you are struggling with.

Joan:

And it’s so important for the support person to go to the interviews with the patient because you need to understand what they’re going to go through. I didn’t want her to do it. I wasn’t for it. And when I went to the interviews I became more and more supportive. So that’s really important to make the whole journey with them.

Martin:

We made sure that we understood what it was that was going to happen to him and, and what he was going to be going through. So that allowed us to help sort of understand some of the things that he would need to adapt to, the changes he had to make, because it is life changing.

Pat:

My son initially was against me having it, but it was more, he was afraid of me going into surgery. Now he’s one of my biggest cheerleaders. He thinks it’s awesome that his mom’s so active and, and going out and doing so many things.

Colleen:

As supportive as my husband has been through the whole process, and he always comes with me when I come to the support group meetings, he has struggled with it. I think he’s happy for me and he’s so pleased that I am where I am and because I’m happy. But I think he went through a real period where I think he felt insecure because I was losing weight, I was getting healthy, I was getting physically healthy, engaging in new activities that I hadn’t done before. And I think he felt, not really threatened, but just sort of like, Oh wow. She’s getting younger and healthier and stronger and I’m sort of still here, and so there was, it was difficult for him, but for the most part I’ve received tremendous support from people, but it’s, I think because there’s that intimate piece with my husband of course, that that that was a bit more challenging.

Barb:

I think there is certainly, there was in me and I think I’ve observed it in some other bariatrics patients, there’s a kind of, I can do it myself kind of attitude and in truth it’s okay to accept and not always be the giver.

Barbara:

I have very good close friends that I know I can count on for anything, but I know when I talk to them about my surgery they don’t, they have empathy but they don’t have a clue. I know when I walk into a support group, I don’t have to say a word. Every single one there knows exactly where I’m coming from and what I’ve been through and there’s nothing that’s better than that.

Sandra Robinson:

Your family and friends and the bariatric team play an important role in supporting you. You will have regularly scheduled appointments with several bariatric team members to help keep you on track. These appointments can help answer questions, assess for complications, and provide motivation. Almost everyone experiences a better quality of life after surgery. Let’s hear about some of the success stories

Barbara:

I cannot stress enough, oh my God, what this did for me. It gave me life. It gave me active life. Nothing’s better.

Barb:

As a mammal, you know, you don’t get to experience metamorphosis like an insect, but like, it’s almost like that.

Cory:

when I look in the mirror, I see a different person and you know, that’s a good thing. I’m more happy today than I was before and this is given me a second opportunity to live life the way I want to and not watch life happen. I can now engage and live life and I’m very grateful that I have that opportunity.

Catherine:

I distinctly remember the first time I walked through a turnstile, the subway. I didn’t have to turn sideways. I didn’t have to squeeze through. I didn’t have to use the gate. It was just, there was so much joy and excitement in the little things. You have to look at those as your rewards because when they happen they will be such a wonderful thing for you.

Pat:

I love clothes, something that I never was able to before. You’re stuck in these stores that had these shapeless, awful clothes and now I just love to [inaudible 00:06:Video 1Video 1], I love colors. I love the fact that I can buy things anywhere I want.

Barb:

I can dance and be airborne occasionally. Like when you’re overweight, you’re never airborne like you never jump because your joints can’t stand the landing.

Joe:

I am the same weight as when I played football. So I never thought I’d be there. I am there, I’m happy with it. I’m going to keep it there.

Colleen:

But as I started losing my weight, I got more involved with running and then trained for and ran a half marathon. So, which was like unbelievable to me. I never thought of or saw myself as a long distance runner. But yeah, I sort of feel like if I put my mind to it, I can do anything now. Like there’s just nothing holding me back, so that’s very liberating, very liberating.

Shane:

I don’t look back. I don’t regret a single thing about the process. I keep looking back to that internist and I don’t even remember her name, but it was the, you have a second chance of life. You have the ability to change how you’re going to feel over the next several years.

Laura:

The biggest tip I can say to anybody is do it for yourself. When I realized I’m not doing this for anybody else and I’m doing it for myself, I realized I can do this. I’m going to lose this weight. I’m going to get thinner, I’m going to be fitter, I’m going to be healthier and I’m just going to feel happier. I am that much happier than I was a year ago.

Pat:

Your first year is golden. Maximize it. Follow the directions. That’s when you’re going to lose the most weight. You’re going to get to your goal, whatever your goal is you set. So try and follow that as much as you can and in that year, set some really good habits that you can stay with.

Colleen:

Just be gentle with yourself. You know, take it one day at a time. You know, everybody’s journey is different, I think, and you know, you do it for you. That’s the most important. You know, it’s your journey, so it’s just, be good to yourself, take one day at a time.

Sandra Robinson:

We hope you have a better understanding of how to prepare for surgery, what the surgery involves, and the benefits, risks, and lifestyle changes that are necessary. Remember, the most important tips for success are to stop smoking, drink less alcohol, eat healthy, do physical activities that you enjoy, take your vitamin supplements, ask for support, and go to all your followup appointments. This concludes the bariatric orientation video.

Sandra Robinson:

We want you to know that are here to support you throughout your weight loss journey. We know that deciding to have bariatric surgery is a major life changing decision. It requires hard work and dedication. So don’t forget to congratulate yourself when you’ve reached your goals. For more information about the bariatric program or to get more resources, please visit uhn.ca.

Most people who need to lose 65 or more pounds have tried multiple times to lose the weight on their own. While they may have some success at first, less than five percent of people keep the weight off for five years or more.

– Philip Schauer, MD, bariatric surgeon and Director of Cleveland Clinic’s Bariatric and Metabolic Institute

How dangerous is weight loss surgery?

All surgeries involve some risk. Specific risks related to weight loss surgery vary depending on the type of surgery performed. Some risks of bariatric surgery may include low blood sugar, malnutrition, nausea, vomiting, and the inability to eat certain foods. Talk to your doctor about the specific risks involved with the type of surgery you choose to have. Your bariatric surgeon and medical team will help you prepare for these risks and learn how to manage them.

How do you qualify for weight loss surgery?

Weight loss surgery is not for everyone. If you have only a small amount of weight to lose, or you haven’t tried to lose weight with diet and exercise first, weight loss surgery probably isn’t right for you. Bariatric surgery is typically recommended for people with a body weight index (BMI) of 40 or more, who have already tried to lose weight through other methods, and are able to commit to the lifestyle changes necessary for success with weight loss surgery (Lim et al., 2010).

Weight loss surgery may also be recommended for people with a BMI of 35 or higher and who have one or more health conditions that may be improved with sustained weight loss, such as type 2 diabetes, obstructive sleep apnea, hypertension, or heart disease (Lim et al., 2010).

Is weight loss surgery covered by insurance?

Weight loss surgery is sometimes covered by health insurance, but it’s important to understand exactly what your insurance plan requires. In order to have weight loss surgery covered by insurance, you may have to meet certain criteria and prerequisites. This may include undergoing psychological counseling and showing documented attempts to first lose weight through diet and exercise. Check with your insurance company to find out what they require, and make sure to follow their guidelines exactly to increase your chances of being approved for the procedure.

What are the different types of weight loss surgery?

Weight loss surgery is a continually growing field, and new procedures often become available after undergoing clinical trials and receiving FDA approval. However, some types of bariatric surgery have been used for years and continue to be popular due to their high success rates. Continue reading to learn more about six common types of weight loss surgery.

Gastric bypass
Gastric sleeve
Gastric banding (Lap-Band)
Gastric balloon
AspireAssist
Endoscopic sleeve gastroplasty Bypass procedure)

Gastric Bypass

(Laparoscopic Roux-En-Y Gastric Bypass Surgery)

What is gastric bypass surgery?

Gastric bypass is a type of bariatric surgery used to help people with severe obesity. Gastric bypass significantly reduces the size of the upper stomach and re-routes part of the small intestine so the food you eat “bypasses” the rest of the intestine, thereby limiting nutrient absorption.

The purpose of gastric bypass surgery is twofold: reduce the amount of food you can eat, and reduce the amount of fat and calories the body absorbs from food.

Gastric bypass surgery can be performed laparoscopically — a minimally invasive approach in which the surgeon makes small incisions and uses tiny surgical instruments rather than large incisions. Laparoscopic surgery reduces trauma on the body and makes recovery easier. It is associated with less risks than open procedures, such as infection at the surgical site.

Who is a candidate for gastric bypass surgery?

Gastric bypass surgery is usually recommended for people with a body mass index (BMI) of 40 or higher who have tried other weight-loss methods without long-term success.

People with a BMI between 35 and 40 and who also suffer from a related health condition such as heart disease, type 2 diabetes, sleep apnea, or high blood pressure may also be candidates for gastric bypass surgery (Neff & Roux, 2012).

Gastric bypass surgery is irreversible, but remains one of the safest and most effective weight-loss procedures for people who suffer from severe obesity.

How does Roux-en-Y gastric bypass work?

Gastric bypass surgery reduces the capacity of your stomach so you can feel full sooner and avoid overeating. After this procedure, foods will bypass part of the stomach and small intestine, which reduces the amount of fat and calories absorbed by the body (Hopkins Medicine).

Roux-en-Y gastric bypass surgery (RYGB) involves two main steps: reducing stomach size and re-routing the small intestine. First, your bariatric surgeon uses surgical staples to reduce your stomach pouch to the size of an egg. Then, the surgeon connects the new small stomach pouch to a section of the small intestine to form a “Y” shape. The re-routing of the intestine bypasses the lower section of the stomach and a portion of the small intestine, effectively reducing calorie absorption (University of Illinois Health, 2020).

What are the pros of gastric bypass surgery?

Gastric bypass surgery offers many benefits to those who are severely obese and who need help losing weight. This highly effective form of bariatric surgery can produce rapid, positive results that lower the risk of serious health problems and complications associated with severe obesity, such as stroke and cancer.

Gastric bypass surgery can also help boost mental and emotional well-being, since losing weight can increase energy and lend to improved confidence and self-esteem.

Increased feelings of satiety and reduced hunger that occur following gastric bypass can often lead to improvements in insulin sensitivity, thereby improving blood glucose control and reducing the risk of type 2 diabetes. It has also been shown to lead to the remission of type 2 diabetes (Cleveland Clinic).

The following are additional benefits associated with gastric bypass surgery.

Gastric bypass surgery offers significant long-term weight-loss results. On average, people who undergo gastric bypass lose more than half of their excess weight following the surgery. Evidence shows that the majority of patients lose between 60 and 80 percent of their excess weight, and maintain a weight loss of more than 50 percent long-term.

Laparoscopic weight-loss procedures like gastric bypass are minimally invasive and offer a faster recovery time compared to open surgery. Many gastric bypass patients spend only two to four days recovering in the hospital following surgery. You may experience mild pain in your abdominal region for about one week following the surgery, which can be treated using over-the-counter pain relievers.

Improvements to gut hormones

Imbalances in the gut can often impair metabolism and interfere with weight loss, but gastric bypass surgery helps facilitate positive hormonal changes in the gut. Improvements to gut hormones can help lower the risk of weight-related health conditions such as type 2 diabetes, reflux, sleep apnea, heartburn, and high blood pressure. Following Roux-en-Y gastric bypass, levels of the ghrelin hormone are decreased, which may lead to feeling less hungry longer (Korner et al., 2005).

What are the risks of gastric bypass surgery?

Gastric bypass surgery comes with its own risks just like any other surgery or medical treatment. One of the greatest risks associated with this surgery is weight regain. By the 10-year mark after surgery, many patients end up gaining back as much as 25 percent of the excess weight they initially lost (Cooper et al., 2015). Weight regain can be prevented by practicing healthy lifestyle behaviors including regular exercise and good nutrition.

Other risks associated with gastric bypass surgery include:

Potential complications

Complications that may stem from gastric bypass surgery include leakage at the sites where the stomach and small intestine were re-routed, shrinkage of openings into the intestine, and gallstones after rapid weight loss (Leyva-Alvizo et al, 2020). Distension of the unused part of the stomach may also occur, though this is rare.

Dumping syndrome

Dumping syndrome is an umbrella term for a group of symptoms that occur when food enters the intestines too quickly before it’s been fully digested. Dumping syndrome is common among people who have had weight-loss surgery — especially for those who continue eating high amounts of sugary, high-fat foods following their procedures. Symptoms of dumping syndrome include nausea, vomiting, bloating, sweating, dizziness, and diarrhea.

Decreased nutrient intake

The re-routing of the small intestine in Roux-en-Y gastric bypass surgery decreases the body’s absorption of vitamins, minerals, and other important nutrients that promote good overall health (Lewis et al., 2020). Eating a diet made up of foods like high-quality proteins, fruits, and vegetables is even more critical for maintaining good health after gastric bypass surgery. You may need to use nutritional supplements for life following surgery to avoid malnutrition that can stem from a reduced ability to absorb nutrients from food.

What happens during gastric bypass surgery?

Laparoscopic Roux-en-Y gastric bypass surgery takes between two and four hours to complete and is performed under general anesthesia. Your bariatric surgeon will insert a laparoscope — a tiny camera — into your belly in order to easily view and perform the procedure. This approach offers benefits such as smaller, less visible scarring, a shorter hospital stay, a faster recovery, and a reduced risk of infection (Elder & Wolf, 2007).

At the beginning of the surgery, the surgeon makes between four and six cuts in the abdominal region. The surgeon inserts the laparoscope and small surgical instruments into these cuts to perform the procedure, which reduces the level of trauma experienced by the body.

Next, the surgeon uses staples to create a smaller stomach pouch in the upper part of the stomach. This reduces the amount of food you can eat in one sitting. The lower part of the stomach that is no longer being used is known as the “blind” stomach.

The smaller upper stomach pouch is then attached directly to a part of the intestine to bypass the remaining portion of stomach and first part of the small intestine, known as the duodenum.

The narrow tunnel created between the stomach pouch and small intestine helps food stay in the pouch longer, which will help you feel full and satisfied for longer periods of time.

The stomach pouch will be roughly one ounce in volume and limits food intake to approximately one-half cup. Following surgery, you’ll start feeling full with much less food than before, and you will absorb far fewer fats and calories. Reducing your calorie consumption will lead to decreased weight and BMI.

Educational Videos: Gastric Bypass

Video information + transcriptions below. Tap to open and read along with video.

Video Name: Gastric Bypass Laparoscopic Surgery PreOp® Patient Education

Video Channel: PreOp.com Patient Engagement – Patient Education

Video Description: Gastric Bypass Laparoscopic Surgery PreOp® Patient Education StoreMD™ for Physician videos: http://store.preop.com Patient Education Company

Video Transcription: Your doctor has recommended that you undergo laparoscopic gastric bypass surgery. But what exactly does that mean?

Gastric Bypass is a surgical procedure used to help a patient lose weight.

It is usually recommended to help those who are morbidly obese – meaning that their weight problem has become a serious health risk.

Most severely overweight patients overeat.

Food enters the body through the mouth, travels down the esophagus where it collects in the stomach.

From there, digested food passes into the small intestine.

Nutrients taken from the food pass from the small intestine into the bloodstream.

Waste travels to the colon and leaves the body through the anus.

The amount of food that a person eats is partly controlled by appetite.

The stomach plays an important role in controlling appetite.

When the stomach is empty, a person feels the urge to eat.

When the stomach is full, that urge goes away.

Gastric bypass dramatically reduces the size of the stomach.

Gastric Bypass also shortens the small intestine so that the body absorbs less of the food eaten.

With less food entering the body, fat stores begin to be used.

The patient loses weight.

So make sure that you ask your doctor to carefully explain the reasons behind this recommendation.

Your Procedure:

On the day of your operation, you will be asked to put on a surgical gown.

You may receive a sedative by mouth and an intravenous line may be put in.

You will then be transferred to the operating table.

The anesthesiologist will begin to administer anesthesia – probably general anesthesia by injection and inhalation mask.

The surgeon will then apply antiseptic solution to the skin and place a sterile drape around the operative site.

Then, when you are asleep, the surgical team will make an incision just above the navel.

A tube-shaped collar called a trocar will be placed inside the incision to hold it open.

Harmless carbon dioxide gas will be used to inflate the abdomen, serving to enlarge the work area and to separate the organs.

The team then inserts the laparoscope.

Once in place, the laparoscope will provide video images that allow the surgeon to see the inside of your abdomen.

Next, the team makes four more incisions – taking special care to keep the openings as small as possible.

These openings will provide access for other surgical instruments.

Using these instruments your doctor will then cut the upper portion of the stomach from the rest of the organ

This upper portion forms a small pouch which is sealed with a stapling tool. The opening in the larger portion of the stomach is closed with staples.

The next step is to divide the small intestine.

The main part of the intestine is pulled upward, behind the colon and positioned near the small upper stomach pouch.

The other free end of the intestine is surgically stitched to the side of an intestinal loop.

The other end is now attached to the small stomach pouch. A new route for food passing from the esophagus into the intestines has now been created.

Finally, your doctor will check to make sure that all the new connections are secure and that there are no leaks.

A drain is added to remove any excess fluids and the carbon dioxide is allowed to escape.

Then the team withdraws all surgical instruments and the incisions are closed with sutures or staples.

Finally, a sterile dressing is applied.

Patient Education Company

Video Name: Bariatric Weight Loss Surgery | What to Expect from a Patient’s Perspective

Video Channel: Johns Hopkins Medicine

Video Description: Learn from a successful patient about what to expect and what you will need to do after bariatric weight loss surgery.

The team at the Johns Hopkins Center for Bariatric Surgery takes pride in superior long-term successes for patients.

To learn more about the Johns Hopkins Center for Bariatric Surgery, call Video 4Video 10-550-0Video 409 or visit hopkinsmedicine.org/jhbmc/bariatrics.

Video Transcription:

Spencer:

I came to the conclusion of bariatric surgery because I was a Video 2Video 2-year-old kid, just started grad school, and didn’t have the life that I wanted to live. I couldn’t go into the career I wanted to go into, and I couldn’t do the things that I wanted to do in my life. I had tried all the diets. I’d tried high protein, low carb diets, and just the whole good old fashioned working out, and none of it worked. One day, my dad actually pulled me aside because he had had the surgery. My mom had had the surgery. I have a lot of people in my life that have had the gastric bypass surgery. And he told me that it was an option. It was kind of like, “Oh, my gosh, this is something that’s a viable option. I can actually do this.”

Speaker Video 2:

How are you?

Speaker Video 3:

Fine, how are you?

Speaker Video 2:

Good.

Spencer:

The most important piece of advice I would give somebody is to do what the bariatric team tells you to do.

Speaker Video 4:

Maintain your fluids.

Spencer:

They tell you to get your 6Video 4 ounces of water, and they tell you to get however much protein you’re supposed to get in. You will be rewarded for it later.

Speaker 5:

Are you okay?

Speaker 6:

Yeah.

Spencer:

You need to get out of bed, and you need to start walking because that’s how the healing process starts to take place. Don’t think that you can’t get out there and walk the day of surgery or the day after to a couple of days after. You’ll be able to do whatever it is that you love to do. You’ll be able to do that. This surgery isn’t something that’s going to keep you on the couch for a month.

Speaker 7:

Today’s topic is going to be all about hydration, and it’s probably the most important thing that you can do immediately postop.

Spencer:

You need to keep fluid going into you, so just have your bottle of water with you. Take little sips every now and then, and you’ll be good. You have limited real estate in your stomach, and you have to use that up with good things like protein to help make you strong and keep your strength throughout the surgery process. The key thing there is you have to get protein in first. No matter what else is around, no matter what else is on your plate, you have to get your meats and fish and all that in. All your protein needs to get in first. Even for a snack, something high protein, just to get that little extra protein in every day, every chance that you can. The vitamins are a little bit of a challenge. Sometimes I’ll forget. I have the support system. I have my mom yelling at me every day, “Get your vitamins in.” I have my dad telling me to get my vitamins in.

Spencer:

I’ll set a reminder on my phone get your vitamins in. Your BVideo 1Video 2, your multivitamin, your vitamin C, all that kind of stuff. It’s something that you need to do because this isn’t just something that you don’t just get your vitamins in for a month or two. It’s something that you have to do for your whole life. Exercise by far has been the biggest factor because it makes that scale tick down even faster, and that’s a very, very cool thing to see, especially in the first year. You start seeing things in your body. You start seeing these changes when the weight’s coming off, and you’re gaining muscle, and you’re working out. It’s an incredible thing to see. I would just say don’t be scared. This is the most rewarding thing that I’ve ever done in my life. It is a blessing. It’s a miracle. And it’s something that I would go back, and I would do tomorrow. I’m now able to be the person that I was meant to be.

Video Name: Laparoscopic Gastric Bypass Surgery

Video Channel: TheSurgerySquad

Video Description:

Visit us at http://www.surgerysquad.com/

A gastric bypass is a surgical procedure designed to support an obese patient with weight control. This surgery involves creating a small stomach pouch from the existing stomach and attaching it to the small intestine. During this interactive laparoscopic gastric bypass surgery, you will oversee every aspect of the procedure. When you are finished you will learn important information regarding gastric bypass recovery and gastric bypass diets. Whenever you are ready, scrub in, put on your gloves, and grab your endoscopic camera so we can get started!

Video Transcription:

Dr. Jeff:

Welcome to Surgery Squad’s Virtual Laparoscopic RNY Gastric Bypass Surgery. I’m Dr. Jeff and I’ll be your guide for this procedure. Are you ready? Let’s scrub in. Gastric bypass surgery is designed to assist an obese patient in weight control. In this operation, we’ll create a very small stomach pouch from the existing stomach. We’ll then attach the reduced section of the stomach to the small intestine.

