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The Procedure

How Weight Loss Surgery Works

How Does Bariatric Surgery Work?

There are two basic ways that bariatric surgery works to help patients lose weight and improve or resolve co-morbidities: One way is malabsorption and the other is restriction. The most common bariatric surgery performed today, Roux-en-Y gastric bypass surgery, uses both.

1. Restrictive procedures limit food intake

Procedures that use restriction limit the amount of food patients can eat. This is accomplished surgically by creating a small stomach pouch. When eating, the pouch fills quickly and gives a feeling of fullness much sooner. Because patients feel satisfied and full sooner, they eat less. Laparoscopic adjustable gastric banding uses food restriction.

2. Malabsorptive procedures alter digestion:

Procedures that use malabsorption change the body’s ability to absorb calories and nutrients from food. The surgeon changes the way food travels through the patient’s system. By rerouting food past a large part of the stomach and a portion of the small intestine, much of the calories and nutrients pass through without being absorbed.
Both methods work to help patients lose excess weight, lower their BMI, and transform their health by resolving or improving co-morbidities. Bariatric surgery has many benefits that can lead to a healthier, higher quality of life, but also has certain risks. Roux-en-Y gastric bypass surgery uses both restriction and malabsorption to achieve weight loss.

Approaches to Surgery: Open Versus Minimally Invasive Surgery

Bariatric surgery has been performed for many decades. For many of those years, the surgery was performed as an open procedure. An open procedure means a surgeon creates a long incision, or cut, opening up the patient. As medical technology evolved, laparoscopic or minimally invasive surgery became a possibility. With laparoscopic surgery, the surgeon creates small incisions. Both approaches have similar success rates in reducing excess weight and improving or resolving co-morbidities.24,25

Most surgeons will perform bariatric surgery using the laparoscopic method. However, this is a decision that the doctor and patient must make together. An important question for patients to ask is: How many minimally invasive versus open procedures has the surgeon performed? Read below to learn more about both procedures.

Open Surgery

Open surgery involves the surgeon creating a long incision line to open the abdomen and operating with "traditional” medical instruments. Because of the incision, the patient’s stay in the hospital will be several days longer than with minimally invasive surgery. The recovery time is also longer. Patients generally will need to heal for several weeks before returning to work and regular physical activities. With a longer wound, there is more of a chance of wound complications such as infections and hernias. A long incision leads to a long scar. In some cases, the open method is necessary due to some patient-specific risks.

Laparoscopic or Minimally Invasive Surgery

A laparoscopic operation involves making several small incisions for different medical devices to be used. There are, on average, four to six ports created. The devices, including a small video camera, are inserted through the ports. The surgeon uses a monitor to perform the procedure. Most laparoscopic surgeons believe this gives them a good view and access to key body parts. Many patients are able to recover from the surgery in a shorter time than open procedures require. In fact, some return to work in little more than a week, and many are able to quickly return to physical activity. Patients generally have very small scars. There is also a lower chance of wound complications such as infection and hernia.

Your Next Step

Laparoscopic and open procedures for bariatric surgery both produce similar weight loss. However, not all patients are candidates for the laparoscopic approach, just as all bariatric surgeons are not trained to perform this less-invasive method. The American Society for Bariatric Surgery recommends that laparoscopic bariatric surgery should be performed only by surgeons who are experienced in both laparoscopic and open bariatric procedures.

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