Stomach Stapling vs. Gastric Bypass
Stomach Stapling (Vertical Banded Gastrectomy)
Vertical banded gastrectomy is one of the oldest forms of surgery for weight loss. It is used to limit the amount of food that can be eaten. It does not alter any part of the digestive process, and none of the stomach is removed. During this procedure, the upper part of the stomach near the esophagus is stapled vertically. This creates a small pouch. The rest of the stomach is then banded, leaving a small opening at the bottom of the small pouch, which opens into the larger portion of the stomach. A mesh or plastic tissue is placed around the small opening to prevent stretching. This process is known as a restrictive surgery because it limits the amount of food that can be consumed at one time, which causes patients to feel fuller faster. After surgery, most meals must be limited to approximately one ounce. This surgery does not typically cause malnutrition or dumping syndrome. The entire procedure typically lasts between 3 and 4 hours. Vertical banded gastrectomy surgery is reversible, but the procedure to do so is quite complex.
In general, candidates for this procedure will either have a BMI over 40 or a BMI between 35 and 40 plus weight-related health problems. Women who are 80 pounds over their goal weight and men who are 100 pounds over their goal weight are also good candidates for this surgery.
Average Weight Loss Results
On average, most patients are able to lose approximately 50 to 60 percent of their excess body weight after one year. Weight gain can happen easily if the patient does not adhere to consuming very small portions of food and drinks.
If the surgery is performed laparoscopically, the patient will need to remain in the hospital for 2 or 3 days. If it is performed in an open surgery, then the hospital stay is longer, usually 4 or 5 days. Patients will initially need to follow a liquid diet and gradually move onto thicker liquids and soft foods. After about one month, most patients are able to eat solid foods and return to normal activities.
Common Side Effects
Patients may experience side effects such as reflux, stomal stenosis, incisional hernia, staple-line disruption, intolerance to the band, gastric leak, bleeding, fistulas, pulmonary embolus, and peritonitis. More commonly, side effects such as vomiting can occur if a strict diet is not followed, if food is not chewed properly, or if food is eaten too quickly.
The average cost of this procedure is $20,000 to $25,000. Insurance may cover a portion of the cost.\
Gastric Bypass (Roux-En-Y)
Gastric bypass surgery is sometimes completed laparoscopically. It typically takes several hours. During the procedure, the surgeon will staple off the upper section of the stomach so it is just a small pouch, about the size of an egg. This pouch is then attached to a part of the small intestine called the Roux limb. This forms a “Y” shape, which is why this procedure is often referred to as Roux-en-Y. This not only reduces the amount of food the patient can consume, it also forces the food to bypass the rest of the stomach and the upper part of the small intestine. After the procedure, the amount of fat and calories that is absorbed from food is reduced and so is the amount of vitamins and minerals. Dramatic weight loss is common after this procedure, and it can also help to reduce or eliminate other health-related problems, such as heartburn, reflux, and other conditions that are common in overweight individuals.
The ideal candidate will have a BMI over 40 or a BMI between 35 and 40 and a weight-related health condition, such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes.
Average Weight Loss Results
The amount of weight loss depends upon the patient’s adherence to diet and lifestyle changes, but on average, people will lose about 100 pounds after gastric bypass surgery. Weight loss typically happens fairly quickly. One year after the surgery, weight loss stops and a patient’s weight stabilizes. At this time, it is very important to maintain healthy eating and exercise habits in order to not regain the weight that was lost.
Patients are often required to stay in the hospital for a day or two after surgery. An all-liquid diet is required during the first week or two; soft foods are then slowly added into the patient’s diet, and within a month of surgery, regular food can be consumed. Normal activities can also typically be resumed at this time.
Common Side Effects
Patients may experience body aches, dry skin, mood changes, temporary hair thinning, tiredness, and feeling cold during the first year following surgery. This is due to the rapid weight loss. Once the weight loss stops, these symptoms usually go away.
Some insurances will cover part of the cost of gastric bypass surgery. In the US costs range anywhere between $8,000 and $27,000 without insurance.