There are several common types of gastric bypass surgeries. We’ve recommended laparoscopic RNY gastric bypass surgery for our patient. The procedure will usually take two hours to perform, but with skills like mine and the magic of the internet, I bet we can whip this stomach into shape in about five minutes. Our patient has been prepared for the procedure with a mild sedative, and now the anesthesiologist places a mask over her nose and mouth, and she’ll drift off into dreamland. From here, we’ll place an endotracheal tube down the patient’s throat. You’re up. See if you can get the tube into place. Great work. This tube is then connected to a respirator.

The patient is ready to go. Now we can begin our laparoscopic procedure. The first thing we’ll do is make six half inch incisions in the abdomen. Slide the scalpel in where I have marked to make the incisions. Be careful. These are small incisions. Don’t get carried away. Nice technique. You must have an excellent teacher. Oh wait, that’s me.

Next, we’ll place a device called a trocar into each incision. These devices allow us to easily slide the instruments into the abdomen. Some of the instruments we’ll use include a light and a camera so we can see what we’re doing on a video monitor, as well as the surgical instruments such as the stapler. Now, to give us plenty of room to work, we fill the abdomen with carbon dioxide. Let’s face it, with a newbie helping out, we’ll need all the room we can get.

Time to start the bypass. We’ll use this monitor here to see our work. In RNY gastric bypass, we eliminate up to 90% of the stomach by making the patient’s stomach the size of an egg. We do this by first placing a line of staples that separate the smaller new stomach from the whole old one. Then we sew along the staple line to make sure there are no leaks. As the patient heals, scar tissue will form to create a permanent separation. Click the stapler where indicated to create the new stomach pouch.

We’ll now separate the small intestine from the old stomach about two feet down. The lower part of the intestine will be connected to the new smaller stomach, with a half inch opening between the stomach and the intestine. It’s kind of like rerouting traffic on the Video 405. Use the electrocautery device to create a half inch opening where indicated in the new stomach pouch. Now drag the loose end of the intestine to the new stomach pouch to attach it. I’ll add some sutures to hold it all in place.

Because we need the secretions from the old stomach to assist in digestion, it gets reattached to the small intestine, several feet below the new stomach. This part takes some guts. I need you to drag the free end of intestine attached to the old stomach over to the spot on the small intestine where indicated. Again, I’ll suture it all into place.

The new smaller stomach pouch was created. Everything has been reattached, and we checked for any leaks in the sutures. This new configuration allows our patient to feel full sooner when eating, but also lets the fluids from their original stomach aid in the digestive process. I’ll need you to remove each of the laparoscopic instruments and trocars. Now we need to suture each of the incisions. Nice work. I bet that won’t even leave a scar.

Now our patient goes off to recovery. In most cases, they’ll spend a few days here in the hospital so we can monitor their progress. Afterward, our patient will meet with her doctor and a nutritional specialist. They will assist her with her new lifestyle and eating habits. You’ve been a great help. Why not try another fantastic surgery at surgerysquad.com.

Video Name: My 260lbs Weight Loss Left Me With 20lbs Of Loose Skin | BRAND NEW ME

Video Channel: Truly

Video Description: SUBSCRIBE to Barcroft TV: http://bit.ly/Oc61Hj SIMPLY tying her shoelaces or walking up a flight of stairs used to leave Catherine struggling for breath. At her heaviest, the childminder from Oklahoma City, weighed 420lbs, wearing a size 6xl pant size. Being treated for numerous medical issues including polycystic ovaries, immune disorders, high blood pressure and diabetes, doctors repeatedly warned Catherine she was putting her life at risk if she didn’t lose weight. Only after multiple warnings and doctors’ insistence that she needed to have a gastric bypass did Catherine discover within herself the reserves needed to lose 260lbs entirely naturally. But Catherine’s weight loss journey is far from over – now awaiting skin removal surgery to remove the estimated 20lbs of excess skin from her body, health complications have meant she has had to delay having the surgery while her body heals from invasive vein removal procedures. Catherine’s GoFundMe page: https://uk.gofundme.com/f/6x5bbiw

Follow Catherine’s story here:

https://www.instagram.com/cshank1986/

https://www.gofundme.com/f/6x5bbiw?ut…

https://www.facebook.com/catherine.sc…

Video Credits:

Videographer / director: Shane Brown

Producer: Nathalie Bonney, Ruby Coote

Editor: Pete Ansell, James Thorne

Click here to follow your favourite Barcroft shows on Instagram!

Barcroft TV – https://www.instagram.com/barcroft_tv/

Born Different – https://www.instagram.com/borndiffere…

Shake My Beauty – https://www.instagram.com/shakemybeauty/

Hooked On The Look – https://www.instagram.com/hookedonthe…

Beastly – https://www.instagram.com/beastlyshow/

Ridiculous Rides – https://www.instagram.com/ridiculousr…

Dog Dynasty – https://www.instagram.com/dogdynastys…

For more amazing content, click here! Barcroft Animals: https://www.youtube.com/barcroftanima…

Barcroft Cars: https://www.youtube.com/user/Barcroft…

Speaker 1:
I was weighing in at my heaviest, 420 pounds. I feel sad I’m going to eat. The emotional connection that I had with it, literally, I knew I had to break up with it. Being told that I should have gastric bypass surgery, I had told them over and over again, no, I can do this on my own. I have lost 260 pounds naturally. It still shocks me when I see pictures and I’m like, is that really me?

Speaker 1:
When I started, I didn’t even think about the loose skin part of it. I mean, it affects you mentally, the way you look at yourself. You’ve done all this hard work and then you look in the mirror and all you see it’s all this loose skin.

Speaker 1:
We really do have a strong emotional connection with food, and it was bad. I was sad. It was something I ran to. Food, comfort food, mac and cheese, but wouldn’t a pizza make you feel better? You get to the point where I had such a relationship with food that it was like a second soulmate. Being 420 pounds, I was being held back from so many things, and just the simple things like tying your own shoe, being out of breath or going up stairs.

Speaker 1:
I’ll never forget it. I left the doctor’s office again, being told that I should have gastric bypass surgery. I had told them over and over again, no, I can do this on my own. I can do this on my own. And I remember realizing more than anything that I wanted this. It was not just going to be a diet that would change me.

Speaker 1:
I have lost 260 pounds naturally. I am so glad I stayed the course to do it on my own and opted out of having surgery.

Speaker 2:
After a year had passed and she had lost her weight, and then, just how much better and how much more life she had, it helped remind me of, okay, well, this is actually what life is supposed to be like.

Speaker 1:
He has also started his own journey as well, which makes it amazing to have somebody doing this with you.

Speaker 1:
It was really just learning portion control and staying away from a lot of processed foods.

Speaker 1:
Hi.

Speaker 3:
Hi.

Speaker 1:
All right, you got your goodies?

Speaker 1:
We like to keep it natural and it’s really taught me. I was not a vegetable eater, so I learned those flavors of vegetables, which are amazing. And the thing was, it was getting my body used to those.

Speaker 1:
Okay, so last week you told me to get some of these white sweet potatoes. They were so good. You were, yeah. So I want to get some more of these.

Speaker 1:
I actually put some oregano, garlic powder, sea salt on it, and then I baked it in the oven and it roasted perfectly. My favorite salad mix. Eat this almost every day.

Speaker 1:
When I first started, I didn’t think I was going to be able to finish. And now looking back three years later, 260 pounds, it’s crazy. There are days when I have major down days where I don’t want get up and go to the gym, or maybe a food type that I miss or I want to eat. Yeah, of course we’re all going to have slips up. But, I mean that’s just part of the journey. That’s just part of life and just got to keep on going.

Speaker 1:
This skirt is a size 30. I got up to 38. And when I wore this it was so tight that afterwards the front button popped off. You could fit a whole nother person in there, maybe two. There’s lots of space on there. This is a reminder of me to never go back to where I was.

Speaker 1:
When I started, I didn’t even think about the loose skin part of it, because in my mind I didn’t even know. I mean, I was hoping just to lose 20 pounds at that point. And then, when I really started to tell that it was affecting me, affecting my workouts. I mean, affects you mentally, the way you look at yourself. You’ve done all this hard work and then you look in the mirror and all you see is all this loose skin.

Speaker 1:
They told me that I have a good at least 20 inches that will be taken off around this whole area. My legs, I know it makes me tear up just thinking about it. I wore almost a size 6X pants, so I knew this would be something I would struggle with afterwards. But what I didn’t realize is that I would be left with not really a knee. All this skin that holds over it. And I just can’t imagine being able to have a knee.

Speaker 1:
I am very nervous about the surgery. I know it’s a risky surgery.

Speaker 4:
Why did you not have the skin surgery? What happened?

Speaker 1:
Why did I not have the skin surgery? So we were good to go, and then the surgeon actually noticed that there could be something wrong. I was having lots of pain always in my upper leg. I assumed, obviously, some of it’s going to be from all that loose skin pulling down on my knee. But when I saw a vein doctor, and she was like, you have very, very bad veins and we need to get these taken care of before you go under and have any surgery like this.

Speaker 1:
It took over 12 weeks of sessions of having veins being stripped and pulled. And it was super uncomfortable, super painful, but I just kept having in my mind, you’re going to have your skin removal surgery. You’re going to have your skin removal surgery. So then, when I found out that was taken away from me, it is a confidence thing that I’ve had to work on, because mentally can get inside your head. Here I was supposed to have my skin removal surgery and now I have 400 scars on my legs from being poked so many times. This was supposed to be my victory story of the loose skin being gone, but it’s dead. Now I get to show off the scarrings from something that I did not want, was not supposed to happen.

Speaker 1:
My sister, my mother-in-law wanted to do something special for me, so they had this necklace inscribed for me. And it says, lost 260 pounds. Now on the other side, it says, gained a new life. I hope that next year that I am going to have that skin removal surgery. I just want to get back and be able to go back to my surgeon. I can’t wait for that day where he can evaluate me again and be like, okay, let’s get this scheduled. I guarantee you, anyone can do this. They just have to want it. They have to find that fight.

Gastric bypass dramatically reduces the size of the stomach. With a smaller stomach, the patient is physically unable to eat large amounts of food. With less food entering the body, fat stores begin to be used. The patient loses weight.

– PreOp® Patient Education

How can I prepare for gastric bypass surgery?

Before surgery, your bariatric surgeon may recommend or require you to join a weight-loss or exercise education program so you can prepare for both the procedure and your new lifestyle following surgery. You may need to modify your diet before undergoing surgery to correct any nutritional deficiencies (Kushner et al., 2020). Nutritional counseling may be available to teach you about the healthy foods and supplements you’ll need following surgery and how to modify your diet to exclude foods that are high in calories. A balanced diet of protein, carbohydrates, and fats is important for your health and weight loss. You may also receive a psychological evaluation, along with education that stresses the importance of regular exercise and an active lifestyle for long-term weight-loss results.

If you smoke, stop smoking several weeks before your surgery. Smoking increases the risk of complications during and after surgery, including pneumonia and infection, and slows down your body’s repair and recovery processes (Haskins et al., 2014). Your surgeon may advise you to stop taking certain medications and over-the-counter medicines that increase the risk of blood clots and other complications, such as aspirin, acetaminophen, ibuprofen, warfarin, and vitamin E. Some patients may be asked to lose as much weight as possible through dietary adjustments before gastric bypass surgery to reduce the size of the liver and promote a safer surgery.

Your bariatric surgeon will provide you with a list of detailed pre-op instructions so you can arrive at your appointment fully prepared and ready to experience a safe and successful surgery. Prepare your home for your recovery period by throwing away unhealthy foods high in sugar and fat, and stock up on plenty of approved healthy foods and liquids. Create a comfortable resting place in your bedroom or living room where you can relax and recover from your gastric bypass surgery.

What happens after gastric bypass surgery?

Many gastric bypass patients go home within three to five days after surgery. Your hospital stay may last this long so you can be closely monitored during recovery and treated for any complications that may arise. Your surgeon will allow you to go home when you can freely move around without experiencing severe pain and are able to keep down liquids without vomiting.

Your surgeon will provide you with post-op instructions so you can experience a safe, full recovery from your gastric bypass surgery. For the first few weeks, you’ll be limited to liquids as your stomach adjusts to its smaller size and recovers from surgery. After the liquids phase, you can transition to soft, pureed foods for one or two weeks before moving on to solid foods.

To make the most of your gastric bypass surgery, you must exercise regularly and eat healthy foods to promote weight loss and maintain a healthy weight. Being sedentary and inactive or resuming poor nutrition habits can compromise your procedure and lead to weight regain. Your weight-loss surgeon will work with you to develop an individualized nutrition and fitness plan that works best for you. Your micronutrient levels may be monitored to make sure you have no deficiencies.

Is gastric bypass surgery right for me?

Gastric bypass surgery is generally recommended for those who are severely obese and who have a BMI of 40 of higher, patients with a BMI greater than 40 who have been unsuccessful with nonsurgical approaches, or who have a BMI of at least 35 and also suffer from a weight-related health condition like hypertension or type 2 diabetes (Elder & Wolfe, 2007). If you meet these qualifiers and have tried other weight-loss methods without experiencing long-term results, you may be an ideal candidate for laparoscopic Roux-en-Y gastric bypass surgery.

Use our directory to find a bariatric surgeon in your area ready to guide you safely through your weight-loss journey using laparoscopic Roux-en-Y gastric bypass surgery.

Gastric Sleeve

(Laparoscopic Sleeve Gastrectomy Surgery)

What is gastric sleeve surgery?

Also known as gastric sleeve surgery, sleeve gastrectomy is a relatively new procedure that has quickly become one of the most common and popular bariatric surgery options. With this surgery, roughly 75 percent of the stomach is removed to leave behind a narrow gastric sleeve about the size and shape of a banana (Cleveland Clinic). There is no re-routing of the small intestine as with gastric bypass surgery — meaning you can lose weight and still absorb important vitamins and nutrients from the food you eat.

Laparoscopic sleeve gastrectomy surgery is a purely restrictive procedure and does not cause malabsorption. A smaller stomach limits food intake so you can eat less, consume fewer calories, and lose excess weight. This procedure may also help reduce food cravings and hunger, since the portion of the stomach that produces hunger hormones is removed during surgery.

Initially, sleeve gastrectomy was conducted as part of the duodenal switch procedure, where it was combined with gastric bypass surgery for weight loss. Today, sleeve gastrectomy is performed as a standalone weight-loss surgery that helps patients lose weight without causing malabsorption. In some instances with high-risk patients, sleeve gastrectomy is performed as a staging procedure before a duodenal switch.

What happens during laparoscopic sleeve gastrectomy surgery?

Laparoscopic sleeve gastrectomy surgery is performed under general anesthesia. This weight-loss surgery takes between 60 and 90 minutes to perform in most instances, but no longer than two hours (Columbia Surgery).

At the beginning of the sleeve gastrectomy surgery, your bariatric surgeon will make five to six cuts in your abdomen to allow for the insertion of the surgical tools and the laparoscope — a tiny camera that allows your doctor to see and perform the procedure more precisely. Your surgeon will then remove 75 percent of your stomach, leaving behind a smaller stomach pouch or sleeve that resembles a banana and that holds between 1.5 to 5 ounces of food and liquid. The stomach is closed using surgical staples, and you will awaken shortly following the procedure.

This minimally invasive weight-loss surgery results in a short hospital stay of between one and two days. You may experience mild pain and soreness in the abdominal region for a few days following the procedure, which can be treated using over-the-counter pain relievers.

What are the pros of laparoscopic sleeve gastrectomy?

Laparoscopic sleeve gastrectomy is a simple procedure associated with less downtime, quick recovery, less pain, and reduced scarring. A reduced stomach size restricts the amount of food you can eat in one sitting to help you achieve significant weight loss within a short period of time. Sleeve gastrectomy has been shown to help patients lose 40-50 percent of their excess weight within the first two years after surgery.

This is a good option for very obese patients with other diseases, such as cardiovascular disease) who are at risk of prolonged exposure to anesthesia and patients who have been unsuccessful with other approaches (Cleveland Clinic, 2020; Rosenthal et al., 2020).

Additional advantages of laparoscopic sleeve gastrectomy include:

Reduced Appetite

During gastric sleeve surgery, your surgeon removes the portion of the stomach that produces ghrelin — a hormone that stimulates appetite. As a result, you may benefit from fewer hunger pangs and a reduced appetite, which facilitates weight loss. Additionally, the stomach is reduced in size by 75 percent to allow for lasting feelings of fullness with smaller food portions (Columbia Surgery).

Lowered Risk of Malnutrition:

Some surgical weight-loss procedures, such as gastric bypass, involve re-routing the small intestine to reduce the body’s absorption of fat and calories. However, this also reduces the body’s absorption of vitamins, minerals, and other important nutrients — increasing the risk of nutritional deficiencies. Gastric sleeve surgery only reduces stomach size to limit food portions, resulting in a lower risk of malnutrition.

Improved Health Conditions:

Gastric sleeve surgery has been shown to be successful at helping people with a high body mass index (BMI) lose most of their excess weight. More than 75 percent of patients who receive sleeve gastrectomy surgery experience an improvement in weight-related health conditions including type 2 diabetes, obstructive sleep apnea, and high blood pressure. This type of bariatric surgery may also help improve certain food intolerances as your body becomes healthier due to excess weight loss.

Educational Videos: Gastric Sleeve

Video information + transcriptions below. Tap to open and read along with video.

Video Name: Sleeve Gastrectomy Educational video – Dr Vytauras Kuzinkovas

Video Channel: DrV. Kuzinkovas

Video Description: www.advancedobesitysurgery.com.au, Tel: 1300 551 533 This is a short introduction into Laparoscopic Sleeve gastrectomy procedure at Advanced Surgicare Clinic, located at St George Private Hospital, Sydney, Australia. Clinic is specializing in Weight loss / Obesity surgery, known as Bariatric surgery. St George Private Hospital has been recently accredited by the Surgical Review Corporation from the USA and was awarded an International Center of Excellence for Bariatric Surgery status. At the moment this is the only hospital in Australia, holding this credential. Our experienced surgeon Dr V. Kuzinkovas (also accredited as a Surgeon of Excellence) performs Laparoscopic Gastric Banding procedures (known as Lap Band ), Laparoscopic Sleeve Gastrectomy, known as “Gastric Sleeve “and Laparoscopic Gastric Bypass surgery. If you tried numerous diets, worked hard in the gym, but had no significant weight loss – then weight loss surgery can be considered as the only proven alternative for weight loss. Failed diets can be very disappointing and weight loss surgery will help you to lose weight and keep it off for years. Weight loss surgery will also help you to improve or cure obesity related diseases, such as diabetes, hypertension, joint pain, sleep apnea, infertility and reduce the risk of some cancers. Successful weight loss gives you an enormous boost to your self-esteem, mobility, relationship and career. Have a look at one of our patients – Rebecca, who had Laparoscopic Sleeve Gastrectomy done in 2011 and her fantastic weight loss results: http://www.advancedsurgicare.com.au/p ….

For more details visit our website www.advancedobesitysurgery.com.au,

Facebook account: https://www.facebook.com/AdvancedSurg… or call us on 1300 551 533.

Video Transcription: Speaker 1:

of your small intestine, the duodenum, by a muscle called the pyloric valve. The pyloric valve is a ring of muscle between your stomach and your duodenum. Most of the nutrients from the broken down food are absorbed in the duodenum and the jejunum, which is the second part of the small intestine.

Speaker 1:

There are three main steps in the sleeve gastrectomy. The first step is disconnecting the tissue between your stomach and your abdomen. The second step is dividing your stomach into two sections. The third step is removing the upper, rounded left part of your stomach.

Speaker 1:

In the first step, tissue between your stomach and your abdomen is disconnected. Your surgeon will separate the tissue that connects the left side of your stomach to your abdominal organs, such as the spleen and the colon.

Speaker 1:

The second step is dividing your stomach into two sections. Your surgeon will divide your stomach using an endoscopic stapler. Your surgeon may also use traditional stitches or a combination of both staples and stitches to seal each section of your stomach. The seal is called the suture line.

Speaker 1:

The third step in the sleeve gastrectomy is removing part of the stomach. Your surgeon will remove the left part of the stomach, which includes the fundus. The fundus is one of the areas of the stomach that produces the hormone that controls your appetite. The remaining portion of your stomach will be about the size and shape of a banana.

Speaker 1:

Once you have healed from the surgery, weight loss will occur because of two reasons. First, your new stomach size will force you to decrease the amount of food you can comfortably eat. Secondly, the sleeve gastrectomy will cause your body to decrease or eliminate the release of a hormone that stimulates the appetite.

Video Name: A Journey: Restoring Health through Bariatric Surgery | Brigham and Women’s Hospital

Video Channel: Brigham And Women’s Hospital

Video Description: Discover how bariatric surgery patient, Quinn, restored her health and her life through bariatric surgery at the Center for Weight Management and Metabolic Surgery at Brigham and Women’s Hospital. Learn about bariatric surgery at the Brigham from bariatric surgeon, Eric Sheu, MD.

Learn more about weight loss surgery at Brigham and Women’s: https://www.brighamandwomens.org/cent…

Video Transcription: Eric Sheu:

with weight loss, and to help with improvement of many obesity related medical conditions, particularly diabetes, heart disease, and sleep apnea. And by doing these surgeries, we seem to rewire how your body responds to food in terms of hunger, satiety signals, and also how your body regulates weight.

Quinn:

I had always tried eating healthy and dieting. But what I would do is I would do the extreme. So I would be eating just salads every day, and then I would lose some weight. And then the second that stopped, because that’s not sustainable, I would then gain it all back. Or I would be working out three times a day eating terribly, nutrition-wise, wasn’t giving my body what it needed, so I would drop the pounds and the second that stopped, I would gain it all back. So I had looked to my future, and was almost 300 pounds and hadn’t gotten diabetes, or high cholesterol, or sleep apnea. And I considered myself very lucky because I absolutely could have had any of those conditions. And I realized that it was only a matter of time until those things started to become my reality in my life, and I didn’t want to do that. And my biggest motivation was being a healthy mother. I’m not a mother yet, but I want to have kids in the near future. And I wanted to be able to have a baby and then be the healthiest mom that I could be.

