Seton Weight Management

The right surgery for you

Bariatric surgery can work in two different ways to help patients lose weight and improve weight-related conditions:

• Malabsorption: This changes the way food travels through the patient's body in order to limit the body's ability to absorb calories and nutrients from food.
• Restriction: This changes the body in order to limit the amount of food the patient can eat.

Seton offers four types of surgical procedures for weight-loss

Roux-en-Y Gastric Bypass Surgery (RNY)

This procedure uses both malabsorption and restriction to promote weight loss. The surgery reduces the size of the stomach from the size of a melon to the size of an egg, restricting the amount of food the patient can eat. It also alters the length of the small intestine, reducing the amount of calories and nutrients the patient's body can absorb.

What you need to know about RNY:

• It's considered the "gold standard" of weight-loss surgery, and has been tested successfully over time.
• It's a complex surgery and not easily reversible.
• Patients typically experience the greatest weight loss during the first 3-12 months post-op.
• It creates deficiencies in vitamin and mineral absorption, so patients must fortify their diet with supplements over the long term.
• It leaves no significant hardware within the patient's body.

Laparoscopic Adjustable Banding Procedure (Lap Band)

This procedure uses only restriction to promote weight loss. The surgery places a band around the top part of the patient's stomach, creating a smaller upper stomach and a larger lower stomach. The band is adjustable (by the surgeon) to let food pass from the upper to the lower stomach at a slower or faster rate, depending upon patient need. The band typically requires 5-6 adjustments within the first year post-op in order to maintain steady weight loss.

What you need to know about Lap Band:

• It involves newer technology, but is a less technical surgery and more easily reversed.
• Patients typically experience more gradual weight loss (1-2 lbs./week), eventually reaching a total loss similar to Roux-En-Y (2 years post-op).
• It can create vitamin and mineral deficiencies, so supplementation is advised.
• It leaves implant material within the patient's body.

Gastric Sleeve

This is a restrictive type of weight-loss surgery that permanently reduces the size of the stomach and controls hunger by removing the part of the stomach that produces the hunger-stimulating hormone Ghrelin. Traditionally the gastric sleeve procedure has been performed as the first part of a two-stage operation, to be followed up by a second procedure such as gastric bypass. In recent years, many bariatric surgeons have begun to perform gastric sleeve surgery as a stand-alone weight-loss procedure.

What you need to know about Gastric Sleeve:

• Overall it is a less complicated operation than gastric bypass.
• It doesn't involve implanting a medical device such as an adjustable band.
• It requires radical changes in the patient's post-operative eating habits.
• It's available to patients who are too heavy for other weight-loss procedures.
• It may not be covered by some insurance plans.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

This procedure is one of the most complex, and represents less than 5% of the weight-loss procedures performed in the U.S., yet is popular with patients because it delivers the best reported long-term percentage of excess weight loss. It combines a reduction of the stomach with a re-routing of a portion of the small intestine, and is primarily reserved for patients with a higher BMI. Seton Austin is one of the few hospitals in Texas that offers this procedure utilizing the laparoscopic approach.

What you need to know about Duodenal Switch:

• The BPD/DS procedure is irreversible.
• Some patients have achieved 80-90% excess weight loss after three years.
• Patients are able to eat larger meals than those allowed with the gastric bypass.
• It requires lifelong monitoring for protein malnutrition and vitamin supplementation.
• It may result in increased risk of gallstone formation and/or intestinal irritation.

As with any major surgery, these procedures can present immediate and long-term complications and risks. Talk with your health care team about the risks associated with the procedure you choose.