Procedures

At present, all of these procedures are performed laparascopically which involve smaller incisions resulting in less postoperative pain, scarring and quick recovery.

Today, most weight loss surgeries are performed laparoscopically (minimally invasive surgery). Rather than making a long incision, the surgeon uses a few small incisions through which long, delicate, surgical instruments and a small video camera are inserted into the abdomen. In this manner, the surgeon is able to perform the procedure by viewing the surgery on a video monitor. When surgery is performed laparoscopically, there is less post-operative pain, scarring is minimal and recovery time is reduced. Dr. Jayakumar is specially trained in single incision laparascopic surgery which further minimizes scarring. The Roux-en-Y Gastric Bypass "RYGBP" is often called the "Gold Standard" for weight loss surgery, combining both a restrictive and a malabsorptive element.

Gastric Sleeve

Sleeve gastrectomy (also referred to as Gastric Sleeve) is a relatively new, restrictive weight loss procedure that limits food intake; the surgeon laparoscopically removes approximately 60 percent of the stomach leaving it shaped like a tube or "sleeve".

This procedure requires an overnight stay in the hospital. With the Gastric Sleeve, weight loss is equal to, or sometimes better than, the Lap-Band® System. Unlike the restrictive banding procedure, no adjustment is needed, and no foreign body is placed around the stomach.

Roux-en-y gastric bypass:

Considered as the gold standard in surgical weight loss procedures by National Institute of Health, Laparascopic RNY Gastric bypass involves the reduction of the stomach capacity and bypass of the upper intestine. Patients usually lose 60-75% of their excess body weight. This is a 1 1/2 - 2 1/2 hour procedure requiring an overnight stay in the hospital. Patients can usually return to work after two weeks. Requires a well-trained bariatric surgeon to perform this procedure. Dr. Jay has performed over 1,390 successful procedures and also teaches other surgeons to perform this procedure. Requires life long supplementation of multivitamin, Iron, vitamin b-12, vitamin D and calcium.

With the RYGBP procedure:

  • Small upper stomach pouch is created with specially designed staples to restrict food consumption.
  • Small upper stomach is then connected to the Upper small bowel bypassing a small portion of the upper small intestine and duodenal

Mechanism of Weight Loss

After surgery, the stomach reduction results in early satisfaction with a smaller amount of food thereby limiting caloric intake. The procedure also results reduced fat absorption resulting in further weight loss. Reduction in secretion of stomach hormone Ghrelin results in reduction in appetite.

Laparascopic Adjustable Gastric Banding

This is an outpatient procedure involving placement of a restrictive plastic device around the upper stomach. Patients are discharged the same day from the hospital. Requires adjustment (tightening of the band) in the office multiple times to optimize weight loss through careful portion control. Results in 45%-55% excess body weight. This is a simpler operation compared to the previously mentioned procedures however, late complications are higher. Namely, band slippage or occasional band erosion requiring revisional surgery.

Biliopancreatic Diversion and Duodenal Switch

This is a complex laparscopic procedure where the stomach size is reduced and the majority of the small bowel is bypassed. Resulting in significant weight loss over 80% excess body weight and therefore recommended for supermorbidly obese patients. This procedure requires 3.5-4.5 hours to perform laparascopically and is usually reserved for super B.M.I. patients (B.M.I. > 50). Due to the patient's size and relative complexity of the procedure, complication rates are higher than in other operations. Patients need to be monitored closely for nutritional deficiencies which usually stabilize after one year. Dr. Jay reserves this operation for super B.M.I. patients and patients who have failed other bariatric procedures.

 

Revisional Bariatric Surgery

In spite of the great success of surgical weight loss procedures over diet and exercise alone for morbidly obese patients, failures do occur. Even the best operation namely Roux-en-y Gastric Bypass has 10 to 15 chance of failure. Lap band procedure has a long term failure rate of over 40%.

Dr. Jay is one of the new surgeons in Houston who specialize in Revisional surgery for failed Bariatric procedures. Most often these are done Laparoscopically, resulting in shorter convalescence.

Complications

Complications depend upon the complexity of the procedure and the number of comorbidities present. The surgery should only be performed by a trained bariatric surgeon with an excellent support group and a commitment  for lifelong follow-up. Most of the complications are similar to other general surgeries of comparable magnitude (1) leakage from staple line resulting in infection (2) bleeding (3) sepsis (4) blood clots in the leg and lung (5) adelactasis - collapse of the lung (6) pneumonia (7) death (8) failure of expected weight loss.

While complications are not entirely avoidable, Dr. Jay follows state of the art recommendations for prevention. He pressure tests all staple line at the time of the procedure and also does x-ray examination post operatively. patients are given blood thinners routinely to prevent blood clots in the leg. Special compression stockings are used in the operating room to minimize blood stagnation. Patients are ambulated on the same day of surgery this helps minimize the formation of blood clots in the leg and improves lung function preventing lung collapse and pneumonia. Detailed post-operative instructions will be given at the time of discharge.