Eric Sheu:

There’s a lot of good study in data now to suggest that if you have the surgery and lose this weight before you develop those medical problems, you might do better from a weight standpoint with the surgery, but you’ll also live longer, live healthier. In particular with Quinn’s case, there’s good data now that bariatric surgery not only helps you lose weight, but will also decrease the risk of developing cancers down the line, will decrease the risk of dying, decrease the risk of sudden heart attacks and strokes. I think in Quinn’s case, she had a lot of foresight and motivation to prevent those issues from being … from coming up.

Quinn:

My experience with the Brigham and Women’s team has been phenomenal. From the minute I made a phone call to get into a new patient appointment, through all of the visits to get approved, through having surgery, through coming back, through interacting with the nutrition team on Facebook, the access that I’ve had to them has been phenomenal. They have been incredibly supportive, very helpful, super encouraging. I couldn’t speak highly enough about the team here at Brigham and Women’s.

Eric Sheu:

Brigham and Women’s Hospital is really one of the leaders in bariatrics, both locally, regionally and nationally. We are one of the largest volume centers that performs these surgeries. We’re accredited by the national organization at the highest level for these surgeries and we have really an outstanding safety and track record with that.

Quinn:

The day of surgery they brought you in, and it was very welcoming. And I felt extremely comfortable, because I just knew that this was the right thing for me. So I wasn’t super nervous or anxious. I was just excited to start this new chapter of my life. So I was like, “Yeah, let’s get in there, and let’s get this done.” I was home within three days, and back to work about 10 days later. I didn’t even take all of my pain meds, because it’s not a super painful surgery, because it’s all done laparoscopically. And I was back to work 10 days later, and started the next phase of my life.

Eric Sheu:

So ideally, I think our most successful patients change their lifestyle and habits after surgery to really get the most out of this surgery for longterm weight loss, and longterm weight benefits ,and the benefits of surgery. The surgery I think helps a lot in the first year in terms of making you feel full sooner, helping you not crave foods, and again, helping your body’s metabolism not fight you to lose weight.

Quinn:

So about a year and a half after my surgery, I completed my first 5K run, and I crossed the finish line thinking, “Wow, this is why I did this. It’s for things like this. It’s not just to lose the weight. It’s to be able to experience these life events that I never thought were in my book.” It has given me a lot more of authentic confidence, and now I feel like I can just be my true self, which has been a very beautiful thing to experience from the inside looking out in the last two years. You owe it to yourself to come to an informational session, to talk to the team to see if this is a viable option for you. So many people that I have told that I’ve had bariatric surgery say, “I’ve been considering it for a long time, but I don’t know if I have time to dedicate to the appointments,” or, “I don’t know if I have time to go through this,” or, “Surgery sounds scary to me.”

Quinn:

And I try to say to them, “Look at me. This is only two years later. This is only a really short period of time in my life.” So I always say, “You’re not too busy to save your life.” When someone asks me how much weight I’ve lost, because it is quite a physical transformation, I always start by saying, “I’ve lost 130 pounds, but besides that, I’ve gained so much life. I’ve gained so much happiness, and confidence, and just knowledge that I get to move through these next phases of my life, the healthiest that I can be. And that’s a heck of a lot more important than the amount that it says on the scale.”

Video Name: Life after sleeve gastrectomy | UCLA Bariatric Surgery

Video Channel: UCLA Health

Video Description: A life long struggle with obesity ends in success for patients undergoing minimally invasive bariatric surgery at UCLA. Hear their stories

following the gastric sleeve procedure and watch as they reclaim their lives.

Learn more at http://surgery.ucla.edu/bariatrics

Video Transcription: Speaker 1:

self esteem.

Jeremy:

It was hard not feeling like I was, I guess as important as I should be to the rest of the world.

Speaker 1:

One year ago, Jeremy underwent bariatric surgery at UCLA. Over the past few months, he has lost 150 pounds.

Jeremy:

It is a complete lifestyle change, but this tool is the thing that makes it possible to achieve longterm success.

Speaker 1:

Jeremy is one of a growing number of people attacking obesity head on. Obesity is a serious problem in this country. According to the CDC, some 40% of Americans are obese and it’s getting worse, driving up related health problems like high blood pressure, high cholesterol, type two diabetes, fatty liver disease, sleep apnea. In fact, severe obesity is the second leading cause of preventable death in the country.

Speaker 3:

Most patients I have seen that have struggled with the weight loss for about 10, 15 some of them trying do 30 years. Or a lot of them into their whole life. They feel that they have tried all kinds of ways, and just fail each one of them. They feel that they are helpless.

Speaker 1:

UCLA’s Center for Obesity and Metabolic Health has helped thousands of seriously overweight patients reclaim their lives through weight loss surgery. The most common worldwide today is what’s called the gastric sleeve. It’s a laparoscopic procedure, removing about 75% of the stomach. Patients eat less and the risks are lower than traditional bypass surgery that involved rerouting the small intestine.

Speaker 3:

You have about 85 to 90% chance to be successful, and you have minimal chance to develop complications.

Speaker 1:

Like Jeremy, Kristen is almost unrecognizable after her gastric sleeve procedure at UCLA. 10 months later, she has lost 140 pounds.

Kristen:

So it’s been great. I’ve weight lifted, I went rock climbing the other day, like this whole world has opened up to me and then there are ways like, I fit in an airplane seat. It’s cost me a fortune in new clothes because I can’t stop shopping, at all. Anyone who’s going to get this procedure just put some money away for clothes right now.

Speaker 1:

Pamela had the gastric sleeve procedure at UCLA two years ago.

Pamela:

And I finally just said I’ve had enough. That I love myself enough to be healthy. I love myself enough to give myself a gift of life.

Speaker 1:

UCLA offers a multidisciplinary team to support patients through their life changing journey. Jeremy, Kristin and Pamela want to be clear, bariatric surgery is not a magic bullet.

Speaker 3:

And a lot of people in the society say that, okay, this is an easy way out. It is not.

Speaker 1:

Their new life requires a commitment to change, but the difference is this time there’s an excellent chance their efforts will work.

Jeremy:

If you’ve struggled through losing, trying to lose weight, gaining it back, and you’re ready to make a lifelong change, this is a tool that can be really helpful in getting you there. I know it was the best decision that I’ve ever made.

Kristen:

I thought it was my fault, and it’s not, obesity is a disease, and seeking medical attention for any other disease is just common sense. And so, don’t be ashamed. Just go in and talk to someone and see what they can do. It’s not, just do it now. Like don’t wait, like don’t waste your life.

Video Name: The Advantages of the Gastric Sleeve

Video Channel: MyQuest Weight Loss Center – University General Hospital

Video Description: Here are some advantages of the Gastric Sleeve Operation for Weight Loss, as explained by Dr. Robert G. Marvin:

* reserved for high risk patients who are very obese

* simple operation, doesn’t require any foreign body or rerouting of intestines

* Gastric sleeve surgery is the safest bariatric surgery.

* Weight loss with the gastric sleeve is much more predictable and early.

* And more!

For more information about the gastric sleeve, visit us online at http://www.myquestweightloss.com.

Video Transcription: Speaker 1:

early complications, the gastric sleeve is intermediate between the lap band operation and the gastric bypass. The bleeding rate is definitely less than the gastric bypass as well as the leak rate. However, the lap band itself is an extremely safe operation on the day of surgery. In fact, there is not another operation that’s any safer than a lap band operation in the abdomen. But the real advantage when it comes to complications with the gastric sleeve are on the longterm problems. The gastric sleeve is not vulnerable for ulcers. It’s not vulnerable for small bowel obstructions or internal hernias like the gastric bypass is, therefore re-operations for these problems are avoided.

Speaker 1:

It has no foreign body. Nothing needs to be adjusted and nothing can slippery road as with the lap band. Therefore, one of the major advantages of the sleeve gastrectomy is the avoidance of longterm problems that might require an operation. Although the gastric sleeve is a simpler operation, it also appears to provide the same amount of weight loss as the gastric bypass. This is very predictable in early weight loss. Patients can expect to lose somewhere between two thirds and three quarters of their extra body weight in the first year and a half after an operation. The weight loss with the gastric sleeve is much more predictable and early, compared to that with the lap band and it avoids some of the other problems that can happen with a bypass such as vitamin and mineral deficiencies.

Speaker 1:

When it comes to carrying other problems related to weight that comes along with obesity such as high blood pressure, diabetes, high cholesterol or sleep apnea, the gastric sleeve operation appears to be almost as good as the gastric bypass. Although the gastric bypass is the best operation to curing diabetes or getting it under control, the gastric sleeve is also very effective. Approximately 60 to 70% of patients who have diabetes prior to surgery will have it resolved completely with a gastric sleeve operation. The remaining patients will either have better control or the disease will be arrested in its current form. Patients after gastric sleeve operation will be required to take a vitamin for the rest of their lives. However, vitamin and mineral deficiencies are not very common. They can occur in the first year to year and a half due to the significant weight loss that the sleep produces. However, vitamin deficiencies are more rare and less severe than with a gastric bypass, and they’re easy to treat in the long run. Most patients with a vitamin and mineral deficiency after a sleeve operation will have that resolve within the first two years.

Speaker 1:

If you have any questions or need any other information, please visit our website or call your surgeon’s office.

You have about an 85 to 90 percent chance to be successful with gastric sleeve surgery. And, you have minimal chance of developing complications.

– Yijun Chen, MD UCLA Bariatric Surgery

What are the risks associated with sleeve gastrectomy?

Laparoscopic sleeve gastrectomy surgery comes with its own risks and disadvantages just like any other surgery or medical procedure. Those who choose this weight-loss surgery must understand this procedure is permanent and irreversible.

Some risks and disadvantages associated with sleeve gastrectomy surgery include:

Potential Complications:

Sleeve gastrectomy can lead to possible complications including inflammation in the stomach lining, infection caused by the leaking of food contents from the staple site, injury to other organs, and bowel blockage caused by scarring in the stomach. Some individuals may experience vomiting from eating portions that are larger than the stomach pouch can hold, but this may be prevented by sticking to liquids and pureed foods during the initial weeks following surgery.

Weight Regain:

Gradually increasing your portion intake in the months and years following sleeve gastrectomy surgery can result in your stomach pouch becoming dilated. This behavior compromises your weight-loss surgery by expanding the stomach, which allows you to return to eating larger portions. Poor nutrition habits and lack of exercise may put you at risk for weight regain following gastric sleeve surgery. Working with your doctor and nutritionist will help keep you on track with your weight loss goals.

How should I prepare for sleeve gastrectomy surgery?

Before the date of your surgery, you may have several meetings with your bariatric surgeon to fully prepare for the procedure and for the lifestyle changes you’ll be required to make following surgery. Some bariatric surgeons require patients to receive education about how weight-loss surgery works and what to expect, along with education on the importance of good nutrition and regular exercise following surgery.

Other ways to prepare for laparoscopic sleeve gastrectomy surgery:

Inform your doctor of any medications, vitamins, herbs, supplements and other substances you may be using, since these may be dangerous to use before and after surgery
If you smoke, stop smoking as soon as possible, since smoking can delay healing and interfere with recovery
Start eating healthier foods to prepare your body for a lifetime of healthy eating after surgery
Remove all unhealthy foods from your home, such as junk foods and frozen TV dinners
Stock your kitchen with healthy foods and drinks, including approved liquids and pureed foods
Create a comfortable spot in your home where you can relax and recover following surgery
Join a support group, either online or in person, to keep you on track (Cleveland Clinic, 2020)
Work to maintain a positive attitude without turning to unhealthy food
Avoid drinking too much alcohol before and after surgery (Penn Medicine, 2015)

Your doctor will give you a list of pre-op instructions so you can arrive at your appointment prepared and ready to experience a safe and successful sleeve gastrectomy.

What happens after sleeve gastrectomy surgery?

Following surgery, your doctor will provide you with detailed post-op instructions on how to care for your incisions and what to eat once you get home. Eating the wrong types of foods or eating too quickly can interfere with the healing of your stomach and overall recovery. In most instances, your surgeon will advise consuming only liquids for the first week, followed by soft and pureed foods for two weeks, before moving onto small portions of solid foods.

Sleeve gastrectomy surgery reduces the size of the stomach — meaning you must adhere to a healthy nutrition plan since your portion sizes will be significantly smaller. A smaller stomach can help you achieve long-term weight loss, but only if you’re eating healthy foods like fruits, vegetables, and high-quality sources of lean protein. A diet made up of foods high in sugar and fat such as pastries, desserts, fried foods, and fast foods will not promote healthy weight loss even if you’ve had weight-loss surgery.

In addition to improving your nutrition, you must also make a series of healthy lifestyle and behavioral changes to get the most out of your surgical weight-loss procedure, such as:

Chewing food more slowly and thoroughly before swallowing
Greatly reducing food and drink portions
Consuming higher amounts of nutritious foods
Drinking more water and healthy fluids throughout the day
Consuming foods and drinks separately
Taking daily nutritional supplements to maintain optimal health
Exercising regularly to promote and sustain weight loss
Creating a support group to keep you on track

Weight gain and weight loss affect everyone differently. Results from sleeve gastrectomy surgery may vary for each individual, as patients are responsible for maintaining good nutrition and exercising regularly following the procedure. Some individuals may experience rapid weight loss after surgery, while others may lose weight at a slower, more gradual pace. Adhering to your surgeon’s instructions and recommendations can help you experience the best possible outcome following gastric sleeve surgery.

Is laparoscopic sleeve gastrectomy surgery right for me?

Laparoscopic sleeve gastrectomy surgery may be ideal for you if you have a BMI greater than or equal to 40 without any associated comorbidities. This surgery is also effective when used as a staged procedure before another weight-loss surgery for patients who have a BMI of 50 or greater. If your BMI is between 35 and 40 and you have tried other weight-loss methods without experiencing long-term results, sleeve gastrectomy surgery may be ideal for you. Laparoscopic sleeve gastrectomy may also be a good option if you are obese and have other underlying medical conditions, such as type 2 diabetes or heart disease (Wolfe et al., 2017; Mechanick et al., 2013).

Gastric sleeve surgery reduces the size of your stomach without changing the way your stomach and intestines function, and allows you to continue absorbing vital minerals and nutrients from the foods you eat. This procedure has been proven effective at treating high-risk patients who may suffer from Crohn’s disease or anemia in addition to obesity.

Use our search directory to find bariatric surgeons in your area who can help you achieve your weight-loss goals using laparoscopic sleeve gastrectomy surgery.

Adjustable Gastric Banding

(Laparoscopic Gastric Banding)

What is a gastric band?

Laparoscopic gastric banding surgery is a restrictive weight-loss procedure in which a band is placed around the upper portion of the stomach to help limit portion sizes. Gastric banding surgery helps you feel full with less food, so you can consume fewer calories and lose excess weight.

Commonly known under the popular brand names LAP-BAND and Realize Band, a adjustable gastric band is a soft, adjustable silicone band or ring that is placed around the upper portion of the stomach (Columbia Surgery). This separates the stomach into two different chambers: a small upper stomach and the remaining lower part of the stomach. The purpose of the adjustable gastric band is to limit food intake and slow the passing of food to the lower part of the stomach and digestive tract. This allows you to stay full for longer periods of time while consuming less food.

The adjustable gastric band has a small, narrow tube that connects to an access point just below your skin on the abdominal wall. Using this port, your bariatric surgeon can adjust the band at any time to increase or decrease the size of your stomach pouch, and to accommodate health conditions such as pregnancy. A fuller band creates a smaller stomach pouch that reduces food intake and slows the emptying of food into the lower part of the stomach. In the weeks, months, and years following gastric banding surgery, you may need to visit your doctor regularly to have the band adjusted as you gradually work toward achieving your weight-loss goals.

What happens during laparoscopic gastric banding surgery?

Laparoscopic gastric banding surgery is performed under general anesthesia, and takes between 30 minutes and one hour to complete.

Your bariatric surgeon begins by making five or six incisions on your abdomen to allow for the insertion of the laparoscope and other small surgical tools used to perform the procedure. The laparoscope is a tiny camera that helps your surgeon gain a better view of the inside of your stomach and perform a precise surgery. Your surgeon then places a small silicone gastric band around the upper part of your stomach to create a small stomach pouch, and attaches the gastric band to an access port on your abdominal wall.

The band will be deflated at the time of surgery, as your stomach will need time to heal before receiving the first fill. During future appointments with your surgeon, the band will be filled to reduce your stomach size as needed.

What are the advantages of gastric banding surgery?

Gastric banding surgery is an evidence-based weight-loss procedure designed to help you lose weight by reducing the amount of food you can eat at one time.

This procedure is less invasive than other bariatric procedures (Columbia Surgery). In many cases, you can go home the same day as the procedure and avoid a hospital stay.

Additional benefits of laparoscopic gastric banding include:

Weight Loss:

People who receive gastric banding surgery lose an average of one-third to one-half of their excess weight. Weight loss with the gastric band usually happens more gradually than other surgical weight-loss procedures, as there is no removal of any portion of the stomach or re-routing of intestines to trigger rapid weight-loss results. On average, people who undergo gastric banding surgery continue losing weight for the following three years.

Less Invasive:

Laparoscopic gastric banding surgery is less invasive than many other weight-loss surgeries. Gastric banding is completely reversible and doesn’t involve removal or re-routing of any organs involved in the digestive process.

People who need the gastric band removed due to certain medical conditions or for personal reasons can do so without facing serious risks or complications. This bariatric procedure has been found to be a safe and effective method of weight loss at the 3-year follow-up.

Adjustable for Your Personal Weight-loss Needs:

A major benefit of gastric banding surgery is having the option to adjust the band based on your personal health and weight-loss needs. For instance, if you feel that your gastric band is no longer helping you stay full or lose weight, you can visit your bariatric surgeon to have the band filled with more saline fluid.

Women who have the gastric band and who become pregnant can have their bands deflated so they can eat more food and experience a healthier, more comfortable pregnancy.surgery

Educational Videos: Gastric Banding

Video information + transcriptions below. Tap to open and read along with video.

Video Name: Adjustable Gastric Banding

Video Channel: Columbia University Department of Surgery

Video Description: In this video, Dr. Marc Bessler, Professor of Surgery at Columbia, covers adjustable gastric banding in detail. This weight loss procedure offers a reversible and relatively safe surgical option for patients undergoing weight loss surgery. To learn more about weight loss surgery at New York-Presbyterian/Columbia University Medical Center,

visit our website at: http://obesitymd.org/

Video Transcription:- Marc Bessler:

Adjustable gastric banding is an operation where we place a ring around the stomach. Here, you can see a ring around the top of the stomach. This ring is attached to a tube and a port under the skin where we can inject fluid to tighten the ring around the stomach. This leaves a small pouch of top of stomach where we can control the opening at the bottom of that pouch, so food fills the pouch and empties slowly.

Marc Bessler:

The band needs to be adjusted to achieve the right diameter around the stomach so that food can go in and empty slowly but not cause vomiting. The band is fairly effective if patients can eat small amounts, chew carefully and slowly at achieving about 40% of your excess weight loss. Bands need to be filled until we get the proper adjustment, and that requires monthly visits in the first six months after surgery.

Marc Bessler:

During the operation, five small incisions are made, or sometimes we do this through the belly button with just one incision, and the band is placed around the stomach and stitched in place. Then, the port, which allows us to adjust the fluid level in the band, is placed under the skin and attached to the tubing of the band. So the entire system is implanted through five small incisions, and most patients go home the same day.

Marc Bessler:

Adjustable gastric banding is the simplest of all the weight loss operations. It doesn’t involve cutting the stomach or intestines, it doesn’t reroute anything, and it’s reversible. So those are its main advantages. Those three things are offset, however, in some ways, by the fact that it’s the hardest operation to learn to live with in some ways because eating behavior really is restricted more than other operations. It has a reoperation rate of up to 30% in the longterm. The weight loss is the least of all the weight loss operations, about 40% of your excess weight, so if you’re 100 pounds, you can expect to lose 40 pounds. Some will do better, some will do worse. The real issue is, will this be permanent for you, and will it achieve the amount of weight loss that you want? That’s something you need to talk about with your doctor.

Marc Bessler:

Adjustable gastric banding is used for patients who fit the qualification for weight loss surgery, BMI of 35 to 40 with medical problems, or above 40 even in the absence of medical problems. Hard to pick who’s the best candidate for a band versus the other operations. Mostly, it’s either patients who are older or at highest risk, or patients who are unwilling to have one of the other operations because they’re more complex. The amount of weight loss with adjustable gastric banding needs to be accepted, it’s 40% or so, and you have to be satisfied with that result or else choose a different operation.

Marc Bessler:

Most patients who have an adjustable gastric band go home the same day, so I expect you’ll go home several hours after surgery. After that, you’ll be at home taking medication for pain for just a couple of days. It takes about two weeks till you’re ready to return to your normal activity and go back to work. Of course, the dietary changes are going on during that time, from liquids and purees to soft and then solid foods. Pretty much the same as with any operation in the first two to three weeks.

Marc Bessler:

After any weight loss operation, you’ll be meeting with a nutritionist, both before and after the surgery, to work on your dietary needs and expectations. After adjustable gastric banding, you’re on liquids and pureed foods for two weeks, and soft diet for two weeks, and then finally, regular food. By the second visit, at about five to six weeks, you’ll be having solid foods. At that point, we’ll make a decision about whether you’re ready for an adjustment or need an adjustment of the band to make it tighter. The difference between banding and the other operations as far as diet is the band adjustments change your tolerance for food, so every time your band is adjusted, you’re going to need to back up to soft and ultimately, soft solid and then solid foods to get a sense for how the tightness of the band is and what you’re ready to eat.

