In a gastric sleeve most of the middle and left side of the main stomach is removed leaving the remainder of the right side as a narrow vertical tube or “sleeve” which retains its normal connection to the esophagus above and the small intestine below. This results in both restriction in the amount of food able to be eaten as well as significant metabolic and gut hormone changes, which are very effective for weight loss.
Weight loss can be expected to be nearly as much, to slightly less than, that seen with a gastric bypass surgery. The sleeve permanently reduces the size of the stomach, and while it can be converted into a gastric bypass later, it can not be reversed back to normal anatomy. The sleeve does not involve cutting or sewing the small intestine and therefore minimizes potential future complications with the intestines or ulcers.
Roux-en-Y Gastric Bypass
In a gastric bypass surgery the upper portion of your own natural stomach tissue is separated from the main stomach to form a thumb-sized pouch. This pouch retains its normal connection to the esophagus (the food tube leading down to the stomach from the throat). The intestines are then surgically divided and one part is connected to the bottom of the pouch, so that your food can pass down into the intestines for digestion where it belongs. The leftover main stomach is bypassed away from the food stream and its outlet is reconnected to the main intestines below in a “Y” shaped connection to allow important digestive enzymes to mix with the food stream.
The gastric bypass results in excellent, fairly rapid weight loss by reducing the amount of food able to be eaten as well as producing significant metabolic and gut hormones changes which are very effective for weight loss.
In a laparoscopic adjustable gastric band surgery, a soft silicone tubular ring (band), like an inner tube, is placed around the very top of the stomach. This produces smaller portion control and can promote a feeling of fullness. This surgery allows slower, gradual weight loss over time to a lesser amount than the bypass or sleeve surgeries. The band is connected inside the body to a tube leading to a raised, disc-like port surgically placed under the skin of your abdomen. This allows the surgeon to adjust the band and make it tighter or looser by sticking a needle through the skin into the port and adjusting the amount of a fluid inside the “inner tube” of the band. The band requires adjustment multiple times throughout your life to work. The band can be removed surgically.
Revision Bariatric Surgery
Revision surgery is more complicated and involves converting someone who has already had a previous weight loss surgery into another form of weight loss surgery with the goal of achieving better results.
The most common revision operation we perform is converting an old failed stomach stapling (vertical banded gastroplasty) or a failed lap band into a gastric bypass or sleeve surgery. Though revision surgery is more risky, good results can often be achieved. Dr. Lourié often uses robotics for complicated gastric bariatric revision surgeries.