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Bariatric Surgery for Obesity

Doctors at NYU Langone’s Weight Management Program and Weight Management Program at NYU Langone Hospital—Brooklyn may recommend bariatric, or weight loss, surgery for people with severe obesity—defined as having a body mass index (BMI) of 40 or greater. Surgery may also be recommended for people who have a BMI of 35 to 39 and a medical condition associated with weight, such as type 2 diabetes, high blood pressure, coronary artery disease, obstructive sleep apnea, hyperlipidemia, or nonalcoholic fatty liver disease.

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By helping people to achieve substantial weight loss, bariatric surgery can help prevent, slow the progression of, or even reverse certain obesity-related conditions, such as type 2 diabetes, obstructive sleep apnea, and coronary artery disease.

Bariatric Surgery

At NYU Langone, our bariatric surgeons perform several different procedures that can help people restrict portion size, decrease their hunger, and limit the calories they absorb from food. These procedures are recommended for people who need to lose around half of their body weight.

Our surgeons perform these procedures in the operating room, using general anesthesia. They specialize in minimally invasive robotic and laparoscopic techniques, which involve small incisions and reduce recovery time. Doctors at NYU Langone also offer a nonsurgical procedure, the gastric balloon, which does not require general anesthesia, or a hospital stay.

Laparoscopic Adjustable Gastric Banding

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

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

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 To do this, saline, or salt water, is either injected or withdrawn through the port.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

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

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

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

Sleeve Gastrectomy

Sleeve gastrectomy is another surgical approach that helps a person to feel full after eating a small amount of food. This surgery is recommended for people who cannot return for monthly follow-up visits to adjust the position of a Lap-Band or who have other conditions that require them to swallow large pills.

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

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

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

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

Gastric Bypass Surgery

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

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

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

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

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

Gastric Balloon

An intragastric balloon system, also known as a gastric balloon, is a temporary device placed in the stomach to reduce space, which helps you feel full. It is recommended for people who need to lose an average of 20 to 40 pounds.

During this short procedure, a surgeon uses a thin, flexible endoscope—a device with a camera and light at the end—to place the balloon into the stomach through the mouth. When the gastric balloon is in place, it is filled with saline, or salt water, so that it expands into a spherical shape.

You are sedated for the nonsurgical procedure, which takes about 20 minutes to perform. Most people are able to go home after a few hours of observation. NYU Langone doctors recommend taking one or two days off from work after the procedure, as many people experience side effects such as abdominal discomfort, nausea, and vomiting during this time. Your doctor provides you with medications to help alleviate these temporary symptoms.

The gastric balloon is left in place for up to six months, during which time your doctors closely monitor you for weight loss and any other side effects. After the device is removed, you continue to work with specialists in NYU Langone’s Weight Management Program or Weight Management Program at NYU Langone Hospital—Brooklyn for an additional six months to ensure that you have established a healthy lifestyle, which includes eating a healthy diet and exercising. It is possible to have the balloon placed again in the future.

What to Expect After Bariatric Surgery

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

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

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

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

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