Marc Bessler:

Weight loss after adjustable gastric banding is pretty variable. Some patients really struggle to lose 20, 30 pounds. Some patients easily lose 70 or 100 pounds. On average, we see patients losing about 40% of their excess weight, which, if you’re a hundred pounds overweight, means about 40 pounds. The problem with this is it’s really unpredictable.

Video Name: LAP-BAND® System Advantages

Video Channel: LAPBANDAPSystem

Video Description: Important LAP-BAND® System Safety Information at http://lapband.com/en/learn_about_lap…

For more information visit http://www.lapband.com?cid=youtube1

The differences between the LAP-BAND® System vs. gastric-bypass.

Video Transcription:- Dr. John Dixon:

There’s a very big difference between the LAP-BAND System and gastric bypass. Gastric bypass, it requires cutting of the stomach, cutting of the bowel, replumbing of the bowel. There’s cutting, there’s stapling and there’s a diversion. There’s a rerouting of the intestine. The LAP-BAND System is quite different. It doesn’t require stapling, cutting, rerouting of the bowel. Nutrition is very well looked after. There aren’t these specific problems and if you’d like, it’s a much more natural, a much safer way of losing weight.

Speaker 1:

This is a no-brainer. They don’t have to cut me open. It’s reversible if I need it to be.

Speaker 3:

When I looked into the LAP-BAND, it just seemed like that was my last hope. The last chance for me to get rid of this weight and to change my life.

Dr. John Dixon:

There are several sizes to the AP band. There’s a large and a standard. The standard band fits most people, but if the surgeon feels that’s needed to put an extra large one in at the time of surgery, then the surgeon will select the larger band.

Laura Baldwin:

It’s very individualized and that’s the great thing about the LAP-BAND System is you can customize the adjustments and the weight loss to the individual.

Speaker 5:

I asked them, I said, what do you see as a better choice for me? And as we discussed the LAP-BAND and he gave me all the information, we came to the conclusion that the LAP-BAND would be my choice.

Dr. John Dixon:

Elegant with its Omni Form technology and its experience with silicone technology has, with the AP band, produced the optimal band for today’s market.

Video Name: Bariatric Surgery – Actual Lap Band Surgery Procedure

Video Channel: LAPBANDAPSystem

Video Description:

http://baysurgicalspecialists.com/lap…

https://plus.google.com/1069966540312…

The advantages of a Lap Band Surgery is that there is no cutting or stapling of the stomach, adjustable bands and it is reversible

To learn more about the medical services we offer, contact us through our online form at http://baysurgicalspecialists.com/con… or call us directly (727) 456-8882.

Bay Surgical Specialists

960 7th Ave N

St. Petersburg, FL 33705USA

Phone: (727) 456-8882

Fax: (727) 825-1357

http://baysurgicalspecialists.com/

Like us on Facebook: https://www.facebook.com/BaySurgicalS…

Add us on Google+: https://plus.google.com/1173127680597…

Follow us on Twitter: https://twitter.com/#!/baysurgicals

Follow us on Pinterest: http://pinterest.com/baysurgery/

Dr. Kevin Huguet on Google+: https://plus.google.com/1069966540312…

St Petersburg Lap Band Surgery,Weight Loss Surgery,Bariatric Surgery in St. Petersburg,Gastric Banding in St Petersburg,Losing Weight in St Petersburg,Bay Surgical Specialists, General Surgery in St Petersburg

http://youtu.be/IKFH18faocc

Video Name: Revision Band to Sleeve Actual Surgery Explained! – Dr. Ariel Ortiz®

Video Channel: Obesity Control Center

Video Description: In the O.R. with Ariel Ortiz MD® explains the process of removing a gastric band and the scar tissue in order to perform a safe revision to a gastric sleeve. The overview of a re-enforced gastric sleeve is also explained.

If you like our content, please comment, share and like this video… and don’t forget to subscribe!

Visit our website: https://obesitycontrolcenter.com/

View before and after pictures + read stories: https://obesitycontrolcenter.com/stor…

Follow us on Social Media:

Facebook: https://www.facebook.com/OCCMedicalCe…

Instagram: @ObesityControlCenter

Twitter: @OCCWeightloss

Video Transcription :

Speaker 2: (00:06)

if it’s going to be a revision from a lap band to a sleeve, it’s considered a revision surgery so it takes a little bit more and we have to take care of certain aspects that I’m going to walk you through. First thing we’re going to do is remove this band. We typically cut it so we don’t have to really work a lot with a stomach gastric tissue. We want to preserve the tissue as much as possible, so right now we’re going ahead and cutting the buckle off. Then we’re just going to pull it through. The band has been removed. We’re going to look at a panoramic view of the stomach, so this is the whole stomach. This is the highest part of the stomach where the band was, so that tunnel is not normal. There’s some six sutures right here that originally were covering the band.

Speaker 2: (01:05)

Now we removed the band and we left a defect right there. Now the idea is to remove this bolt and release the stomach from the big stations over here of the stomach to liberate the stomach was folded over the band. This is obviously extremely important because we want a fresh looking stomach revision. Surgery is not for the faint of heart. We’re going to find different types of surgical anatomy because surgeons tend to do different types of surgeries. They have their own style of suturing. The more stitching stitching material we find, the more we action we’re going to find inside the abdomen, the more difficult the surgery is going to be here. Where removing the suture material.

Speaker 2: (02:03)

In this case, this patient had a band from 2006 we have a previous interview of her and the band basically stopped working, so we’re going to check it. Probably there was a leak in it, but ultimately she decided to have a revision surgery and get a sleep. Now the other important aspect of doing the surgery is releasing all the different fibrous tissue that has stuck parts of the body together that shouldn’t be stuck. In this case, we have the highest part of the stomach that’s stuck to the liver. Liver is this structure right here that we’re lifting up and this area is the highest of the stomach where the stomach actually goes up into the chest. This is where we check for a Hyatt offering or using a harmonic scalpel and we’re dissecting out the area until we can see the esophagus. So this is a very important step because we just don’t want to come in here and just staple without knowing what we’re stapling because patients that have that type of surgery where the area of the esophagus is not looked into the hiatus.

Speaker 2: (03:35)

Mike ended up with chronic heartburn after the surgical procedure, so this is what we’re looking at is the area of scar tissue where the band was, and you can see it right here. An important thing that we always do, Dr. Martinez, also a very ethic surgeon. It’s nicer when you have two surgeons working together and thinking together during the operation because especially in revision surgery, we’re never, we never know what we’re going to find. So here it’s two heads thinking better than one. We’re still using the same incisions the patient had. We’re using specialized instruments. These instruments go through the abdominal wall, but they actually spread the tissue. They do not cut. Uh, so the recovery tends to be extremely quick. And at the end of surgery we’re going to close all the small quarter inch and half inch incisions with Jeremiah Vaughn was to the special medical grade superglue.

Speaker 2: (04:43)

That way patients end up with no suture material in their abdomen. In other words, they go back home. That glue falls off and around seven to 10 days and no need for suture removal to the entrained diet. This looks like, well, I don’t know what it looks like, but we’re going to see a panoramic deal. This the spleen over here, you’ve got the liver up here, and this is the stomach, but he can’t really see where the stomach becomes the esophagus and goes into the diaphragm right here. This is the diaphragm. This is a flatten muscle and you can see the heart beating, uh, behind it. So what we’re going to do is we’re going to open up the hiatus. In this case, the hiatus is basically the hole where the esophagus goes through because we have to verify that there is or isn’t a hernia.

Speaker 2: (05:36)

In this case, this patient does have a hernia and it’s a large one. Again, if we don’t fix this, we’re going to have heartburn and reflux after the surgical procedure and of course that diminishes the quality of life for the patient. I’ll see you there. Hello. Okay, so this small little almost difficult to perceive fold right here is actually the scar tissue that’s left behind by the band is extremely important to remove because well, you don’t want to staple over it when performing a gastric sleeve or any other type of weight loss procedure because that could lead to a catastrophic leak. So what we’re doing right here, as you can see, we’re pulling the tissue down and pushing some other tissue up and we’re finally arriving is to the entrance of the stomach up into the chest area. This is what we call the hiatus. This is where the stomach meets the esophagus and precisely this tissue that we’re seeing right here. Those small little linear veins is exactly what the esophagus looks like. So now we can be sure that this patient had a hernia but it’s been resolved. So we pulled all of the stomach and the tissue back in place. Now the next step is once this area is revised, what we’re going to do then we’re going to remove all the scar tissue left by the band.

Speaker 2: (07:36)

Of course revision surgery is a more costly procedure since , the use of equipment tends (to be more complex) This is what we visualize right now. Again, this to the non trained eye will seem difficult to understand. What you have is a clean stomach now and it good path to staple. So now we’re going to introduce this calibration tube. We always calibrate with a 32 French bougie tube. 32 French is around 1.2 centimeters. The width of your staple across the lowest part of the stomach.

Speaker 2: (08:38)

We’re getting closer to the area where the band was sitting here and we want to be very careful about stapling and healthy tissue. Again, since we are removing part of the stomach where the scar tissue is, well, we don’t really want to remove all the scar tissue. It will be removed once we staple off, that part of the stomach. Now wer’e stapling across the area where the band used to be and my assistant is pulling the bad tissue away from the fateful line, so we’ve got a nice clean staple across healthy tissue. That is what makes for us a nice safe revision. As you can see, we can see the staple line nice and straight.

Speaker 2: (09:37)

Now that we’re stapling on healthy tissue. Again, it looks a little red, but to the trained eye, we know where healthy stomach, we removed all the potential for stapling across on healthy tissue and there you go. We’ve done our last staple and now what we’re going to do is we’re going to oversoul the staple line to reinforce it to create a leak proof seal and also a reinforce sleeve that should last the patient a lifetime. Probably one of the most important steps that is not performed frequently because probably of time issues or economics, especially in the lower price places is this over sewing of the staple line. So we’re going to use a non-absorbable material. This material is going to last in the body for basically a lifetime and as you can see the staple line is being buried or hidden under this, oversold this over sewing again does two things. It creates a leak proof seal and it also creates a strengthening of the sleeve which prevents it from failing. So this is a leak proof fail proof technique where a second over sewing permits the patient to enjoy a safe and long lived effective procedure, especially in cases such as this one where the typical leak rate is extremely high

Speaker 2: (11:50)

So we performed many of these cases a week where revising bands particularly to sleeves with extremely good results, good weight loss and we’re happy to report that we’ve never had a leak.

Speaker 2: (12:09)

And this high risk patient Mark, we’ve removed all the, the band, we’ve removed all the scar tissue, we’ve revised the hiatus, checked for hiatal hernia. And fixed it. And now what we’re going to do is we’re going to do something called a flat tire test, which is basically checked for any weeks routinely. This is done. We take our time in order to be sure that there are no leaks, that this double seal that we provided on this patient ends up with a good seal. And of course a good reinforcement of this sleeve that should be long lasting. Long lift. Perfect. Okay. So once the liquid floods the abdominal cavity, now we’re going to inflate, alright, let me stop and played. We’re blowing up air and see that in all leaks under. Okay, Lisa. No bubbles, which means that there were no leaks.

Speaker 2: (13:33)

All right, so, this was a pretty quick procedure. Again, it’s a revision surgery. There is a stepped up approach to this. So we start off by removing the band and removing all the scar tissue. We again fix the hiatus and the hiatal hernia because there’s always going to be some type of anatomical change because of the presence of that band. And we want to fix that because you don’t want reflux or heartburn after the surgery. I mean, that diminishes the quality of life. And we removed the scar tissue we were mentioning because you want to staple through healthy tissue just as we demonstrate. And then we oversew to strengthen and make it a leak proof, and of course a fail proof procedure. So the procedure is finished and around 45 minutes, patients going to go back to her room. In this case, we’re not going to use a drink. I’m going to let her recover and she’s going to be walking around maybe two hours after the procedure and we’ll discharge her tomorrow morning.

The Lap-Band System … is a much more natural, much safer way of losing weight.

– John Dixon, MBBS, PhD Expert on obesity and bariatric surgery

What are the risks and disadvantages of gastric banding surgery?

Laparoscopic gastric banding surgery comes with its own risks, just like any other surgery or medical procedure. You can greatly reduce your risk of complications by following your doctor’s pre- and post-op instructions, such as quitting smoking and exercising regularly.

Short-term complications are not common with this surgery, but the long-term complications rate is higher (Columbia Surgery). Many patients have to undergo additional surgeries (Ellsmere et al.; Seeras et al., 2020).

Some of the risks and disadvantages associated with gastric banding surgery include:

Potential Complications:

Risks of anesthesia and any surgery include nausea, vomiting, infection, blood clots that may travel to lungs, heart attack, stroke, respiratory complications, neurologic complications, hypothermia, and pain and the site of operation (Thompson et al., 2011; Sun et al., 2015). Risks and potential complications specific to laparoscopic gastric banding surgery include slipping of the stomach through the band, gastritis, infection at the port site, and scarring in the belly, which can cause bowel blockage. You may experience vomiting if you eat portions of food larger than the stomach pouch can hold.

Weight Regain:

Risks of anesthesia and any surgery include infection, blood clots that may travel to lungs, heart attack, and stroke. Risks and potential complications specific to laparoscopic gastric banding surgery include slipping of the stomach through the band, gastritis, infection at the port site, and scarring in the belly, which can cause bowel blockage. You may experience vomiting if you eat portions of food larger than the stomach pouch can hold.

Major Lifestyle Changes:

Risks of anesthesia and any surgery include infection, blood clots that may travel to lungs, heart attack, and stroke. Risks and potential complications specific to laparoscopic gastric banding surgery include slipping of the stomach through the band, gastritis, infection at the port site, and scarring in the belly, which can cause bowel blockage. You may experience vomiting if you eat portions of food larger than the stomach pouch can hold.

Weight regain

Around 40-60 percent of weight loss has been reported for this bariatric procedure. The extent of weight loss is largely dependent on how well the patient follows their doctor’s recommendations (Columbia Surgery). Your doctor or nutritionist might suggest tracking your food intake. You may need to chew food more slowly to avoid vomiting.

Major Lifestyle Changes

You may need to make substantial changes to your diet. Eating sugary or high-calorie foods may lead to weight regain. You may need to start cooking or start buying healthy foods at the grocery store. You may not be able to drink soft drinks or eat the same quantity of food as before. In addition, you will need to maintain a healthy lifestyle—this may mean starting an exercise program or reducing time spent sitting.

How can I prepare for laparoscopic gastric banding surgery?

Weight-loss surgery requires you to make lifelong commitments and healthy changes surrounding your diet and exercise regimen. Nutrition counseling and education may be offered at your weight-loss clinic so you can learn how to lead a healthy lifestyle following laparoscopic gastric banding surgery. Your bariatric surgeon will give you detailed pre-op instructions, including information on when you can eat and drink before surgery.

How to prepare for laparoscopic gastric banding:

Inform your surgeon about any medications, herbs, vitamins, supplements, and other substances you may be using, since these can interfere with anesthesia and surgery.
Start eating healthier foods to prepare your body for surgery and for life after surgery.
Start chewing and eating your food more slowly, since this is required for your smaller post-surgery stomach.
If you smoke, quit smoking at least 30 days before your gastric banding surgery, as smoking increases the risk of surgery-related complications and delays the body’s healing processes.
Start exercising regularly to lose as much excess weight as possible before surgery, which helps lower the risk of complications during surgery.
Replace unhealthy foods in your kitchen with healthy counterparts and foods approved for post-surgery eating, such as chicken broth and vegetables that can be pureed.
Prepare your bedroom or living room for post-op recovery, and place essentials nearby so you can relax without having to move around excessively.
Make childcare or pet arrangements as necessary for the days you’ll be having and recovering from your laparoscopic gastric banding surgery.

Don’t hesitate to ask your bariatric surgeon any other questions you may have about preparing for surgery, since doing so can reduce your risk of complications and promote a smooth recovery.

What happens after laparoscopic gastric banding surgery?

A key advantage of laparoscopic gastric banding is the ability to visit your bariatric surgeon any time to have the band adjusted, or “filled.” Your first band fill will take place about six weeks following surgery, after your stomach has completely healed. Following the first fill, you can have your gastric band adjusted between four and six times per year. Regular appointments with your bariatric surgeon can promote weight loss, and can help ensure the band isn’t too tight to the point it causes discomfort or interferes with your ability to perform everyday tasks. A band that is too tight can lead to excessive vomiting (Kushner et al., 2019).

Following gastric banding surgery, you’ll need to eat small portions of healthy foods that promote weight loss and overall nutrition. Eggs, beans, and fish are just some foods that can be consumed in small portions and that can help you stay full and energetic. Your bariatric surgeon will also recommend that you exercise regularly to enhance the effects of the gastric band and to keep weight off long-term after reaching your goal weight.

Keep track of the foods and portions you eat and whether they cause discomfort so you can avoid certain foods that cause negative reactions. Chew and eat your food slowly and thoroughly to avoid overeating, since your stomach pouch will be much smaller than before. Don’t hesitate to contact your bariatric surgeon if at any time you feel something is wrong with the gastric band, or you experience discomfort when eating.

Is laparoscopic gastric banding surgery right for me?

Laparoscopic gastric banding surgery may be ideal for you if your body mass index (BMI) is 40 or higher, or 35 or higher with health conditions that can be improved with weight loss, including type 2 diabetes, high blood pressure, and sleep apnea. This type of bariatric surgery is also ideal if you’re severely obese, or have tried other weight-loss methods that haven’t led to long-term results.

Use our search directory to find a bariatric surgeon near you who can help you lose weight using laparoscopic gastric banding surgery. A bariatric surgeon can determine whether you’re an ideal candidate for this procedure, or recommend other weight-loss solutions that work best for you.

Lap-Band’s drastic decline in popularity

Why you may want to consider gastric sleeve surgery instead of the Lap-Band — or even have your Lap-Band removed

Lap-Band surgery, or gastric banding, has been one of the most popular forms of weight-loss surgery since it was introduced in 2001. In recent years, however, popularity of gastric banding procedures has been sharply declining.

As more information has emerged from long-term studies, gastric banding has been revealed to be associated with serious complications that make it inferior to procedures such as gastric sleeve (O’Brien & Dixon, 2004). Many people who have had Lap-Bands placed in the past are now choosing to have them removed.

What does the new data show about Lap-Band surgery, and is it still recommended for weight loss? If you already have a Lap-Band, should you consider having it removed?

History of the Lap-Band

The Lap-Band was approved by the FDA for weight-loss surgery in 2001. Much of the appeal of the Lap-Band stemmed from 2 key features: it’s adjustable, and unlike other forms of bariatric surgery, it’s reversible.

Gastric banding is also considered a minimally invasive procedure that can be performed laparoscopically. Unlike gastric bypass or gastric sleeve, it doesn’t involve cutting into the stomach or rerouting the intestines. Micronutrient deficiencies are not common after this procedure (Kushner et al., 2020)

The ease of the procedure and claims of relative safety drew many people to gastric banding. It appeared to be a simple solution to the often-frustrating process of weight loss.

As recently as 2011, the number of Lap-Band surgeries performed was on par with gastric bypass. But recent, longer-term research has revealed that gastric banding can lead to significant complications, and that other forms of weight-loss surgery lead to better success rates and fewer complications.

The Lap-Band’s popularity has been in steady decline since 2011, and in 2018 it accounted for only 1% of weight-loss surgeries (ASMBS).

Gastric sleeve surgery is now the most popular, accounting for close to 61% of surgeries, while gastric bypass — the “gold standard” of weight-loss surgery — accounts for roughly 17%.

How weight-loss surgeries work

There are 3 primary categories of weight-loss surgery:

Restrictive procedures, which restrict how much food you can eat
Malabsorptive procedures, which change the way your body absorbs calories
Combination procedures, which have elements of both

How the Lap-Band works

Gastric banding is a restrictive procedure. The Lap-Band involves inserting a silicone band around the upper portion of the stomach to help create a feeling of fullness. The band can be “filled” or “unfilled” to help control the amount of restriction it delivers. Saline is inserted or removed through a port on the side of the abdomen to adjust the fit of the band.

How gastric sleeve works

Sleeve gastrectomy, or gastric sleeve, is also a restrictive procedure. With gastric sleeve surgery, roughly 75 percent of the stomach is removed, creating a narrow sleeve roughly the size and shape of a banana. This smaller stomach limits the amount of food that can be eaten, so patients eat less and consume fewer calories. Gastric sleeve also helps reduce food cravings and hunger, as the surgeon removes the portion of the stomach that produces ghrelin — a hormone that stimulates appetite.

How gastric bypass works

Gastric bypass is both physically restrictive and malabsorptive. The purpose of gastric bypass surgery is twofold: reduce the amount of food the patient can eat, and reduce the amount of fat and calories the body absorbs from food (Yehoshua et al., 2008; Korner & Liebel, 2003; Ionut et al., 2013).

In a gastric bypass surgery, the stomach size is reduced, and the small intestine is rerouted to bypass the lower section of the stomach and a portion of the small intestine, effectively reducing calorie absorption.

Other forms of bariatric surgery include biliopancreatic diversion and gastric balloon surgery.

The darker side of the Lap-Band

All forms of weight-loss surgery pose certain risks, but the presence of the band around the upper portion of the stomach can lead to certain risks and complications that are unique to gastric banding.

Potential side effects of the Lap-Band include:

Abdominal pain or pain when eating
Band slippage, which occurs when the band slips out of the correct place.
Band slippage can lead to complications such as vomiting, gastric perforation, and acid reflux.
Infection at the port or band site, which may require removal of the device. A new device can then be implanted to replace it.
Band intolerance, which can lead to excessive scar tissue formation and prolapse of part of the stomach, as well as nausea, vomiting, and reflux (Png et al., 2013; Gagner et al., 2013)
Band erosion, which occurs when the band erodes through the outer stomach wall.

Lap-Band patients may also require heartburn medication, which can have an effect on bone density, and they may be at risk of long-term effects of malnutrition caused by a limited diet.

