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Laparoscopic Surgery Benefits:
- Tiny Incisions
- Less Discomfort
- Reduced Risk of Incisional Hernias
- Less Stress on Body's Defenses
- Shorter Hospital Time
- Quick Recovery
Our surgeons developed the Laparoscopic Gastric Bypass, and are the most experienced in the world in performing it. People come to us from all over the world, for this special operation.
No brag, just fact!
Laparoscopic surgery began to be performed widely in the United States in the early 1990's, when it first began to be used for removal of the gallbladder. Using a thin tubular telescope and a tiny high-resolution video camera, the surgeon can see, on a TV monitor, what the camera sees inside the abdomen, through a pencil-sized "portal" passed through the abdominal wall. Other "ports" are placed, through which long, slender instruments can be inserted, to do the actual surgery. The surgeon must learn to move the instruments, based upon what he sees on the screen, not what he feels. Sometimes lasers are used as well, although many operations are accomplished just as well, without the need for lasers. Although the operation achieves the same result, there is no large and painful incision. Patients who have undergone Laparoscopic Gallbladder surgery can attest to reduced discomfort and rapid recovery, and excellent cosmetic results that are usually achieved with this method.
In just a few years, a wide variety of instruments have been developed, including sophisticated stapling and suturing devices, which permit laparoscopy to be applied to many other types of surgical operations. The use of laparoscopy for more complex operations, in which the stomach or bowel is cut and re-connected, is called "Advanced Laparoscopy". Few surgeons can and have become skilled in these techniques, and none had performed the Gastric Bypass laparoscopically, until Drs. Wesley Clark and Alan Wittgrove first developed the technique in 1993. They have now performed over 3000 such operations by this method, as well as other advanced laparoscopic procedures, and they have trained hundreds of other advanced surgeons in the performance of the operation.
Gastric Bypass, Roux en-Y has been said to be the "gold standard" operation for the treatment of Morbid Obesity, for several years, meaning that it is a solidly established reference, to which other operations must measure up.. It is, in our opinion, the procedure with the best combination of benefits and risks, for most patients. The operation is complex and difficult, whether performed by an open incision, or by laparoscopy. It can be organized into three steps:
- Division or partitioning of the stomach into two parts - an upper small pouch, and a lower, large pouch.
- Creation of a Y-connection in the small bowel, to make a new end to connect to the stomach.
- Connection of the new small bowel end to the upper stomach pouch, to bypass the stomach.
The steps of the operation are described in How We Do the Operation
You can read more about the effects of this operation, in Surgical Operations for Morbid Obesity.
In 1993, we set out to recreate the Gastric Bypass, Roux en-Y as an advanced laparoscopic procedure, using the same anatomy and connections, and varying only the instruments used to perform it laparoscopically. That way, we did not sacrifice principles, and known effectiveness, to make the operation easier to perform by this new method.
The results of this operation, which we have published and presented internationally, show:
- Operating time is slightly longer than the open operation (about 75 - 120 minutes laparoscopically, versus 60 - 90 minutes open).
- Recovery time is shorter: typically 2 days in the hospital, and 10 -14 days to return to full activity.
- Weight loss is excellent, averaging 80% of excess body weight after one year, and maintained at 80% for four years following surgery (for as long as the operation has been done this way).
- Over 95% of all weight-related health problems (co-morbidities), such as high blood pressure, diabetes, sleep apnea, gastroesophageal reflux, stress incontinence, and degenerative arthritis pain, are relieved by one year after the operation - often much sooner.
- Mortality rate has been less than 0.3%.
- Complication rate has been similar to that with the open operation, except that no incisional hernias (hernias occurring through the scar of the incision) have occurred, with the laparoscopic technique. We emphasize that one should not think of the laparoscopic operation as reducing the risks of bariatric surgery. It reduces pain and discomfort, inconvenience, recovery time, hernias, and scarring.
- Cosmetic results have been an added benefit for some of our younger patients, who now are proud to wear a two-piece bathing suit.
- Laparoscopic Gastric Bypass can be performed on all but the very severely obese (over 380 lb). We advise against attempting the technique when patients have had prior open operations on the stomach or esophagus.
The Laparoscopic Adjustable Silicone Gastric Band (LapBand®, Inamed)was approved by the FDA in June 2001, for use in treatment of Severe Obesity.
The LapBand is a device designed to produce a small upper gastric pouch, and a narrow opening from it into the lower stomach. It causes a sense of fullness after only a few bites of food, and it helps make the decision to reduce food intake, and to lose weight. We participated as one of the original eight centers whose studies were the basis for FDA approval, and we therefore had experience with this device long before it became availabe to most U.S. surgeons. We were required to use the LapBand according to a strict protocol which required the patient to participate in frequent follow-up examinations for 3 years.
The LapBand has several potential advantages:
- It is inserted laparoscopically, without a major incision., with a short hospital stay - usually just overnight.
- There is no opening made into the GI (gastrointestinal) tract, so the risk of leakage and infection is likely to be reduced.
- There is no staple line (like in the gastroplasty, the nearest other procedure) to potentially break down.
- It is adjustable.
- It is reversible, by laparoscopic removal of the band.
- It is potentially convertible to another operation, if the procedure fails to maintain the desired weight loss. A conversion is always associated with a higher risk.
Over several years, many thousands of these devices have been used, primarily overseas. The preliminary indications are that they are reasonably safe, when inserted by a skilled laparoscopic surgeon, and that they produce an average weight loss of more than half the excess body weight, for most patients. In several European reports, mortality risk has been acceptably low, and complication rates have been low. The most common problem is a slippage of the stomach through the band, causing the upper stomach pouch to enlarge and obstruct, often requiring a revisional surgery, which can usually be done laparoscopically.
This operation is especially attractive to persons who can spare only a small amount of time, and who need to return quickly to full activity. With one to two days hospitalization, a busy executive can return to his desk, and gain control over troublesome weight problems.
A more accurate evaluation, particularly the effectiveness of this device in American patients (we eat differently than most other countries), awaits accomplishment of more independent studies, and the test of time. Until then, a person who chooses this technique must accept the possibility of some uncertainty about the ultimate safety and results of the device.
The bottom line on the laparoscopic approach:
- Laparoscopic Gastric Bypass, Roux en-Y: a proven effective operation, with dramatic weight loss, 2 - 3 day hospital stay, and low risk of morbidity and mortality.
- Laparoscopic Adjustable Silicone Gastric Banding: a less proven procedure, with slower and less dramatic weight loss, 1-2 day hospital stay, and (probably) the lowest risk of morbidity and mortality.
If shorter hospital stay, reduced discomfort and disability, and superior cosmetic results are important to your decision, the choice of Laparoscopic Gastric Bypass or LapBand, is a choice you should consider.
We were the among the first to perform these procedures, and have an experience of thousands of operations, and a worldwide reputation as leaders in Bariatric Surgery.