Ephrata Community Hospital

Weight Loss Surgery

The term bariatric surgery comes from the Greek words meaning "weight" and "treatment". Bariatric or weight loss surgery treats people who are experiencing health problems as a direct result of excess weight when other more conventional weight-loss programs have failed. 

Goals of Surgery

The foremost goal of weight loss surgery is to improve or resolve obesity-related medical risks. The second is to prevent the development of new medical risks. Lastly, the patient's quality of life should improve as a result of significant weight loss and improvement of medical risks. The goal is to become healthy and not skinny.

How Surgery Causes Weight Loss

Weight loss surgery causes weight loss by altering the body's energy balance. Energy balance is the relationship between how much food is absorbed and how much energy the body uses. Excess energy is stored as fat and held in reserve until needed, at which time it is burned for energy. When the amount of energy expended by the body exceeds the amount of energy eaten, the fat reserves can be used to meet your body's needs. A reduction in food intake or absorption, or an increase in physical activity can therefore result in weight loss.

There are two ways that surgery can alter the energy balance:

  1. Decreasing food intake (Restriction)
  2. Decreasing food absorption (Malabsorption)

Restrictive Procedures (Laparoscopic Banding or the "Lap Band)

Restrictive weight loss surgery works by decreasing the amount of food consumed at one time. It does not interfere with the normal digestions and absorption of food. This is accomplished by creating a smaller upper stomach pouch. The pouch connects to the rest of the stomach through an outlet (soma). The smaller pouch and narrowed opening cause early fullness with smaller quantities.

After the healing and adaptation process, most patients can eat 1/2 to 1 cup of food before becoming uncomfortably full. Patients must learn to eat slowly, eat less, and avoid drinking fluids with their meals. Failure to follow these guidelines can defeat the purpose of the surgery by stretching the pouch and/or the outlet. Snacking throughout the day and drinking high-calorie liquids also reduces the effectiveness of restrictive procedures.

Restrictive & Malabsorptive Procedures (Surgical Laparoscopic "Roux-En-Y")

Malabsorptive procedures work by altering digestion, thereby causing food to be poorly digested and incompletely absorbed. This is achieved by bypassing a portion of the small intestine, limiting the absorption of calories. Because this type of surgery affects digestion, it also carries the risk of metabolic complications caused by nutritional deficiencies. The risks of complications generally increase with the lengthening of the small intestine bypass. Pure malabsorptive procedures do not restrict food intake, however, some procedures combine both restrictive and malabsorptive components.

Vertical Sleeve Gastrectomy

Vertical Sleeve gastrectomy is a purely restrictive form of weight loss surgery in which approximately three-fourths of the stomach is removed.  Unlike many other forms of bariatric surgery, the outlet valve and the nerves to the stomach remain intact, while the stomach is drastically reduced in size, its, function is preserved. Sleeve gastrectomy is not reversible.

One of the greatest advantages of the gastric sleeve is that it does not involve any bypassing or rerouting of the intestinal tract so patients have decreased risk for developing vitamin and protein deficiencies.

The vertical sleeve gastrectomy provides a solution for patients with conditions which places them at an unacceptably high risk from other forms of bariatric surgery.

See video here: Vertical Sleeve Gastrectomy  

For more information, contact the Weight Loss Clinic at 717-336-6578.