Lap-Band and disordered eating

The makers of the Lap-Band claim that it encourages healthier eating habits, but does it?

Perhaps not surprisingly, the Lap-Band can contribute to disordered eating. To relieve the pressure caused by the band, some Lap-Band patients deliberately vomit after eating. Many others will continue to primarily eat high-glycemic foods such as crackers and bowls of cereal, because fiber-rich foods like raw vegetables or greens are painful to digest.

Some people will purposely keep the band overfilled to make it harder to eat, despite the pain it causes. In these cases, rather than promoting healthier habits, the device becomes a crutch that will quit working if it ever needs to be removed.

The Lap-Band and hunger

Another drawback of the Lap-Band is that it does not produce any physiological or hormonal changes that help reduce hunger. Patients still feel the same level of hunger as before, but are unable to eat as much.

People often find ways to compensate, such as drinking more calories. Lap-Band patients often learn which high-calorie foods can easily slip through the narrow stomach opening. They may respond to hunger and cravings with foods such as high-calorie milk shakes and mashed potatoes, ultimately impeding their weight-loss efforts.

Revisional surgery is common after Lap-Band

Emerging studies have shown that a number of Lap-Band patients have required additional surgeries after having their band inserted.

These additional surgeries may involve removing the band, replacing it, correcting band erosion, or a revisional surgery, which involves following the initial procedures with another type of weight-loss surgery, such as gastric bypass.

In a 2017 study that demonstrates just how problematic gastric banding can be, researchers looked at 16 years of data from 25,000 patients to determine how common additional surgeries were after the initial Lap-Band operation. They found that 20% of the Lap-Band patients required an additional operation.

That’s far higher than re-operation rates for gastric bypass and gastric sleeve, which fall between 3 and 9 percent.

Many patients had more than one follow-up surgery. In fact, the average number of surgeries per patient was 3.8 (Ibrahim et al., 2017).

Inferior weight loss compared to other surgeries

Long-term success rates with the Lap-Band are also inferior to other forms of weight-loss surgery. A 2016 study found that Lap-Band patients lost significantly less weight than those who underwent gastric sleeve or gastric bypass.

After 4 years, gastric bypass patients had lost 28 percent of their original body weight and gastric sleeve patients lost 18 percent. But Lap-Band patients lost only 10 percent.

Those numbers make it hard to justify the risks involved with gastric banding, and explain why many doctors no longer recommend gastric banding to their patients. Fewer patients are asking for the device, and fewer doctors are recommending it.

Be aware of the risks

If you’re considering Lap-Band surgery, it’s important to do your research and be aware of the potential risks and complications.

Also be aware that having the band removed could come with a hefty price tag that insurance may not cover unless it’s medically necessary.

Talk to a bariatric surgeon to determine the best approach for your unique situation. A bariatric surgeon will be able to provide you with options for safe, evidence-based weight-loss procedures designed to help you reach and maintain your goal weight.

Gastric Balloon

(Intragastric balloon weight-loss procedure)

What is a gastric balloon?

The gastric balloon is a non-surgical weight-loss procedure that reduces the size of your stomach so you can feel full while eating smaller portions and consuming fewer calories. The gastric balloon itself is a medical device inserted into the stomach via the mouth and esophagus, and then inflated to take up room in the stomach. This helps patients experience a lasting feeling of fullness after eating smaller food portions.

Many people who use the gastric balloon lose between 20 and 30 percent of their excess weight during the first six months. After the six-month mark, many gastric balloon patients go on to lose up to 51 percent of their excess weight. The gastric balloon may be right for you if you’ve tried other weight-loss programs without experiencing long-term success, and if you want an effective, proven non-surgical solution for weight loss.

Several brands are available for gastric balloons, but the brands most commonly used are the Orbera Intragastric Balloon, the ReShape Duo, the Obalon Gastric Balloon, the Spatz balloon, and the Elipse balloon (Kim et al., 2016). If you’re not sure which gastric balloon is right for you, your doctor and medical team can offer professional recommendations and help you choose a device.

What happens during the gastric balloon procedure?

Before your doctor inserts the gastric balloon into your stomach, you will be mildly sedated to reduce any related discomfort. After you are sedated, your doctor will use a thin, flexible tube called an endoscope to insert a deflated silicone balloon into your stomach via the esophagus. The endoscope has a light and camera on the end, which allows your doctor to see inside your stomach and perform the procedure safely and precisely.

After the balloon is inserted into your stomach, your doctor fills the balloon with air or a safe, sterile saline solution to inflate the balloon to roughly the size of a grapefruit. This reduces the amount of room in your stomach available for food. Some doctors use a gastric balloon pill capsule that has a fine, thin tube attached. Patients swallow the capsule, and the doctor inflates the balloon using the tube, which is then safely pulled out of the stomach via the esophagus. No sedation is necessary for the insertion of the gastric balloon in capsule pill form.

The gastric balloon procedure is performed as an outpatient service and usually takes only between 15 and 30 minutes to complete. There is no surgery involved, and no need for incisions for the placement of the balloon. Two hours after your endoscopic procedure, you can return to the comfort of your home to experience a speedy recovery.

Some balloons are also removed after a period of time. For example, the Orbera balloon is kept in place for 6 months, at which point it is removed via endoscope (Kim et al., 2016).

What are the advantages of gastric balloons?

One of the main advantages of the gastric balloon is that this procedure is non-surgical, meaning you can enjoy the benefits of having a smaller stomach without having to care for incisions, developing scars, or worrying about serious complications. This procedure can effectively complement healthy eating and regular exercise to help you achieve weight loss.

Other advantages of the gastric balloon procedure include:

The gastric balloon is a non-invasive medical procedure that does not involve incisions, the removal of tissue, or the rerouting of the digestive tract. People who have the gastric balloon procedure can reduce the size of their stomachs without anesthesia or downtime, and without facing the side effects and complications associated with surgical weight loss. Patients can return home the same day of the procedure without hospitalization.

Weight-loss surgery options like gastric bypass and sleeve gastrectomy involve the permanent removal of stomach tissue. The gastric balloon is a temporary weight-loss device that can be removed after six months or at any time per your discretion.

Fast weight loss

The gastric balloon has been shown to help people lose patients lost 6 percent of total body weight one month after balloon placement (Armijo et al., 2019). Patients ultimately lose approximately 10 percent of excess body weight (Courcoulas et al., 2017). This medical device contributes to relatively fast weight loss so you can start losing weight much sooner than with many other weight-loss methods.

Reduced risk of complications

The gastric balloon has been shown to be more effective than conventional surgical procedures and offers fewer risks. Most people who choose this weight-loss option do not experience complications. Weight-loss surgery, on the other hand, comes with risks that include infection, malnutrition, and obstruction of the bowel or stomach.

Improvements in health

In addition to helping you shed excess weight, the gastric balloon may help improve weight-related health conditions including heart disease, hypertension, type 2 diabetes, and obstructive sleep apnea. These conditions will gradually improve as you continue losing weight with the gastric balloon.

Less costly weight-loss option

The gastric balloon does not require you to undergo surgery, anesthesia, or hospitalization, and is less costly compared to many other weight-loss procedures. The cost of the gastric balloon ranges between $6,000 and $9,000, while many bariatric surgeries range between $15,000 and $25,000, or higher (NIH & NIDDK). Many weight-loss practices offer financing options to help people who want the gastric balloon and can’t pay the full cost upfront.

Educational Videos: Gastric Balloon

Video information + transcriptions below. Tap to open and read along with video.

Video Name: How Obalon™ Gastric Weight Loss Balloon Works

Video Channel: Surgical Healing Arts Center-Dr. Moses Shieh

Video Description:Surgical Healing Arts Center shows how the Obalon™ Gastric Balloon works. The Obalon™ Balloon System helps facilitate weight loss by taking up space in your stomach so you eat less. During treatment you should receive professional nutrition and exercise support to help you make the lifestyle changes that promote weight loss. The Obalon™ Balloon System supports you to help change your eating habits and keep the weight off for the long term.

WHY OBALON™?

SIMPLE CONCEPT:

The Obalon™ Balloon System helps facilitate weight loss by taking up space in your stomach so you eat less.

MEANINGFUL RESULTS:

When used with a diet and exercise program, people in the clinical trial lost twice as much weight as those with diet and exercise alone.

HELPS SUPPORT LONG LASTING RESULTS:

Average of 89% of weight loss was kept off at 1 year (6 months post-removal), when combined with a moderate intensity diet and exercise program.

QUICK PLACEMENT:

The placement of each Obalon™ balloon typically takes less than 10 minutes and doesn’t require sedation. In your physician’s office, you swallow a capsule containing a small balloon, and then your physician inflates the balloon.

LIGHTWEIGHT:

A fully inflated single balloon has a volume of 250cc, weighing approximately 3 grams (less than a penny) and about the size of a small orange. Therefore, all three balloons have a combined volume of 750cc.

Video Name: Dr. Keith Wright of South Texas Surgeons Discusses the Advantages of the Gastric Balloon

Video Channel: andrew morales

Video Description: The Orbera Gastric Balloon is a non-invasive, reversible, weight loss procedure designed for a moderate weight loss candidate. Contact Dr. Keith Wright from South Texas Surgeons to discuss which weight loss procedure may be right for you.

Video Transcription:

Dr. Keith Wright:

The gastric balloon is an inflatable device that’s implanted into the stomach without surgery. So as opposed to making incisions on the abdomen, this is placed endoscopically using a scope like we see here in the GI lab, and it looks like this. It’s a silicone balloon that’s filled with saline. It’s implanted into the stomach, endoscopically, meaning with the scope. It’s very small when we implant it and then it’s filled with the saline to expand it to about this size. And what it does is takes up space in the stomach to allow the patient to feel satisfied quicker on a small portion of food, satisfied for a longer period of time, and help curb hunger between meals. And that’s how it helps with weight loss.

Dr. Keith Wright:

So, a good candidate for the gastric balloon as someone who wishes, first of all, to avoid surgery completely, because there is no surgical incision and there’s no recovery period involved with the gastric balloon, other than just a day of sedation. So there’s no pain, as you can return to work or regular activities the following day. Also, patients that have maybe not quite as much weight to lose as someone who goes through a more aggressive surgical procedure. So I’d say on average my patients lose about 40 pounds with the balloon over about a six month period of time, and then after that period the balloon is removed, so it’s also reversible. So a good candidate would be somebody who wishes to avoid surgery, wants a reversible procedure, or wants to just kickstart their weight loss, or just has a smaller amount of weight to lose than somebody with a more aggressive procedure.

Dr. Keith Wright:

Well, the best way to get started is to call our office, South Texas Surgeons, and make an appointment with either me or Dr. Carcamo here at the NIX hospital, and we can talk about the balloon. We can also make sure that you have all of the formation that you need. There are some patients that come to me curious about the balloon, but once they find out about some of the other procedures that may have a more permanent or durable solution to their weight, they may choose one of those other procedures. It goes the other way, as well. Once people learn about surgical options, they may want to try something completely reversible and noninvasive first prior to making that step. So we’ll talk about all the options and help them make the right decision for that particular patient.

Video Name: Endoscopic Gastric Balloon for Bariatric Weight Loss

Video Channel: Mayo Clinic

Video Description: No

Video Transcription: Victoria Gomez:

My name is Victoria Gomez. I’m Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Florida. I also have a significant interest in bariatric medicine and endoscopic therapies.

Victoria Gomez:

Obesity is associated with significant health, social and economic effects. These include social bias and discrimination, increased medical costs, and increased risk of many diseases including death. We all know that achieving significant weight loss is difficult and although many weight loss options exist, including dieting and pharmaceutical drugs and surgery, it can still be difficult. Diets can be successful in the short term, but fail for many reasons. Exercise also does not always lead to weight loss, and although a growing number of pharmaceutical options exist for weight loss, these only produce a modest effect. Surgery, while the most effective approach for longterm weight loss, is not desired by all people wanting to lose significant weight for many important reasons.

Victoria Gomez:

Our team at the Mayo Clinic now offers Endoscopic Bariatric Therapies, which are weight loss therapies through the use of endoscopy. Endoscopy is a minimally invasive approach in which a flexible plastic tube with a camera and a light are placed down someone’s swallowing pipe also called the esophagus and into the stomach and intestine. Using endoscopy, one of these approved therapies that we now offer is the Intragastric Balloon. The Intragastric Balloon is placed temporarily in the stomach for six months, and it encourages portion control.

Victoria Gomez:

For more than 20 years, the global medical community has been using these gastric balloons to help thousands of people lose weight. These balloons are now FDA approved and have been evaluated in numerous studies, and have been shown to help people lose more weight, when you compare it to just diet alone. The balloon takes up about a third of the stomach and in doing so, it helps you eat smaller meals and enables you to stick to your diet. On average patients that had the balloon placed, were able to lose three times the weight, one would typically lose with just diet and exercise alone. And studies have shown that this weight loss can be maintained for a considerable period of time, once the balloon is removed.

Victoria Gomez:

Placement of the balloon is performed an our GI Endoscopy Center under sedation. We place the balloon in the stomach in a deflated state, and then we fill it with saline until it reaches the size of a grapefruit. The balloon is then deployed and sits in the stomach for up to six months. We then bring the patient back six months later to remove the balloon. This also occurs in our GI Endoscopy Center using sedation. During this procedure, we puncture the balloon with a needle, we aspirate all the salient and then we remove the deflated balloon through the mouth. This procedure also takes less than 30 minutes, and the majority of patients home the same day.

Victoria Gomez:

Evaluation for the Intragastric Balloon involves extensive and important counseling and education by your physician and multidisciplinary team. During your visits with each team member, weight loss expectations, the expected symptoms with the balloon and the risks involved with placement of the balloon will be reviewed. You will follow up with our team during regularly scheduled meetings to review and sustain healthy habits, that hopefully will allow you to keep the weight off. Additionally, as with other treatments, the Intragastric Balloon may not work for everyone, and this is an important point to make and one that would be discussed during your clinic visits.

Victoria Gomez:

Achieving a sustaining weight loss with the Intragastric Balloon or with any weight loss enhancement for that matter, can really only be accomplished with behavior modification through the support of your multidisciplinary team. To be considered for the balloon, you must have a BMI of 30 or greater, regardless of obesity related diseases such as asthma, sleep apnea, arthritis, or diabetes. Most importantly, you must be motivated and ready to make that lifestyle change. Our Mayo Clinic Bariatric Center and Department of Gastroenterology are here for you and ready to help you take that next step toward a healthier lifestyle and successful weight loss.

Video Name: Intragastric Balloon Weight Loss Procedure Video – Brigham and Women’s Hospital

Video Channel: Brigham And Women’s Hospital

Video Description: Chris Thompson, MD, Director of Therapeutic Endoscopy at Brigham and Women’s Hospital (BWH), explains the intragastric balloon procedure, an option for patients who need to lose weight due to co-morbid conditions, but whose BMI does not qualify for them for standard bariatric weight loss procedures such as a sleeve gastrectomy or gastric bypass.

These procedures are very effective in treating obesity. However, bariatric surgery is limited to patients with body (BMI) greater than 40 or greater than 35 with weight-related conditions, such as diabetes or heart disease. For obese patients who don’t meet this criteria, the intragastric balloon may be an option. Eligible patients will have a BMI between 30-40 and have had no prior stomach (gastric) surgery.

The intragastric balloon is a silicon balloon about the size of a grapefruit or a softball. The balloon is placed into the patient’s stomach through an endoscope and filled with fluid while the patient is under sedation. The minimally invasive procedure takes about15 minutes and in most cases patients will go home that same day.

Learn more about the Intragastric Balloon Procedure at Brigham and Women’s Hospital: https://www.brighamandwomens.org/medi…

Read the Intragastric Balloon video transcript: https://www.brighamandwomens.org/medi…

Video Transcription: – Speaker 1:

Obesity is an epidemic and actually it’s evolving into a global pandemic. It’s affecting many people. There’s over 200 million Americans that suffer from being overweight or obese. There has been several different options available for patients, in particular there’s diet and exercise and some medical therapy. Then at the other end of the spectrum, we have surgical therapies. There are several different types of surgery that are available. Sleeve gastrectomy procedures or adjustable gastric bands and then we have the more invasive, more serious and definitive procedures such as the Roux-en-Y gastric bypass and some of the longer limb bypass procedures.

Speaker 1:

Now they’re very effective in treating obesity. However, for patients to qualify for those procedures, they have to be very heavy, have what we call morbid obesity and most of the people we talk about don’t achieve that level of obesity or that level of illness of obesity. So most people do not actually have a surgical alternative. That’s why less than 2% of the obese population actually end up getting treated. So there are many obese people without an option. We’ve learned that there’s certain substances released from the stomach, the small bowel and the distal small bowel that are involved in appetite regulation and an insulin secretion, also in insulin resistance and how your body responds to insulin. So that has allowed us to develop targeted endoscopic therapies.

Speaker 1:

One of the devices we’re focusing on currently and we have available at Brigham and Women’s Hospital is the intragastric balloon. There are several different types of balloons available and we have one balloon here that has been widely studied and we’re now offering to patients. The intragastric balloon is a silicone balloon, it’s about the size of a grapefruit or a softball and we place it endoscopically into the patient while they’re under sedation. So they’ll go to sleep for the procedure, it takes us about 15 minutes and we go in and put the balloon into the stomach and fill it with fluid and the patient then wakes up and goes home that same day.

Speaker 1:

A candidate for this procedure would be anyone that has mild to moderate obesity. So we classify obesity based on a scale that is the body mass index. So this is someone’s weight in kilograms divided by their height in meters squared. So it was a complex formula, but anyone with a BMI of 30 to 40 would qualify for the procedure. People do not qualify for surgery if their BMI is 30 to 35 and they even need other additional illnesses to receive surgery if their BMI is from 35 to 40 such as diabetes. So this really is designed to help people that don’t yet qualify for surgery.

Speaker 1:

There have been over 220,000 procedures performed globally and the device has been available outside of the United States for the past decade and we are the first hospital in New England to offer it. Weight loss is fairly well defined. We know that in the clinical trials the United States, people can expect over a 30% excess weight loss.

Speaker 1:

The preparation before the procedure is actually quite limited. We like to see patients a couple of weeks before to describe the procedure to them in detail, let them know what they can expect afterwards. We like to start them on a medication called a proton pump inhibitor as that decreases acid secretion in the stomach and prepares the stomach to receive the balloon. Additionally, we do have them talk to nutritionists about proper dietary behavior and what the diet will look like after the procedure as well.

Speaker 1:

The recovery period is really just a couple of hours in the endoscopy recovery room and generally getting some IV fluids and anti-emetics which are antinausea medicines and the patient will then be discharged that same day. The major thing that we worry about is nausea after the procedure. We have very effective ways of dealing with that using different types of antinausea medicines. There are some dietary restrictions. For the first two days, patients will be on a full liquid diet focusing on protein shakes and similar products and then they’ll transition to a soft and back onto a regular diet. So they should be eating regularly within a week. The balloon is approved for a six month dwell time and then that program itself consists of an additional six month of a medically managed weight loss. So that’s an entire 12 month period of time.

Speaker 1:

There’s a lot of very exciting activity in bariatric endoscopy right now. So there’s many new devices on the horizon and we are participating in several trials here at Brigham and Women’s Hospital as well. As a matter of fact, some of the technologies that are now in companies have actually come from laboratories at Brigham and Women’s Hospital.

There’s no surgical incision and there’s no recovery period involved with the gastric balloon. So there’s no pain. The patient can return to work or regular activities the following day.

– Dr. Keith Wright South Texas Surgeons

What are risks associated with the gastric balloon?

As with any other medical procedure, the gastric balloon comes with its own risks and disadvantages. Take these factors into consideration when choosing the gastric balloon.

Mild pain and discomfort

You may experience mild pain and discomfort during the insertion and removal of the gastric balloon, though sedation may help reduce these feelings. Some people experience discomfort for the first few days after the procedure, accompanied by nausea and vomiting. However, these symptoms will go away on their own as your body and stomach adjust to the presence of the gastric balloon.

Potential complications

During the insertion and removal of the gastric balloon, there is a risk of perforation or bleeding in the esophagus and/or stomach. Other complications associated with the gastric balloon include abdominal or back pain, reflux, a heavy feeling in the abdomen, and indigestion. In rare instances, the gastric balloon may leak or deflate on its own. This may also happen to those who do not have their gastric balloons removed or replaced every six months.

Requires commitment and dedication

The gastric balloon can be used as a weight-loss tool, but cannot trigger significant weight loss on its own without your help, commitment, and dedication to living a healthier lifestyle. Additionally, this weight-loss procedure isn’t permanent — meaning at some point the balloon will be removed, and you’ll have to rely on optimal nutrition and physical activity to keep off the excess weight you initially lose with the gastric balloon.

How can I prepare for my gastric balloon procedure?

Prior to your gastric balloon procedure, your doctor will work with you to develop a healthy nutrition plan you must follow in order to safely facilitate weight loss using this medical device. Before your procedure, clean out your kitchen pantry and refrigerator, and stock up on healthy foods and liquids approved by your doctor.

Ask your doctor when you should stop consuming foods and liquids before the procedure, since your stomach should be completely empty for the insertion of gastric balloon. You may also want to make childcare arrangements if necessary, and arrange to be driven to and from the procedure since mild sedation and discomfort may interfere with your ability to drive safely. Your doctor will give you a detailed list of ways to prepare beforehand so you can experience a safe procedure and fast recovery.

What happens after my gastric balloon procedure?

After the insertion of the gastric balloon, you will start feeling full sooner after eating smaller amounts of food.

Following the procedure, you’ll be required to practice healthy eating habits and exercise regularly. For the first two weeks, you’ll be limited to liquids only as your stomach adjusts to the presence of the device. After two weeks, you can start eating soft, moist, pureed foods such as applesauce and ground meats. Beginning at week five and beyond, your diet should consist of a healthy balance of proteins, fruits, vegetables, and other nutritious foods that help promote weight loss.

