Dr. Machado is a very experienced bariatric surgeon who approaches each patient individually. Not every patient is the same, and therefore not a single procedure is the best for everyone. Dr. Machado has helped patients achieve success with all of the procedures. It is important to approach the decision process with an open mind and understand what tool you require to help you achieve your health and weight loss goals.
Bariatric surgery is a tool, choose the right tool for you!
Gastric Bypass (or Roux-en-Y Gastric Bypass)
Gastric bypass (or Roux-en-Y Gastric Bypass) provides:
- Fullness with much smaller meals (restriction)
- Improved metabolism
- Consequences if sugars or fatty foods are eaten
- Decreased hunger and cravings
- Remission of diabetes in the majority of patients (80-85%)
Gastric bypass surgery is considered the gold standard procedure for a reason, it works! The gastric bypass procedure is best described as metabolic NOT malabsorptive. Gastric bypass combines changes in stomach size with changes in intestinal absorption that result in efficient and safe weight loss. The operation involves essentially rearranging the anatomy that results in a number of internal changes that correct what has become dysfunctional with the disease of obesity. Combined with the appropriate diet, behaviors, and supplements, patients have an effective tool that results in very efficient weight loss and improved health.
Gastric bypass involves creating a small stomach pouch (less than one ounce) that will limit meal size. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the intestine, thus bypassing some calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the “Y” shape that gives the technique its name. The length of either segment of the intestine can be modified to produce lower or higher hormonal effects. Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
- The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures (Gastric Sleeve or Lap-band®).
- One year after surgery, weight loss can average 77% of excess body weight.
- May lead to conditions that increase energy expenditure (metabolism)
- Produces favorable changes in gut hormones that reduce appetite and enhance satiety
- Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
- A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.
- Long-term success is improved when patients remain active in a comprehensive bariatric program.
- Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia.
- Vitamin supplements are required to prevent deficiencies of iron, folate, calcium, vitamin B12, and thiamine.
- Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.
- All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
- A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
- The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.
Sleeve Gastrectomy provides:
- Restriction of meal size
- Decreased hunger and cravings
- Keeps the surgery isolated to the stomach
The Laparoscopic Vertical Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80-85 percent of the stomach. The remaining stomach is a long, narrow tubular pouch that significantly reduces the volume of food that can be consumed, while still allowing the stomach to function normally.
This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that affect hunger, satiety, and blood sugar control. The part of the stomach that is removed drastically reduces the production of Ghrelin, one of the major hunger hormones.
Short term studies show that the sleeve may approach the gastric bypass in terms of weight loss and improvement or remission of diabetes. However, there is great variability in how this procedure is performed and it can be associated with a higher risk of healing complications. Although the procedure appears relatively simple, there are a number of complex factors involved to perform this procedure effectively and safely. Dr. Machado learned her technique from one of the most experienced Sleeve surgeons in the country to assure her patients receive the best surgery possible with the lowest postoperative risks.
- Restricts the amount of food the stomach can hold
- Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass.
- Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety
- No dumping syndrome because the pylorus is preserved.
- Minimizes the potential for ulcer, so the use anti-inflammatory drugs such as aspirin, Motrin, Aleve and ibuprofen are not problematic (great procedure for those with arthritis, joint pain or migraine headaches).
- No intestinal bypass and therefore little or no chance of nutritional and vitamin deficiencies
- Most patients with BMI between 35-50 kg/M2 achieve their goal weight within 12 months following surgery.
- Is a non-reversible procedure
- Has the potential for long-term vitamin deficiencies
- Has a higher early complication rate
Laparoscopic Adjustable Gastric Band
- Reduction in portion size
- Control of hunger
- No changes in anatomy and completely reversible
The Lap-Band® procedure involves placing an adjustable ring or band around the upper portion of the stomach. The band is adjusted to control hunger and help patients feel full longer with smaller meal portions. The band is the least invasive bariatric procedure than involves an implant or foreign body, rather than anatomical changes.
Controlling hunger is created gradually with adjustments or “fills.” The notion that the band is a restrictive procedure (works by restricting how much food can be consumed per meal and by restricting the emptying of the food through the band) has been challenged by studies that show the food passes rather quickly through the band, and that absence of hunger or feeling of being satisfied was not related to food remaining in the pouch above the band. What is known is that there is no malabsorption; the food is digested and absorbed as it would be normally.
The clinical impact of the band seems to be that it reduces hunger, which helps the patients to decrease the amount of calories that are consumed. It is important to understand that the band is expected to be a more gradual method to assist patients with weight loss, but when used correctly can be just as effective as other weight loss procedures. Dr. Machado had performed nearly 1000 Lap-band procedures and understands how to effectively utilize this tool to maximize a patient’s success.
- Reduces the amount of food the stomach can hold
- Induces excess weight loss more gradually
- Involves no cutting of the stomach or rerouting of the intestines
- Outpatient surgery
- Reversible and Adjustable
- Has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures
- Has the lowest risk for vitamin/mineral deficiencies
- Slower and less early weight loss than other surgical procedures
- Requires a foreign device to remain in the body
- Mechanical problems with band position or system function can occur in a small percentage of patients.
- Can result in vomiting if the patient overeats or the band is over tightened
- Requires strict adherence to the postoperative diet and to postoperative follow-up visits
Revisional Bariatric Surgery
Dr. Machado is certainly one of the most experienced surgeons in the region when it comes to revisions. Revisional bariatric surgery requires careful evaluation and is approached on an individual basis. The first consideration is evaluation of the procedure that was initially performed and its integrity. Secondly, is an evaluation of how that procedure is or is not functioning. As surgery advances, we learn about improved techniques and methods that may bring further benefit to an individual patient. At times, patients may feel that their surgery ‘changed’ over the years. Dr. Machado is happy to assist you in evaluating your potential indications for a revision.
Sacramento Bariatric Medical Associates is happy to provide long-term postoperative care to patients, regardless of where their surgery was performed. Often patients change insurance carriers or relocate which can provide barriers to their long-term support and care. It is critical to all patients to have the specialty care and expertise of a comprehensive bariatric program.
To learn more, join Dr. Machado for a free informational seminar or call our office at 916-338-7200. Click here to contact our office.