Bariatric Surgery for Obesity

Sleeve gastrectomy, in which surgeons reduce stomach volume, helps people feel full after eating only a small amount of food. It can help patients lose an average of 50 percent to 60 percent of their excess weight.

In this procedure, the surgeon removes 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 banana. The new stomach holds less food and liquid to restrict the calories you consume at any given time.

Sleeve gastrectomy can also decrease your hunger drive. The portion of the stomach removed during a sleeve gastrectomy contains ghrelin, an appetite-stimulating hormone. With less ghrelin, you may feel less hungry.

Surgery usually takes 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 is effective in achieving and maintaining significant weight loss. It can help you lose an average of 70 to 75 percent of excess body weight.

During the procedure, a surgeon creates a small pouch at the top of the stomach by separating the upper portion of the stomach from the lower portion. This pouch, which becomes the “new” stomach, limits the amount of food you can consume. The pouch is connected to the small intestine through two openings that redirect food to a lower part of the digestive system. Gastric bypass results in food bypassing the lower stomach as well as the first and the second sections of the small intestine. It provides two ways to lose excess weight—by restricting the amount of food you can consume and by allowing you to absorb fewer calories.

Gastric bypass surgery is typically completed in two hours, and patients stay overnight 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 smaller amount of food you can consume after the procedure, it is essential to take multivitamins and to follow up with your doctor to prevent vitamin deficiencies.

Gastric bypass is an 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 the hormones PYY and GLP-1, which are made in the intestines and help regulate insulin, blood sugar, and feelings of hunger and fullness. These changes can make it harder to lose weight. Still, even small weight changes can add up to big health gains. Losing just 5 percent of excess weight in people who are obese can help manage diabetes and prevent complications. More significant weight loss may be able to help reverse the condition.

Single anastomosis duodenal–ileal bypass with sleeve gastrectomy, or SADI-S, can be highly effective for long-term excess-weight loss and remission of type 2 diabetes. SADI-S shortens the route digested food travels, allowing it to bypass more than half the small intestine; it therefore limits the calories absorbed. It can be an excellent option for someone who has had sleeve gastrectomy and who would like to lose more excess weight.

The operation starts the same way as the sleeve gastrectomy: The surgeon makes the stomach smaller, leaving a tube-shaped stomach, and then creates a bypass through one connection to the intestine. Food goes through the pouch and directly into the latter portion of the small intestine. Like other forms of weight loss surgery, SADI-S also rewires how the gut signals the brain, triggering hormonal changes that curb hunger.

After surgery, patients should follow a high-protein diet and take multivitamins to make sure they get adequate nutrition.

One-anastomosis gastric bypass (OABG), also known as mini gastric bypass, is similar to a traditional gastric bypass, but it creates only one new intestinal connection instead of two. As a first step, the surgeon divides the stomach to create a small pouch that functions as the new stomach. Next, the surgeon connects a loop of bowel to the stomach pouch so that food is rerouted to a lower part of the small intestine, to limit the absorption of food and calories.

Like SADI-S, OABG may be a good option for someone who wants to lose more excess weight after sleeve gastrectomy for long-term weight loss.

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.

Please note that Lap-Band surgery is performed at NYU Langone’s Tisch Hospital through our Weight Management Program—Manhattan.

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, meaning sterile 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 can return for monthly for the first year of follow-up visits.

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 in the long term.

Your NYU Langone doctor and registered dietitian 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.