Six months after the insertion of the gastric balloon, you must have the balloon removed to prevent the device from deflating or deteriorating while in your stomach. Prior to removal, the gastric balloon is deflated, then removed from your stomach using the same tiny endoscopic tube your doctor used for the insertion of the balloon. You may either decide to have the balloon replaced, or continue on your weight-loss journey without the balloon. Keep in mind that your stomach will return to its normal shape and size following the removal of the gastric balloon.

Am I an ideal candidate for the gastric balloon?

The gastric balloon is primarily used to help people achieve modest weight reduction, and is most ideal for people who have a body mass index (BMI) higher than 35. People who have a BMI of at least 30 may also qualify for the gastric balloon if they suffer one or more weight-related health conditions, including high blood pressure, type 2 diabetes, and sleep apnea. You may be an ideal candidate for the gastric balloon if you have a qualifying BMI, and if you have tried other weight-loss methods without experiencing long-term results.

Use our search directory to find a doctor near you who offers the gastric balloon for weight loss. A bariatric surgeon can evaluate your overall health and determine whether you can benefit from the gastric balloon or another safe, proven weight-loss procedure.

AspireAssist

What is an AspireAssist?

AspireAssist is a minimally invasive, non-permanent weight-loss procedure that reduces calorie absorption, allowing patients to lose weight and improve weight-related health conditions.

This reversible procedure is ideal for those who want to experience moderate to significant weight loss without removal of any part of the stomach or re-routing of the intestine.

Evidence shows that AspireAssist can help patients lose up to three times more weight than they can just with diet and exercise alone.

How does AspireAssist work?

AspireAssist is a system that allows you to remove 30 percent of your stomach contents after every meal to reduce the body’s calorie absorption. A small incision is made in the abdomen for the insertion of a tube and small disk-shaped valve. The tube connects the stomach to the valve, which is connected to an access port on the outside of the abdomen.

Twenty minutes after a meal, the patient connects a device to the access port and empties a portion of the stomach contents into a toilet, while the remaining food is digested normally.

This reduction in the amount of food digested can help patients lose weight at a steady, consistent pace when combined with good nutrition and regular exercise. For the AspireAssist to work optimally, you must chew your food slowly, thoroughly, and mindfully to prevent overeating, and to allow for proper digestion. Chewing food thoroughly also helps contents pass more easily into the tube for removal after you are finished eating.

This rendering provided by Aspire Bariatrics, Inc. demonstrates the use of the AspireAssist weight loss device, approved by the Food and Drug Administration on Tuesday, June 14, 2016. The AspireAssist system consists of a thin tube implanted in the stomach, connecting to an outside port on the skin of the belly, which itself is connected to an external device, which helps remove nearly a third of the food stored in the stomach before calories are absorbed into the body, causing weight loss. (Aspire Bariatrics, Inc. via AP)

What are the benefits of AspireAssist?

AspireAssist is an FDA-approved medical device for use in weight-loss treatment for patients who are 22 and older and obese. The AspireAssist offers several advantages to help you achieve your weight-loss goals.

People using AspireAssist have been shown to lose more than 12 percent of their original body weight within the first year of using the device, which is more favorable than the average 3.6 percent of body weight lost with just weight counseling on its own. Those who are severely obese may lose over 100 pounds with the AspireAssist. Results will vary based on your food choices, portion sizes, and physical activity level.

Completely reversible

This weight-loss procedure is completely reversible and does not reroute the intestines or remove a portion of the stomach. This minimally invasive surgery requires your surgeon to make one tiny cut on your abdomen for the insertion of the tube and valve. If you decide later on that you want the AspireAssist removed, your doctor can remove the tube and valve and facilitate proper healing of your stomach and abdomen.

Reinforces healthy eating

Nutrition will be more important than ever with the AspireAssist, as your body will be absorbing fewer calories. The food choices you make must be highly nutrient-dense so you can benefit from a higher level of vitamins and minerals that sustain your energy and help prevent nutrient deficiencies. The AspireAssist can help you ease into improved nutrition and food choices as you benefit from weight loss.

Educational Videos: AspireAssist

Video information + transcriptions below. Tap to open and read along with video.

Video Name: AspireAssist: Tube Placement Procedure

Video Channel: AspireAssist Weight Loss Procedure

Video Description: This video demonstrates the minimally-invasive 20-minute procedure used to place the AspireAssist A-Tube. The AspireAssist is a new method for long-term weight loss, now available in the EU, United States, and beyond.

Learn more today: aspirebariatrics.com

Video Transcription: – Speaker 1:

During this procedure your doctor will insert an endoscope through your mouth and thread it down your esophagus and into your stomach. A camera attached to the endoscope will produce images of the inside of your stomach, which will be displayed on a video monitor. Next, your doctor will insert a needle through your skin into your stomach at the location where the A-Tube is to be placed. The endoscope will be used to locate the end of the needle inside your stomach and encircle it with a wire snare. Your doctor will then pass a thin wire through this needle into your stomach. Grasp the wire with the snare and pull both the endoscope and wire out through your mouth. At this point, there will be a thin wire entering the front of your abdomen into your stomach and continuing upward and out of your mouth. Your doctor will attach the A-Tube to the wire outside of your mouth by gently tugging on the other end of the wire.

Speaker 1:

He or she will pull the tube back through your mouth and esophagus and into your stomach. Your doctor will continue to pull until the tip of the tube comes through a small one centimeter incision in your abdominal skin. A soft round bumper attached to the portion of the tube that remains inside the stomach helps secure the tube in place. Once, your skin has healed around the A-Tube the tube will be shortened to the surface of your abdomen. A small thin skin port is attached to the end of the A-Tube and will sit nearly flush against your skin. The skin port serves as a valve to open and close the tube when you aspirate your stomach contents using the Aspire assist aspiration therapy system.

Video Name: AspireAssist Procedure on Good Day Chicago

Video Channel: AspireAssist Weight Loss Procedure

Video Description: Bariatric Surgeon Vafa Shayani MD and patient Amber James discuss how this non-surgical and reversible method helped Amber lose 70 pounds.

To learn more,

visit aspirebariatrics.com.

Video Transcription: Speaker 1:

It may sound unusual, but a feeding tube is behind a new FDA approved weight loss procedure called Aspire Assist. Now this procedure helps people who are moderately to severely obese, that is. And it removes about 30% of the food from their stomach before the calories are absorbed. So how does this work? Well here to tell us more about it is bariatric surgeon, [ Wafa Shani 00:00:00:23] and weight loss patient, Amber James. Thank you so much to both of you for coming in this morning. Hey doctor, let’s start with you. So how does this work?

Speaker 2:

I think most of us are very familiar with feeding tubes being used for feeding patients. This technology allows us to use a feeding tube to empty the stomach. So imagine a patient’s consuming normal amounts of food that they’re used to, but that amount of food does not allow them to lose weight. By giving the opportunity to the patients to empty their stomach through a small button that is on the outside, you can kind of contribute to caloric reduction. So imagine a patient eating about 2000 calories in a day. By allowing a third to half of that coming out. Now their body sees actually somewhere around 12 to 1500 calories and that allows them to lose weight.

Speaker 1:

Okay, so you put a feeding tube and we have this animation, this graphic here. Okay. We talked about this before. So this is really unusual and I have to admit there is a bit of an ick factor to go with this. So why this particular technique?

Speaker 2:

You’re not the first person who’s asked that. And in fact, in our own home, my 20 year old daughter who’s a psychology student has brought that up and we’ve talked about it. At some point on our patient, Amber will talk about that, as well.

Speaker 2:

When we talk about the epidemic of obesity and the great lengths that patients go through to combat that, this is another option for patients that give them the control over what they can do to help themselves with reducing calories and weight loss. And most of the patients who do this actually love the fact that they have the control. And perhaps the most unique thing about this procedure is it takes away the element of deprivation.

Speaker 2:

Just about everything we do with our patients for weight loss comes with an element of deprivation. And patients who utilize the Aspire Assist device tell us that that element to some extent is eliminated. They’re able to enjoy the food the way they have always eaten. They do become cognizant of how much waste there might be and little by little their improve their eating habits. But all of that without feeling deprived. And I would love to hear what-

Speaker 1:

I was going to say, well Amber, let’s talk about your experience. So you’ve started this how long ago?

Speaker 3:

Three years ago.

Speaker 1:

Three years ago. And you’ve lost?

Speaker 3:

70 pounds.

Speaker 1:

70 pounds. And tell us what you think about this method.

Speaker 3:

Oh, I love this method. And it did help me learn how to eat better and make better choices. And sometimes because you have to chew and chew and chew to get the portion small enough to make it easy to aspirate. Some people would learn how to eat less automatically because they help the aspirate you have the chew and plus drink water.

Speaker 1:

Okay. Wow. Do we have the before and after picture? Did we put that up already? Let’s put that up again because … so this is a big difference. And tell me how this has affected you and changed your life.

Speaker 3:

I’m more confident now because of it. I exercise more and I learned how to eat different and make better food choices. I start eating more vegetables and it kind of helped me understand why certain foods like donuts, cookies or muffins was the bad choices and why I felt not satisfied with eating them versus if I eat like apples or pineapples or oranges.

Speaker 1:

Obviously then this is something you would recommend. So doctor, who is this particular procedure for and who should not be doing it?

Speaker 2:

Any patient who has a body mass index of 30 to 40 that’s commonly somewhere between 50 and 100 pounds overweight would benefit from an entirely nonsurgical procedure. This is done without use for general anesthesia, without making any cuts in the abdomen. Entirely reversible. And it also preserves the natural anatomy. There’s no cutting, there’s no elimination of any portion of their stomach. There’s no re-rerouting of the intestinal track. So many patients would welcome having the opportunity to lose weight with a totally reversible nonsurgical option that then can be possibly transitioned to something else, if needed.

Speaker 1:

So that’s probably why you’re going to say it’s better than a bariatric surgery or the other types of surgeries.

Speaker 2:

I wouldn’t necessarily use the word better. It’s another option and it’s different. And many patients welcome it because they feel like they’re in control.

Speaker 1:

And I think it’s interesting that both of you said you learn how to eat differently because for me, I would think, how does this teach you how to eat differently? Because you know you’re still able to eat whatever you want. So I don’t understand that part.

Speaker 2:

Well, I think a lot of my patients have told me when they see how much waste there is when they empty their stomach, it has had an impact on how much food they consume.

Speaker 1:

Which is what you said. Yeah, so, and this is one year now, FDA approved?

Speaker 2:

One year FDA approved, but has been around internationally for about three years.

Speaker 1:

Okay. Very, very interesting. And if people want more information, what should they do?

Speaker 2:

They can go on aspirebariatrics.com or in these days online, there’s lots of good from patients like Amber and other people who’ve had the experience with the procedure.

Speaker 1:

One last question. Do you still have it?

Speaker 3:

Oh yes. So I’m in maintenance mode with it.

Speaker 1:

Okay. So how long will she keep it?

Speaker 2:

This can be a permanent device. There’s no reason to think of it as temporary. So for patients who struggle with this for life, this is ideal.

Speaker 1:

Very interesting. Thanks for coming in and sharing your experience, Amber. We appreciate it. And thanks for sharing this new technique with us. So as you said another option. Okay, let’s go over …

Video Name: AspireAssist: Patient Interview (Full)

Video Channel: AspireAssist Weight Loss Procedure

Video Description: Listen to AspireAssist patient Mikael Cederhag discuss his 100-pound weight loss (over 9 months post-procedure), with this new, non-surgical weight loss solution for people with obesity. Ready to take the first step towards a healthier you?

Find a physician near you: https://www.aspirebariatrics.com/get-…

Video Transcription: – Speaker 2: (00:12)

I’ve been struggling with my weight since I was actually, since I was a kid and then I had a few years with a lot of training, so my weight was no problem for me. And, um, when I became father for the first time, my weight problem came back. And ever since I’ve, and that’s 30 years ago, I’ve been overweight, pretty much overweight, so to speak, obese. I had my, um, Castro oscopy done in July last year in 2012 and I started to use the device, uh, 1st of August, 2012. And, uh, since then I’ve actually lost 90 pounds or 40 kilos, 41 kilos actually to be exact. And just a few weeks before that I actually, um, was able to lose another 10 pounds. So all together since I decided to start the whole thing, it’s, it’s a hundred pounds. And I think, uh, I feel great about that. I love it. Uh, the biggest change in my life with this weight loss that I have, that I have had now is that actually my, my, uh, ability to, uh, play with my granddaughter.

Speaker 2: (01:33)

It’s Selma is a lot better than, than I would think of that I could do before that. She’s one and a half year now. So she’s starting to move around my, uh, my sons and my daughters also tells me that I’m, I’m able to help them a lot in their homes and, uh, to, uh, to do things with them that I couldn’t do or I could do. But it was a struggle for me before. So I’m, um, I’m a lot more movable than before and I love it. I started my exercise a few months ago with a starting to jogging and running and then I have a personal trainer I, I have had for a couple of years. And, um, when I came back after my weight loss, he couldn’t believe what he saw. So to start all over again with a new test on my, what my body looked like inside and, uh, and also what kind of program he wanted to put me on.

Speaker 2: (02:32)

So, um, we decided to go more for building up a little bit of my muscles, which I feel great about because that’s, that’s one of the, um, when you lose a lot of weight, you actually also lose some of your muscle mass and that’s something you need to take care of. And, uh, there is one huge change for me personally and that is that I don’t have to take any medications for my diabetes anymore. I don’t have to take an medications for my blood pressure, my high blood pressure that I had, uh, which is great. So I don’t actually take the medications anymore. I love that. Well, the eight two placement, uh, the, the surgical procedure was a lot easier than I thought it would be. I had, you know, a little anxiety to do that, that gastroscopy, but, uh, it turned out to be really easy to do.

Speaker 2: (03:24)

Um, on the other hand, there was a little bit more pain afterwards than I thought it would be. Um, so, um, that was a surprise to me, but it just lasts for a three or four days and then it was totally gone. So it wasn’t that much of a struggle. I was able to work, uh, I did it on the Friday, so I was able to work on Monday again. Um, I’m not sure everyone will be able to do that. It depends on what kind of work you have. Um, but um, for most people I think that that that’ll be the, the case actually. Well, when I started to, to flush and to use the device, um, I, I didn’t have any expectations. I was just curious what it would be like to do it. And, um, it, uh, it was, um, it was easier in the beginning that I thought it would be, but, uh, kind of rather quick, I, I discovered that, uh, it all came, came out on the question how much I chew my food.

Speaker 2: (04:28)

So, um, I started to, to be really, you know, eager to, to chew everything I ate and um, uh, I found out really quick that there isn’t actually anything that I can eat. I can eat vegetables and all those things that I was told to be careful about. With cauliflower and broccoli, there’s no problem for me to eat that. Even raw broccoli is okay if I chew it properly. But that also gives me another advantage because when I chew my food, it takes a lot longer for me to eat. So the signals to my brain from my stomach that I have actually eaten enough. Uh, it’s coming when I just came through the first one, third or the half of my normal portion size. So the portion size went down really quickly. It took me a few weeks to learn, not to fill my plate with a normal portion and then just leave half of it.

Speaker 2: (05:27)

So nowadays I give myself just half the normal portion I had before and I eat that than I, I feel fine with that. And then half an hour later I flush it. To use the device means that I have to first of all chew my food and it takes a little bit longer for me to eat every meal. Um, and then after that, half an hour or 20 minutes, I need to flush and it takes me in average, five to 10 minutes. Sometimes a little bit longer. Um, and I just fit that into my daily routine by, uh, just making it part of my daily routine. And, uh, with my kind of work, it’s, I don’t have any problem with it and I don’t see any problem for anyone because you really need whatever your work you do. You need to actually go to the toilet every now and then, I guess.

Speaker 2: (06:19)

So, uh, I don’t see any problem with it and I don’t know any of my friends who is on the same device that have any problem with it. Well, when I decided to do the S buyer and to, to have my, a tube installed and, and, and to walk into the program, uh, we had a lot of discussions at home about it. And, um, from the beginning, my wife didn’t want me to do it because she didn’t think I was that big and, but I was, and I told her that, that it’s totally my decision to do whatever I want. And when I then started to use it, she was really supportive about me using it and to, to all the flushing that I needed to do. And um, so we had a good cooperation with that and also in choosing food, uh, dinner and that actually was a little bit easier to flush than other things in the beginning.

Speaker 2: (07:13)

At least now I don’t have any problem with any, any food as I said. So, uh, there’s no discussion about things anymore. She saw that it really did something good for me and she wanted me to, I mean, she knew that with my overweight I was in the risk of getting a heart heart in, uh, infarction or whatever kind of all kinds of awful things happening to me. And she wanted to keep me alive for another couple of years. And she also respected my decision when I told her that if I can lose all my overweight, it might be so that I, I’m also not, I won’t need any medication for either my diabetes or my high blood pressure. And, and that was actually what happened just a few weeks into the treatment. It was really quick actually. So, um, she became very, very supportive of me doing it. And then she likes me being a little bit, look a little bit younger than before. So, and I love that too.

Speaker 2: (08:21)

This is actually not the biggest jeans I had. Um, it still is kind of impressive to see. This is the old Mike and this is the new Mike. So, um, I think you can get the picture of uh, that I can’t use this anymore than maybe two to uh, uh, scrub off some oil in my garage, but actually loved to go into a normal, uh, shop normal store and can find my sizes anywhere. And I couldn’t do that ever before ever. It was only casual XL in the U S or um, back here, draftsman Excel, which is more or less the same. Um, I hate that I hated to buy clothes and now it’s the opposite. One question that I usually get from people, my friends, and at least in the beginning was when you use the ass buyer and you start and you flush your dinner or lunch, do you get hungry immediately afterwards?

Speaker 2: (09:30)

And the answer is no, I don’t. And the reason for that is kind of a, there’s a simple explanation to it that if you chew your food and you, you, you, you give yourself the time you need to chew and eat your signals from your stomach that you have had enough and you’re, you’re satisfied hits your brain and it actually tells your brain that you, you’ve, you, you don’t need to eat anymore. And when you then empty your stomach or you take out those 30%, those signals stays in your, your brain that tells you that you’re still not hungry. I would, I would say a one, one advice that I would give to someone, uh, who is considering to do as Spire therapy is, why didn’t you do this yesterday? Because it’s, it has been such an easy trip for me and it is, uh, so easy to handle.

Speaker 2: (10:31)

And it, as I said, it doesn’t alter anything of yours. Normal social behavior, just do it. But you have to also know that if you don’t chew your food, you can’t flush. And if you can’t flush, you don’t lose any weight. It’s that simple about the whole ass buyer therapy that I went through. There are actually two parts of it that I also would like to in involve in the advice that I would give someone who is considering to start as buyer. That it, it’s not only the, the, um, physical, a tube and flushing that is essential for the success. It’s also the lifestyle counseling and, and changing your behavior of with food. And if you don’t do that, you won’t be successful. It’s that simple too. So, uh, I was fortunate enough to, to went to go through a really good lifestyle and the program and um, it changed me a lot and it also helped my family to understand what, what was essential for my, my success, longterm success with my weight loss and to keep my weight off what I learned.

Speaker 2: (11:46)

The most important thing I learned was my thinking about food and food intake. And also my thinking about do I really need to eat every time I feel sad or if I have any problems, any in my life or whatever. Uh, just like, you know, a kind of an eating disorder, eating instead of uh, just go through, um, my problems in other ways. And that is a struggle I think for many people who are obese that they, they have eating as a treat for themselves and, and the lifestyle changing program. That man I went through really gave me tools to um, to think before I opened my mouth if you want to, to structure it. It’s also about your, your way of, it’s kind of your reflect over how you think about food and, and, and how you, what kind of food you’re eating if you’re eating that crap food or if you take more vegetables and all that.

Speaker 2: (12:55)

And that’s the hardest thing because you are so into your routines about eating your lunches at, at work and what kind of breakfast you have and all that. So for myself, I actually did it the easy way out. So I started to look into my normal behavior, my normal food intake. I was lucky because I was eating a lot of good food and not that much bad food or junk food. I still do eat some junk food, but, um, I, I do think a lot more before I do it now than I did before. And now that helped me through my, that, that therapy that I went through. And, and I think really that’s something that people who wants to, to do as buyer, they also need to reflect over that. It’s not just, it’s not a quick fix to, to keep your weight off for the rest of your life is not a quick fix. It takes a lot of work, but it’s worth it every single minute of it.

Video Name: VLOG Update: Aspire Bariatrics ‘assisted bulimia’ device

Video Channel: https://www.youtube.com/watch?v=WNb6QSHKEhk&t=11s

Video Description: Controversial AspireAssist machine removes calories from the body 20 minutes after eating.

Video Transcription:

Speaker 1: (00:00)

Could you really eat your favorite fattening foods and still lose weight while a radical new device,

Speaker 2: (00:07)

A shocking new device could hold the key to consequence free indulgence, but it is not for the faint of heart. It’s a weight loss stomach pump that actually removed

Speaker 1: (00:17)

Some of the food you eat from your body.

