Types of Surgery

• Open surgery requires a large abdominal incision and may require revisional operations
• Open surgery wound infection and hernia rates are as high as 30 percent
• Laparoscopic surgery offers better wound healing with more cosmetically appealing results
• Laparoscopic surgery is less painful and allows for an earlier return to usual activity
• In laparoscopic surgery, the surgeon has a better view of abdominal anatomy
• Shorter hospital stay

Types of Laparoscopic Surgery

Gastric bypass
A small gastric pouch is created with stapling devices.

• Benefits:
  - 75 to 80 percent of patients lose at least 50 percent of their excess weight
  - Weight loss is sustainable with proper patient selection and follow-up
• Risks:
  - Major complications include leaking, hemorrhaging and obstruction
  - Mortality is 0.5 percent (1/200)
  - Morbidity is 10 percent
  - Anastomotic leaks are 4.4 percent
  - Jejunojejunostomy obstruction is 1.5 percent
  - Bleeding is 3.3 percent
  - Pulmonary embolism is 0.7 percent
  - Weight loss is predominantly due to nutrient restriction but may also be influenced by other factors, such as:
        Mild malabsorption
        Dumping syndrome
        Food intolerances
        Hormonal changes (ghrelin)
        75 to 80 percent of patients lose at least 50 percent of their excess weight- Weight loss is sustainable with proper patient selection and follow-up

Adjustable Gastric Banding
A silicone band is placed around the upper stomach to create a small pouch. The diameter of the outlet can be changed by infusing or withdrawing saline from the port. This is a purely restrictive procedure reported to have few operative complications and results similar to vertical banded gastroplasty.

• Benefits:
  Recent research shows patients experience a 40 - 60 percent excess weight loss, with more than 200,000 bands implanted worldwide
• Risks:
  10 percent complication rate requiring re-operation