Speaker 2: (00:20)

It turns into fat. Now there’s cringe inducing. As that might seem doesn’t work. Is it safe? Is it even right? Here’s ABC’s Juju Chang

Speaker 1: (00:30)

In the battle against obesity. It seems people will try just about anything from soup to nuts. There’s the caveman diet. You can’t eat like a Hunter and gatherer. If you’re sitting on the couch, the stomach turning roadkill diet,

Speaker 3: (00:44)

I mostly find pheasants and rabbits, squirrels and hairs and foxes and badgers blackbirds, hedgehogs, of course, then occasionally seagulls,

Speaker 1: (00:53)

You get the idea, but while prepackaged meals, I lost 40 pounds and I gained confidence or push and control regimens are good at helping people lose weight. I lost over 50 pounds on weight Watchers, most dieters overall gain it all back. It’s that yo-yo effect. That’s driving. Those who suffered from morbid obesity towards more and more radical options that often involve a scalpel. The latest less invasive approach is called aspire assist. And it’s basically a feeding tube in reverse creating an opening in your stomach requires an inpatient procedure, lot of frisk. So she’s tried and failed at seemingly every diet,

Speaker 3: (01:33)

The wrong things. I ate a lot of cookies, bread, uh, fat stuff, uh, candy. Um, well I ate fat food,

Speaker 1: (01:46)

So she took a radical step and joined a clinical trial in Sweden for the shocking new weight loss device. That’s now being tested in the U S the feeding tube in reverse, basically pumps a third of the food you’ve eaten right out of your stomach. About 20 minutes after every meal. So fewer calories are absorbed in six months. Lada has lost 76 pounds.

Speaker 3: (02:08)

It’s a big help, um, and a, a boost when you’re standing on the scale,

Speaker 1: (02:14)

But we have to warn you how it works. May be hard for some to stomach.

Speaker 2: (02:18)

In this procedure, a tube is placed into the stomach and food is drained out of the stomach. Once the food is eaten about like 20 minutes after, right? Yes, 20 minutes after someone eats about one third of the food is drained out. And as a result, it appears as though people feel full, they wind up eating less food

Speaker 1: (02:40)

To Louis aroni will be head researcher of an upcoming American clinical trial. He says that although the device is still in early testing, it seems to have long lasting effects.

Speaker 2: (02:50)

If we look at the pilot studies, the average weight loss was about 20% of total weight. That’s equivalent to lap band surgery.

Speaker 1: (03:03)

Now mind you, the lap band surgery, squeezes the stomach with a silicone band, which is not to be confused with gastric bypass, which reroutes your small intestine to a smaller stomach pouch. And of course, there’s the sleeve gastrectomy, which basically removed 85% of Melanie’s stomach. I had my surgery five months ago. I had the gastric sleeve and I’ve lost 83 pounds compared to those other forms of bariatric surgery. The aspire assist is less invasive, less costly and is not permanent, but that doesn’t make it less controversial.

Speaker 2: (03:37)

We want people to be normal. We want them to enjoy the quality of their life. We don’t want them attached to a bathroom or attached to a syringe

Speaker 1: (03:45)

To Roslyn the chief of bariatric surgery at new York’s Lenox Hill hospital. Doesn’t think the feeding tube option will be as effective in quieting. The brain’s hunger signals to the stomach. He doubts the device will work longterm like surgical methods do in changing patient’s eating habits. The researchers say, well, the initial data suggests that when you get this people eat less.

Speaker 2: (04:07)

If you continue to siphon 30% of what you eat, you will maintain the weight loss. When you stop doing it. I would bet my bottom dollar that you’re eating is actually going to increase and go beyond what you used to eat. And you’re going to gain every last pound back,

Speaker 1: (04:22)

Dr. Roney, who spent decades as a foremost, obesity researcher, respectfully disagrees are patients able to change their lifestyle when they’re able to have their cake and eat it too.

Speaker 2: (04:33)

So to speak, one of the most interesting things about the pilot studies has been that people appear to reduce their food intake and this needs further study, but it seems to help people to comply with a better diet. So it’s not like they’re cheating with a feeding tube. It’s not like they’re eating a tremendous amount of food and then they’re just draining it out.

Speaker 1: (04:55)

And then of course, there’s the added ache factor of what you need to do after every meal.

Speaker 2: (05:00)

It’s sometimes a little Jackie and smell it, but it’s nothing too. I don’t think it’s a big problem at all. I just feel that relief to, uh, to lose that food in a, one of the things though is with weight loss, what has surprised me, and it’s, it’s really, really problematic is what people will sustain in order to lose weight.

Speaker 1: (05:23)

Surprised researchers most is that one year into the U S study, 70% of the patients were pleased enough with the results that they asked to keep the two bins indefinitely patients like lotta are required to have counseling, to learn, to chew more, eat slower, and fill up on water, which may prevent them from gorging.

Speaker 2: (05:42)

I think it’s wonderful. It’s easy. And it’s no problem to flush

Speaker 1: (05:49)

So much for the X factor for not lying. I’m Juju Chang in New York.

The most unique thing about this procedure is, it takes away the element of deprivation. Patients who use the AspireAssist device tell us that they’re able to enjoy food the way they have always eaten. Little by little, they improve their eating habits without feeling deprived.

– Dr. Vafa Shayani Bariatric Institute Greater Chicago

What are the risks and drawbacks of AspireAssist?

Every weight-loss system comes with its own risks and drawbacks — especially since there is no one-size-fits-all solution that works for everyone when it comes to losing weight.

The potential risks and disadvantages associated with the AspireAssist include:

Side effects and complications

The most common side effects of the AspireAssist are skin irritation around the button site and abdominal discomfort following the procedure. Potential complications include herniation, infection, and ulceration, which may be treated using medications or by removing or replacing the tube. Though the AspireAssist is minimally invasive, this procedure may cause side effects and complications just like any other weight-loss surgery.

Time and commitment

The AspireAssist requires you to chew food into small pieces that can be aspirated in five to 10 minutes without clogging the tube. Approximately 30 percent of your stomach contents can be emptied into a toilet. People who use this weight-loss method are urged to aspirate three times per day every day, approximately 20 to 30 minutes after completing their meal, to achieve the best weight-loss results. You’ll also be required to meet with your doctor regularly for monitoring and checkups, and to discuss your weight-loss progress.

Changes to eating habits

After your AspireAssist procedure, you must chew your food slowly and carefully before swallowing to control your portion intake. You will also work with a nutrition counselor to develop a healthy meal plan that delivers an adequate amount of vitamins, minerals, and other important nutrients. Because the AspireAssist limits calorie absorption, you will need to use nutritional supplements to reduce the risk of nutritional deficiencies. You may need to modify the aspiration time depending on the type of food you consume.

Regular maintenance

As you lose weight with the AspireAssist, you must visit your doctor as often as needed to have the tube shortened, which may be inconvenient for some people. Additionally, the medical device will lock up and stop working after 115 aspiration sessions, which is normally between five and six weeks if you aspirate three times per day. This requires you to visit your doctor regularly for replacement parts. The regular maintenance involved with the AspireAssist may not work for those who have extremely busy lifestyles.

What happens during the AspireAssist procedure?

Patients are given mild anesthesia so they can be sedated for the entirety of the procedure, which takes roughly 15 minutes to complete in an outpatient setting. After you are sedated, your doctor makes a tiny incision on your abdomen for the insertion of the tube and valve that make up the AspireAssist weight-loss system. Many patients are able to return home within one to two hours following the procedure, and require very little downtime from work and other activities.

What happens after I have the AspireAssist procedure?

Chewing your food slowly and thoroughly is critical to making the AspireAssist work, since food particles must be small enough to pass through the tubing during aspiration. You must aspirate 20 to 30 minutes after every meal, three times per day, to experience the best possible weight-loss results.

The AspireAssist is combined with lifestyle counseling to help you adjust to a healthier lifestyle that involves improved nutrition, smaller portion sizes, and regular exercise. You’ll be meeting with your lifestyle counselor and doctor regularly to discuss your weight-loss goals and progress, and to make changes to your nutrition and fitness regimens as needed to promote further weight loss.

The lifestyle counseling that is paired with the AspireAssist weight-loss system can provide you with the education, support, and motivation you need to continue losing weight long after you stop using the system. Lifestyle counseling may also help you overcome certain emotional and situational triggers that can lead to overeating, such as stress and spending time around family members who demonstrate poor nutrition. Identifying and learning how to manage these triggers can help you avoid situations that lead to unhealthy food choices and overeating.

How can I make the most out of my AspireAssist procedure?

The AspireAssist may help you reach your weight-loss goals, but is not to be viewed as a cure for weight loss. To get the most out of the AspireAssist, you must stay active, exercise regularly, and make healthy food choices that drive weight loss. As you lose weight, you can reduce the number of times you aspirate per day and eventually have the device removed completely.

Use the tips provided by your doctor and lifestyle counselor to seamlessly incorporate the AspireAssist into your day-to-day routine. Having a solid routine that works great for you can make you feel more confident about using the AspireAssist for weight loss. Making regular appointments with your doctor and lifestyle counselor can help you stay motivated to maintain long-term weight loss (AspireAssist, 2016).

Am I an ideal candidate for AspireAssist?

The AspireAssist weight-loss procedure is ideal for those who are aged 22 years or older and have a body mass index (BMI) of at least 35. This weight-loss system is intended for long-term use combined with lifestyle counseling and ongoing medical monitoring, which means ideal candidates must be willing to attend regular appointments for the maintenance of the AspireAssist and to receive continuous medical care and support.

The AspireAssist may not be right for you if you have medical conditions such as anemia, blood clotting disorders, disorders that interfere with swallowing and digestion, or an eating disorder like bulimia or binge eating disorder.

Use our search directory to find a bariatric surgeon near you who can help you lose weight using the AspireAssist. A doctor can help you determine whether you’re an ideal candidate for AspireAssist or another evidence-based weight-loss procedure that can help you achieve your weight-loss goals.

Endoscopic Sleeve Gastroplasty

What is endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty is a non-surgical alternative to vertical sleeve gastrectomy. This minimally invasive weight-loss procedure reduces your stomach to the size and shape of a banana just like sleeve gastrectomy, but uses staples to reduce the size of the stomach instead of relying on tissue removal.

Endoscopic sleeve gastroplasty is ideal for those who have a BMI between 30 and 35 and who want to experience significant weight loss without surgery.

Endoscopic sleeve gastroplasty is performed as an outpatient procedure, which means you can go home the same day you have surgery. General anesthesia is used so you can remain unconscious during the procedure without feeling any pain. This weight-loss procedure usually takes roughly 45 minutes to perform, after which you will wake up in a recovery room where medical staff will check your vitals and monitor you for complications.

Your bariatric surgeon begins by inserting an endoscope into your stomach via the esophagus. The endoscope is a long, thin, flexible tube with a camera and suturing device attached. The doctor will use the endoscope to see the inside of your stomach, and to make approximately 12 sutures inside the stomach. Because the procedure is performed with an endoscope, your surgeon will not need to make incisions on your abdomen.

After your doctor has sutured your stomach, the stitches will be pulled tight to constrict the stomach and turn it into a smaller pouch roughly 30 percent of its normal size.

Endoscopic sleeve gastroplasty can help you achieve weight-loss results similar to those produced by sleeve gastrectomy, but is far less invasive in that it doesn’t involve the permanent removal of stomach tissue. This significantly reduces the risk of complications associated with bariatric surgery and shortens recovery time.

What are the advantages of endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty is a safe, effective alternative to permanent, non-reversible weight-loss surgeries such as vertical sleeve gastrectomy and gastric bypass surgery. Patients who have had endoscopic sleeve gastroplasty report that the procedure has allowed them to benefit from improved quality of life and long-term weight loss.

Advantages associated with endoscopic sleeve gastroplasty include:

Simple and minimally invasive

This gastric bypass surgery is minimally invasive and eliminates the need for incisions — meaning there will be no visible scarring. Endoscopic sleeve gastroplasty is ideal for those who want to undergo an effective weight-loss procedure that offers minimal pain and downtime, and that can be reversed at any time later down the road.

Proven weight loss

The smaller stomach pouch that results from endoscopic sleeve gastroplasty allows you to consume smaller portion sizes at each sitting. Lower caloric intake can help you lose weight — especially when you’re also eating healthy foods and staying physically active. This relatively new weight-loss procedure has been shown to help people lose more than 18 percent of their total body weight after one year after the gastric bypass surgery.

Safe and effective

Unlike surgical weight-loss procedures that come with potential risks of infection and blood clots, data on endoscopic sleeve gastroplasty show high patient survival rates and low rates of adverse events. Endoscopic sleeve gastroplasty is safer than many conventional bariatric surgeries, yet equally as effective, with weight-loss results comparable to many surgical solutions and the gastric balloon (Dayyeh et al., 2013).

Lowered risk of health problems

Obesity can increase your risk of serious medical conditions including gallbladder disease, cancer, heart disease, and stroke. Endoscopic sleeve gastroplasty can help you lose weight and lower your risk of these and other obesity-related health problems — including common comorbidities such as reflux, sleep apnea, and type 2 diabetes.

Less costly weight-loss procedure

Endoscopic sleeve gastroplasty is less costly than most other surgical weight-loss options at around $12,000 (Milton S. Hershey Medical Center). This surgery is ideal for those who don’t want to spend a high amount of money on more complex, involved procedures that require longer hospitalization, such as gastric bypass surgery, which tend to cost more than $25,000.

Educational Videos: Endoscopic Sleeve Gastroplasty Section

Video information + transcriptions below. Tap to open and read along with video.

Video Name: What is Endoscopic Sleeve Gastroplasty and How Does it Work?

Video Channel: Johns Hopkins Medicine

Video Description: Vivek Kumbhari, director of bariatric endoscopy for Johns Hopkins, answers questions about the endoscopic sleeve gastroplasty procedure, including what it involves and how it is different from weight loss surgery.

Learn more about this procedure: http://www.hopkinsmedicine.org/digest…

What is Endoscopic Sleeve Gastroplasty and How Does it Work? 0:04

What does the procedure involve? 1:28

How is the procedure different from weight loss surgery? 2:22

Who is best suited for endoscopic sleeve gastroplasty? 2:45

How much weight can you expect to lose? 3:10

Video Transcription: Vivek Kumbhari:

Bariatric surgery is the most effective method of weight loss currently. However, surgery is complex and involves an inpatient stay and there are some associated adverse events. Therefore, the endoscopic community has been trying to emulate the benefits of surgery in a minimally-invasive fashion. There is a procedure called the endoscopic sleeve gastroplasty, otherwise known as ESG, which essentially emulates what’s done during laparoscopic sleeve gastrectomy. In a sleeve gastrectomy, the volume of the stomach is reduced by approximately 70 to 80%.

Vivek Kumbhari:

Now with the new endoscopic suturing equipment, we’ve been able to also reduce the volume of the stomach by approximately 70%. This appears to be achieving excellent weight loss for patients who either don’t want surgery or are unable to have surgery. There are several reasons why we believe ESG to be effective in weight loss. Firstly, the volume of the stomach is significantly reduced and therefore patients aren’t able to eat as much as they normally would have. Secondly, there is some recent data to show that food actually empties the stomach at a far lower rate. Therefore, as it’s sitting in a stomach for longer, you tend to eat less. Lastly, and potentially most importantly, we know that the hormonal profile changes as a result of this procedure.

Vivek Kumbhari:

This animation depicts the endoscopic sleeve gastroplasty procedure. The camera is inserted into the mouth and then onwards into the stomach. The aim of this procedure is to reduce the volume of a stomach by approximately 70% in a similar fashion to a surgical sleeve gastrectomy. Initially, the front and the back walls of the stomach are marked to help us guide the placement of our sutures. Then the endoscopic suturing system is attached to the endoscope and then bites are performed. We perform a running suture pattern, which connects the front and back walls of the stomach. Then the sutures are tightened, bringing the walls together. This process is repeated from one end of the stomach to the other, reducing its volume as well as the actual length of the stomach itself.

Vivek Kumbhari:

The beauties of this procedure is that it’s purely endoscopic (i.e. it only involves a camera going into the mouth). There’s no external scars. Because it’s minimally invasive, it can be performed as an outpatient procedure. The procedure itself takes approximately 90 minutes to two hours and the recovery time is anywhere between one to three days.

Vivek Kumbhari:

ESG is most suited for patients who haven’t had the weight loss that they’ve desired with diet and lifestyle intervention or medication. It’s also very useful for patients who either don’t want to undergo surgery or don’t meet the criteria to undergo traditional bariatric surgery. In those patients who’ve had multiple surgeries or transoral options such as ESG would still be quite suitable.

Vivek Kumbhari:

There is some literature which closely examines patients in the first one year after an ESG. We know that on average patients lose approximately 50% of their excess body weight at the six-month mark, and this extends to approximately 60% of the excess body weight at the one-year mark. It’s important to keep in mind though, that in addition to weight loss, we know that patients who have an ESG procedure get an improvement in their metabolic profile so that they can have an improvement in their blood sugar, their blood pressure, as well as other conditions like mood and obstructive sleep apnea.

Video Name: Endoscopic Sleeve Gastroplasty | Christie’s Story

Video Channel: Johns Hopkins Medicine

Video Description: Christie, a young woman weighing 300 pounds, needed a change to maintain her busy job and active lifestyle. She met with gastroenterologist, Vivek Kumbhari, MD, and had an outpatient procedure called endoscopic sleeve gastroplasty that helped her lose 100 pounds.

For more information: www.hopkinsmedicine.org/weightloss

Video Transcription: – Speaker 1:

Christie is our superstar patient in that in a little over a year, she’s lost over 100 pounds, which is amazing. And she’s also been written up in her local newspaper. That’s been exciting to watch and fun to celebrate with her.

Speaker 2:

I’m proud of her and I’m excited for where she is in life now compared to where she was last year. There just is no comparison. It has been a huge change physically, emotionally, mentally, in every way that you can think of. She’s at a different place than she was last year.

Speaker 3:

I was never overweight until after college. I studied social work and then got a job as a crisis worker. So , that was a lot of instant stressful situations that I needed to manage. And a lot of times I would get off work at midnight and the only thing open would be fast food to get something to eat.

Speaker 3:

And I eventually came to the point where I was no longer able to wear normal sized clothing. I wasn’t able to even keep up walking with friends. I was out of breath. So at that point I realized that I needed to make a more drastic move.

Speaker 2:

She always said, if I could just get started, I think I can do this. She really felt pretty sure. It was just that getting started and that’s the beauty of this procedure. It gets you going.

Speaker 3:

I had an initial appointment with Dr. Kumbhari. He explained the procedure and I knew with the noninvasive aspect that that was something I really wanted to do.

Speaker 4:

So the endoscopic sleeve gastroplasty is a very nice procedure because there’s very few reasons why a patient couldn’t have it. It’s a safe procedure performed as a day only case. The patient goes to sleep, we pop a camera through the mouth, we end up placating the stomachs and take it from a bag type organ to a very narrow sleeve and so we ended up taking away approximately 70% of the stomach from exposure to food

Speaker 3:

Went in for my procedure and was wheeled out to my car by noon that day and headed home on the three hour trip back to Williamsport, Pennsylvania.

Speaker 3:

There was drastic weight loss within the first month or two I would say. And with the aftercare, that was key for me. You also have your support system of the nutritionist, the exercise specialist, a behavioral specialist and a weight loss physician. I needed the accountability of going down there and checking in, weighing in, but also to run ideas past and get ideas from them on how I could stay on track.

Speaker 5:

Try to do more strength training. Will definitely help with that.

Speaker 4:

So one of the unique features of our program is in fact that we’re not just doing clinical work, we are heavily involved in researching why people are obese. There’s lots of not only social factors, but certainly genetic and hormonal factors that precipitate someone to fall ill with this disease. And with our program, with the research we’re doing, I think we’re really able to work well with people.

Speaker 3:

I think realizing that I can find exercise that I enjoy has been the most surprising thing. Finding things that don’t feel like exercise or are with friends. That’s probably been the most surprising part of all this.

Video Name: Video Q&A about Endoscopic Sleeve Gastroplasty (ESG): What it is and What it does

Video Channel: Mayo Clinic

Video Description: Drs. Barham Abu Dayyeh and Andres Acosta, Gastroenterology and Hepatology, talk about the endoscopic sleeve gastroplasty (ESG) procedure performed at Mayo Clinic as a non-surgical intervention for weight loss.

Video Transcription:– Dr. Dayyeh:

Hello and good morning. Thank you for joining us for our Facebook Live question and answer session. My name is Dr. Barhma Abu Dayyeh and joining me is Dr. Andres Acosta. Today we are talking about endoscopic sleeve gastroplasty, what it is and what it does. Throughout the broadcast, we’ll be taking questions, so please make sure to post your questions in the comment section below. Dr Acosta, thank you for joining me. Let’s start off conversation by talking about the spectrum of obesity care in the United States.

Dr. Acosta:

Yes. Dr. Dayyeh, thank you for doing the session with me. I think it’s terrific to be here talking with you about this game changer for obesity management. When we talk about obesity management, as we can see in this slide, we have many options, many good options, actually. We have on one side of the spectrum with very low risk, things like our Mayo Clinic Diet experience or our healthy living programs, which basically focus on lifestyle and medications.

Dr. Acosta:

Then we have with a little more risk, but a little more small benefit medications, and then we go to the other spectrum bariatric surgery. Bariatric surgery, you can lose a lot of weight. It’s successful, but it comes with a lot of complications and we know as a major surgery, longterm complications, minerals and vitamin deficiencies that we have to watch for life. So what we have envisioned, and you and many others pioneer on this, is these endoscopic procedures.

Dr. Acosta:

The one that we want to talk today is the endoscopic sleeve gastropalasty and I’ll let you explain this more detail, but this procedure fills the gap between less invasive procedures with minimal [inaudible 00:01:46] benefits and more aggressive procedures in which they have a lot of benefits, but also a lot of risks. So these procedures by endoscopy, meaning no sutures, no scars, fills that gap and patients can benefit from a longterm sustained weight loss that is very less invasive. Could you tell us more? You were one of the pioneers in developing this technique. That’s now being adopted by most of the world and he’s kind of the hot thing in obesity management and we have seen great results. Could you explain to us more about this procedure?

Dr. Dayyeh:

Thank you, Andres. As you allude at this procedure was pioneered in humans at the Mayo clinic starting in 2013 with Dr. Christopher Gostout and myself and you joining us along with Dr. Kamilah Arry and the whole idea is to find a gap between nonsurgical and surgical management of obesity. This is not surgery, it’s endoscopy. That means the whole procedure is done through your mouth. It’s an outpatient procedure. The recovery period is quick and the safety margin is also very good. So that means this is a tool to allow a patient to get significant weight loss results more than diet, exercise or medications alone, but it’s less than surgical with loss, but it’s in between. And the idea is we are giving patients the opportunity to empower themselves to lose a lot of weight without all the risks that comes with surgical intervention. Therefore, the people that this should be targeting are those people who have anywhere between 10 to 50 pounds to lose.

Dr. Dayyeh:

If you have more than that, surgical options are more effective. If you have less than that, starting with lifestyle interventions alone is enough. And this is the gap that these intervention, like the endoscopic sleeve gastroplasty are filling. So let’s look at a video that we have here about the procedure to illustrate how it’s done. The procedure basically is done through the endoscope. It’s a camera that goes through the patient’s mouth and we use a new development with an endoscopy, which is a suturing machine or a sewing machine that allows us to put sutures within the gastric wall or the stomach wall and shrink the size of the stomach from a sack or a big bag to the size of a banana basically. And that does two things. One, it restricts the amount of food you could eat at one session because your stomach now is about 80 to 90 percent smaller than it was before.

Dr. Dayyeh:

And number two, it seems to delay the rate by which food is emptied. That means you could eat a small meal and that meal would last you for a longer time. So you feel satiety and you have enhanced [inaudible 00:04:31] for a longer period of time. However, we’ve been there with multiple interventions for obesity and we know that there is no cure for obesity. Like diabetes, like high blood pressure, it’s a chronic disease. And we know now, unlike before we have many tools to manage this chronic disease. We know that there is no one intervention that will cure the disease. With that in mind, what did we do at Mayo clinic to enhance the weight maintenance, which is the key component of the weight loss that comes with [crosstalk 00:05:01] the procedure?

Dr. Acosta:

Great. So exactly, the endoscopic sleeve gastroplasty is a great tool. We are having great results, but we’re a strong believer that this tool, as many others that we have here at Mayo Clinic has to come together within a multidisciplinary team. And at Mayo clinic, we are known for our collaboration and working together to serve the patient interests and the patient is the first thing that we care for. So we have worked together to put probably the best of the best team of experts in each of these areas. So we have a group of gastroenterologists such as us and advanced endoscopy that can do these procedures. We have a group of endocrinologist, experts in obesity. We have a group of dietitians, have a group of nutritionist, wellness coaches, physical therapists, exercise physiologist, bariatric surgeons and so on. We have a very multidisciplinary team. We can put up the next slide.

Dr. Acosta:

We have this, what is called the H.E.A.L.T.H. It’s healthy eating, active lifestyle through habits. What it means is that when patients come to Mayo Clinic, they meet these multidisciplinary team and they go through our healthy living program experience. We put the next slide. The healthy living program is our state-of-the-art facility, brand new, beautiful. We offer the best of the best in care. The patients will come to visit us at Mayo clinic and they go through our healthy living program. They take advantage of the healthy Mayo clinic diet, and they have a personalized healthy living program, which they have their own coach that will walk with them through this process. We introduced the tool of this sleeve gastroplasty and then we have a comprehensive evaluation, physical fitness plan, and a team of experts that will walk through this whole program with patients.

Dr. Acosta:

Because of what you well said, obesity is a chronic disease and we need to have these constant reliable tools and resources in order to be successful in the longterm. So with that said, could you explain to us a little more about this procedure? What are the expected outcomes when you adopt something like the sleeve within this multidisciplinary program? And explain to us more about the procedure itself as well as what we’re expecting within our multidisciplinary program.

Dr. Dayyeh:

I mean, we can’t emphasize that point enough, Andres. This procedure as to any other procedures is a tool. So if a patient gets this procedure, they could expect to lose anywhere between 15 to 20% of their total body weight loss within a short period of time. And within short period, I mean three to six months, they expect to see the significant weight loss.

Dr. Acosta:

So just to drop in there. So someone who comes in with around 220 pounds, we’ll do somewhere around 30 to 40 pounds.

Dr. Dayyeh:

30 to 40 sometimes 50 the [crosstalk 00:07:51] average is about 40 to 50 pounds [crosstalk 00:07:54] with this procedure. So that means in a short period of time we took somebody and we have them lose a lot of weight. They’re feeling well and now is the time to switch strategy. The strategy is you lost a lot of weight, now the fight is to keep it off. That’s why I really had to partner with the multidisciplinary program. We had to go to the health delivery program, which is a unique thing at the Mayo Clinic. It’s based on solid principle of the Mayo Clinic diet and it’s based on “not everybody is going to follow the same recommendations”. That means people have different lifestyles, they’re busy, there are different commitments. So we can’t just tell somebody, okay, now go diet and exercise. We have to coach them through the process.

Dr. Dayyeh:

And that’s what the healthy living program does. It’s personalized the maintenance plan around your schedule.

Dr. Acosta:

Correct.

Dr. Dayyeh:

So we worked with you to find that when you could exercise and work with you on how to cook, how to buy food and how to interact. So somebody who follows this principle of a weight loss procedure like the endoscopic sleeve gastroplasty lose 40 50 pounds. Now you’re feeling better. You have a coach to support you and teach you how to maintain it. They should expect to keep this weight loss off for a very long time. The key is engagement. There’s a tool to empower weight loss, but then there is a weight maintenance plan to follow. To follow with that. That being said, is this procedure for everyone, who should be considering this procedure? Could you tell us about this?

Dr. Acosta:

Yeah, so when we try to select the best candidates for the procedure it’s important that we have patients who are committed and understand that any intervention, medications, devices, this type of endoscopy procedural surgery is a tool as you well said. So the next thing to select is, we follow the criteria of body mass index or BMI. So usually we have a BMI above 30’s; is what is considered obesity in certain populations, Hispanics, Asians, 27.5 should be considered obesity. And if you have a comorbidity, you even better candidate something like hypertension, diabetes, high cholesterol. So if you have a BMI above 30 you are a good candidate for the endoscopic sleeve gastroplasty and we have had great results with that in contrary to something like surgery that you need to have a BMI above 40 or a BMI above 35 with comorbidities. So if you guys on the other side of the screen are thinking what’s my BMI?

Dr. Acosta:

It’s very easy. You can go to Mayo clinic, the webpage, and look at BMI and calculate your BMI based on your weight versus your height. And then you can see if you can qualify for a procedure of that such as this. And it turns out to be a great tool because you don’t need to be as heavy as you need to be for biotic surgery. So this can target that population that falls in, again in this gap in which they might want surgery but they don’t qualify, but they still want to lose weight because of their comorbidities or other reasons. And they’re heavier for medications.

Dr. Dayyeh:

Which fits in perfectly with the question from a viewer. Is there a weight limit on when the gastric sleeve ones work or it would become too risky? And the answer is the group of people we’re trying to target are those who have anywhere between 10 to 50 pounds to lose. That means what would put them in the category of BMI 30 to 40.

Dr. Acosta:

Correct.

Dr. Dayyeh:

Because these, we could think we with this procedure plus a healthy living plan, we could get them to a whole different class of the Avista classification. [crosstalk 00:11:25] And we think we could have an impact on health. It doesn’t become risky if we offer it to people with higher BMI but then it becomes less effective in my opinion because if you have more than 50 pounds to lose, you’re better off having one of the effective surgical options that would, that we know that would produce this type of weight loss. So to answer directly, the question is that the recommendation here for this procedure is people with body mass index between 30 to 40. If you have, if you’re on the above 40 category then our recommendation would be bariatric surgery. What do you think about these recommendations?

Dr. Acosta:

I completely agree. I think that’s a way to see what you need to gain from a procedure. And the 30-40 is probably the ideal. Another thing I can add about that is, sometimes patients who are very heavy and I don’t know, that’s where they might need a bridge procedure. And what I mean by a bridge procedure is a less aggressive procedure in which there’s minimal risks to the procedure. Like, the endoscopic sleeve gastroplasty that we’re talking about today in which is a 45 minute procedure. Outpatient procedure, is very quick and patients who are very heavy can rely on a procedure like this. Acknowledging or understanding that there’s only going to be a bridge maybe to consider another procedure down in the future such as something like surgery, but we rarely do this, this type of approach. We prefer to classify them into the BMI of 30 or 42 said and leave patients with BMI above 40 for bariatric surgery or a more aggressive interventions.

Dr. Dayyeh:

Absolutely, and that I think, you’re right. I mean a bariatric surgery is an effective and safe option for those with body mass index about 40. However, not everyone is comfortable with the concept of surgery and there’s barriers to getting surgery sometimes. Whether it’s your insurance coverage or other things, which we cannot go beyond the scope of discussing today. But for those who do not wish to proceed with bariatric surgery or it cannot get bariatric surgery the endoscopic sleeve scopic sleeve becomes an option. But we have to know that we have to be very aggressive with the lifestyle intervention around it.

Dr. Dayyeh:

So it’s not the standard option, but it’s not too risky to have it if you’re about 40 but we have to set reasonable expectations [crosstalk 00:00:13:41]. What to expect with the procedure in that group of people are or of patients with this body mass index. You do a lot of physiology. You know how we humans regulate our appetite and what happens when we are trying to diet and we know that we try to diet, we are committed to diet, but then we go on a restrictive diet. That means we’re following low calories every day and at the end of the week we’re miserably hungry and we tend to over eat and we go into this yo-yo diets that ends up with weight gain in the long term. How does procedures like the endoscopic sleeve gastroplasty work to disrupt these hunger signals?

Dr. Acosta:

You know, totally. I discussed this with my patients all the time. Well, unfortunately when we’re dieting alone, our body is kind of fighting us back. It doesn’t allow us to be successful. Why? Because of many reasons. But the most important is we have hormones such as insulin that many of you may have heard of as cortisol so there’s a hormone called ghrelin, our appetite hormone. This hormone, every time we will go into a diet goes way high. So it makes it so difficult to stick to the diet because we are starving. The hormone goes high, we’re so hungry and it’s very difficult to stick to that. Everyone is very disciplined, is trying to follow the diet. They understand they need to lose weight, they want to lose weight. They’re trying very hard, but they cannot fight our body. They cannot fight our own physiology.

Dr. Acosta:

So what we need to do is use these tools like the sleeve, that what it does when it restricts down the stomach and brings it to this banana side stomach, as you clearly mentioned, it will reduce these type of hormones such as ghrelin. And then when we try to diet, it will not go so high so we can actually stick to the diet. That’s why we call it a tool because it helps us fight back. So it produces that restriction of the stomach so we can feel fuller also with less calories. And then also delays the time of the food coming out of the stomach. And there’s data coming from your lab that delays how the food comes out of the stomach. So the food sits longer on the stomach and we feel full longer.

Dr. Acosta:

So there’s many reasons behind how exactly this works and unfortunately why diets alone don’t work. And that’s why we, as experts in the field, tend to recommend not only these tools, but many of the tools that we have available for those patients who have tried a diet and exercise program and are not being so successful. So, and that’s why I think the benefits, and you can tell us a little bit more about is what are the benefits in the longterm? What have you seen in your initial studies since you were doing this since 2012 what have you seen in the longterm when we use these types of tools?

Dr. Dayyeh:

We see good things. If the patient’s committed to the [inaudible 00:16:40] approach, we know for a fact if you have 40 to 50 pounds to lose and you lose them, your diabetes is going to significantly improve. If you’re on diabetes meds, there’s a good chance you might be off the diabetes meds. We know your high blood pressure will also improve and you could go off the high blood pressure medications. While we also know that if you are having 40 to 50 pounds to lose and you have history of diabetes, your chances in your family, your chances of developing type two diabetes is reduced by at least 80% in the coming 10 years. If you lose the weight and you keep it unfit. So there’s a lot of health benefits and we just mentioned a few here with this kind of weight loss, but the key is we’re going to partner with the patient. We, over the past three to four years, we’ve spent hours and hours and weeks developing this program. Partnering with the state of the art Dan Abraham Healthy Living Facility in order to do this combined program where we empower a patient with a procedure that produces significant and quick weight loss and gives them the tools to maintain it over the long term.

Dr. Dayyeh:

Any people who should not consider a procedure like endoscopic sleeve gastroplasty? We talked about the weight limits, but what about surgical history and stuff like that?

Dr. Acosta:

We tend to prefer to stay away from patients who have had gastric surgeries in the past. So if you had any reasons why you had a surgery in your stomach, tend not to be a good candidate. Right now it’s controversial and, and we’ll have to say as an individual basis; those patients who have large hiatal hernias or other problems in the stomach that might [inaudible 00:18:24].

Dr. Dayyeh:

Could you clarify for our viewers, what’s a hiatal hernia?

Dr. Acosta:

Yeah, I hiatal hernia is when a part of your stomach goes beyond your diaphragm muscles into your thoracic cavity and that tends to be associated with acid reflux. So when we see those type of patients, we tend to, we, but we analyze that at an individual basis based on their size of their hernia.

Dr. Dayyeh:

Some people don’t know their habits, so we’ll always look [crosstalk 00:18:44] and we make our decisions. Small ones, we could still do the procedure. Larger one, we can’t do the procedure. Now as far as recovery expectation, diet after the procedure. Any, any words of wisdom that you could give our viewers?

Dr. Acosta:

You know we see our patients every day or the day after the procedure. So just to make an emphasis, this is an outpatient procedure. So the patient comes, they come to our endoscopy unit within 45 minutes, the procedure is completed and then they go back to their home. We tend to see them the day after and the majority of our patients are doing well. Their pain is well controlled with medications.

Dr. Dayyeh:

How long does this pain after the procedure usually last?

Dr. Acosta:

Usually lasts a day to two.

Dr. Dayyeh:

Okay.

Dr. Acosta:

So it’s a quick recovery and it’s a pain that it, allows patients to be functional, allows patients to be okay, maybe a little bit of nausea that is well controlled with medications and usually, very well and safe and tolerated procedure. To the point that most of our patients within 48 hours to 72 hours are back to work so they don’t need to take a whole week. We usually, we plan to do this on Thursday or Friday so by next Monday they can return to work. So very limited need to take time out of job, which is important because most of our patients are working.

Dr. Acosta:

And then after that, the patients recover completely and what we do is we put them on a diet and that’s something we haven’t talked. We put them on a liquid diet for a whole month and there’s an important reason for that. It’s because we want them to stay on liquids in order for allowing the stomach to really form this banana sized stomach and preventing the sutures from giving up. When your initial studies with our Chris Gostout, when you went back to see it, you saw that those patients who stick to the liquid calories do the best and it’s a great way to be compliant with the diet and within a month they are back to their regular healthy diet that we, that we come up and discuss with the dieticians and the coaches. Can you tell us a little bit about the safety of this procedure in our experience as well as in others procedures experience?

Dr. Dayyeh:

Before we talk about that, there’s a question which is an important question from one of the viewers. Is this procedure and this complexity of gastroplasty the same as gastric sleeve? And thank you for the viewer who asked this question because that’s an important distinction. A gastric sleeve procedure is a surgical procedure where the surgeon uses cameras that are inserted in your abdomen in order to cut part of the stomach to create the sleeve. So it’s not the same. What we’re talking about here is an endoscopic option where there is no surgical scars or surgical incisions. We go through the mouth and we use a sewing machine in order to fold the stomach on itself in order to restrict its capacity. So at the end of the day it looks similar but they’re completely different procedures. One is surgery and the other is not surgery and one does not cut your stomach. The other cuts your stomach. So that it’s very important to keep this separate.

Dr. Acosta:

And one is inpatient and the other one is outpatient?

Dr. Dayyeh:

Absolutely. So we have a few more minutes left here. It’s worth discussing the expectation for the program. If people or viewers out there saying “this is might be appealing to me”, I would like to do it. Here again, we ask patients to prepare themselves to be in Mayo Clinic in Rochester for a whole week because we have this healthy living program and it’s almost a bootcamp.

Dr. Dayyeh:

The first two days of the program you have a full multidisciplinary team evaluation with psychology, nutrition, exercise physiology, we do some measurement on your body composition and muscle and fat. We tailor a plan of eating, a plan of buying groceries, a plan of exercising, and you leave these two full days from the Dan Abraham Healthy Living with this program. Day three, you’ll get your procedure. Day four, we see you in clinic and if everything is good we put you in touch back with your healthcare coach that’s assigned to you and off you go for the next 12 months of this intensive coaching program to help you lose the weight and then maintain it.

Dr. Dayyeh:

Okay. Any final departing words of wisdom here?

Dr. Acosta:

Well, I think on the screen you can see our phone number. If you’re interested in making an appointment, I will be happy to see you in the clinic and discuss this. We know that many people will be interested. Also invite them to visit our webpage. We have many of this information with videos and more information as well as other broadcasts that we have done and YouTube videos that has a lot more information and you can hear the comments not only from us but our patients as well as other perspectives. Yeah.

Dr. Dayyeh:

So, [inaudible 00:23:32]. That’s all we have time for today. Thank you for joining us today for our discussion about endoscopic sleeve gastroplasty. The discussion will be on Mayo clinics, YouTube channel for future viewing. If we did not get a chance to answer your question. We will try to do so after the broadcast. Thank you and have a great day. Thank you, Dr, Acosta.

Dr. Dayyeh:

Thanks, Abu Dayyeh. Pleasure to be here.

Video Name: Endoscopic Sleeve Gastroplasty – A New Weight Loss Option

Video Channel: NewYork-Presbyterian Hospital

Video Description: Drs. Reem Sharaiha and Michel Kahaleh from the Center for Advanced Digestive Care NewYork-Presbyterian/Weill Cornell Medical Center plus Dr. Louis Arrone from the Center for Weight Management at NYP explain the Endoscopic Sleeve Gastroplasty procedure.

Video Transcription: – Reem Sharaiha:

The procedure is done for people who want to lose those extra 40, 60 pounds that they’ve been trying to lose for a while. It gives them the kickstart they need to jumpstart their life.

Michel Kahaleh:

Endoscopic sleeve gastroplasty is a very interesting procedure for people that couldn’t be offered the sleeve gastroplasty before. Some people have major scarring of the abdomen, preventing any laparoscopy approach, some people have a very bad heart, or some people are extremely obese. They finally have now an option to receive the procedure completely from the inside.

Reem Sharaiha:

Basically, we constrict the stomach to make it the size of a sleeve. It’s similar to surgery, but we just do everything through the stomach in a noninvasive manner. This procedure can be reversed, repeated, and done as many times to fit the patient’s needs. We say that it’s similar to doing orthodontics, where you need to tighten braces every once in a while.

Michel Kahaleh:

We have converted a very complex procedure that used to be done surgically to an outpatient procedures that can be done in a few hours, with the patient going back home the same day.

We have converted a very complex procedure that used to be done surgically to an outpatient procedure that can be done in a few hours, with the patient going back home the same day.

– Michel Kahaleh, MD, AGAF, FACG, FASGE

What can I expect after having endoscopic sleeve gastroplasty?

Eating will be off-limits for the first eight hours following your procedure. After that, you’ll be restricted to a liquid diet to prevent nausea and vomiting, and to allow your body to adjust to its new stomach size. The liquid food phase may last one to two weeks. After the liquid phase, you can move on to eating soft, pureed foods such as mashed vegetables and applesauce. When you’ve fully recovered from endoscopic sleeve gastroplasty, you can eat solid foods just like you did prior to your procedure.

The amount of food you’ll be able to consume in one sitting will be significantly reduced after having endoscopic sleeve gastroplasty. This will lead to the absorption of fewer calories, along with weight loss.

People who undergo endoscopic sleeve gastroplasty are shown to experience an average weight loss of 18.7 percent of body weight one year following the procedure. Evidence also shows that people who have this procedure and who have a starting body mass index (BMI) of 38 can experience an average weight loss of 39 pounds after six months, and 42 pounds after 12 months. For those with a BMI of 45, weight loss is roughly 73 pounds during a six-month period.

Am I an ideal candidate for an endoscopic sleeve gastroplasty?

This stomach reduction procedure is most ideal for people who want to lose excess weight and who have a BMI greater than 30, but cannot or do not want to have weight-loss surgery. If you have a BMI of 30 or higher, are at least 18 years of age, and haven’t experienced weight-loss success with diet and exercise, then endoscopic sleeve gastroplasty may be right for you.

Having endoscopic sleeve gastroplasty requires you to participate in a medically supervised weight-loss program. This program comes with nutrition education and planning, along with a personalized weight-loss and fitness plan. You must be willing to attend regular appointments to stay on track with weight loss after having this procedure.

Endoscopic sleeve gastroplasty is not ideal for those who have a hiatal hernia that is larger than three centimeters, those who have already had stomach surgery, or those who have gastrointestinal bleeding. If you are not an ideal candidate for this procedure, talk to your doctor about alternate weight-loss options that won’t pose serious risks for your health conditions.

Use our directory to find an experienced bariatric surgeon in your area who is qualified to perform endoscopic sleeve gastroplasty. A bariatric surgeon will discuss your available options for safe, evidence-based weight-loss procedures designed to help you reach and maintain your goal weight.

vertical sleeve gastrectomy and gastric bypass surgery. Patients who have had endoscopic sleeve gastroplasty report that the procedure has allowed them to benefit from improved quality of life and long-term weight loss.

Contributing Authors

Karen Eisenbraun

Certified Holistic Nutrition Consultant

LowCarbSoul.com

Karen Eisenbraun is a certified holistic nutrition consultant and writer with a background in digital marketing. She has written extensively on the topics of nutrition and holistic health for many leading websites.

Karen received her nutrition certification from the American College of Healthcare Sciences in 2012. She follows a ketogenic diet and practices intermittent fasting. Karen advocates a whole foods approach to nutrition and believes in empowering yourself with information that allows you to make smarter decisions about your health.

Article Citations

MyBigLife.com does not provide medical advice, diagnosis or treatment for any medical condition.

If you are having a medical emergency please call 911 immediately!