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LAP-BANDŽ and Gastric Bypass procedures in Los Angeles, California
presented by the Coastal Center for Obesity
for residents of Bellflower, Beverly Hills, Brentwood, Carson, Cerritos, Culver City, Downey, Glendale, Hermosa Beach, Hollywood, Hollywood Hills, La Mirada, Lakewood, Lawndale, Long Beach, Los Altos, Los Angeles, Marina del Rey, Norwalk, Palms, Paramount, Pasadena, Playa del Rey, Playa Vista, Rancho Palos Verdes, Redondo Beach, Rolling Hills Estates, San Pedro, Santa Monica, Torrance, Venice, West Hollywood, West Los Angeles, Westchester, and Whittier
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our surgeons _______________ |
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Dr. Milton Owens, M.D.,
F.A.C.S., Medical Director -
Bio /
Curriculum Vitae |
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daily news
about obesity ______ |
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Surgical weight loss operations performed at Coastal Center for Obesity
Coastal Center for Obesity include laparoscopic, open Roux-en-Y gastric
bypass and the LAP-BANDŽ procedure. We do not perform the duodenal switch
procedure or the biliopancreatic diversion. We feel these operations are
associated with more short and long term complications and therefore are not
currently performing them.
LAP-BANDŽ
- Less invasive
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Outpatient surgery
- Reversible Adjustable
- No rearrangement of anatomy
- Slower weight loss
- Not endorsed by NIH
- Less well studied in US
- More follow-up required
- More dietary compliance required
Gastric Bypass
- More invasive Inpatient surgery
- Not easily reversible
- Not adjustable
- Anatomy rearranged
- Faster weight loss
- Endorsed by NIH
- Well studied in US
- Less follow-up required
- Less dietary compliance required
Roux-en-Y Gastric Bypass
Operation
In the
gastric bypass procedure, a 15-20cc stomach pouch is
constructed (usual stomach approximately 1500cc or greater). The remainder of
the stomach is separated from the new stomach pouch and stapled closed. This
part of the stomach is not removed. The new stomach pouch is then connected to
the small intestine. This is done by dividing the intestine approximately 40cm
from the stomach and attaching the distal part to the stomach pouch. The
proximal part of the divided intestine is then connected to the side of the
intestine that was previously attached to the pouch. The roux limb is that part
of the intestine between the stomach pouch and the connection to the proximal
small intestine.
The difference between short limb (or proximal) and long limb (or distal)
gastric bypass is the length of the roux limb. Long limb gastric bypass results
in more malabsorption than short limb gastric bypass.
Laparoscopic vs. Open
The most significant recent advance in bariatric surgery is the technique of
laparoscopy. Using laparoscopy,
Roux-en-Y gastric bypass can be done with five
small incisions rather that one large incision. Otherwise the laparoscopic
procedure is the same as the open procedure. The laparoscopic approach results
in less pain, quicker recovery, shorter hospital stay, less scarring, and
quicker return to normal activity. Complications related to the incision, such
as infections and hernias, are nearly eliminated with the laparoscopic approach.
Despite these benefits of laparoscopic surgery, only a small percentage of
gastric bypasses are currently being done laparoscopically. This is because the
laparoscopic approach is new and is difficult to learn. Research completed by
Dr. Oliak demonstrated the difficulty of learning laparoscopic gastric bypass.
Dr. Oliak found that complication rates and operative times are much higher
during a surgeon's first 75 laparoscopic gastric bypasses. Complication rates
and operative times stabilize at low rates beyond 75 procedures. The importance
of this is that an experienced laparoscopic gastric bypass surgeon is essential
for good outcomes. Dr. Owens, Dr. Hajduczek and Dr. Oliak have combined
experience of well over 600 laparoscopic bariatric procedures, operations, and
bypasses (including laparoscopic revisions). Not all patients are appropriate
for laparoscopy. Open gastric bypass is probably better for patients with BMI's
of 60 or higher (more than 200 pounds overweight). Other research completed by
Dr. Oliak demonstrates that serious complications occur more often in patients
with BMI's of 60 or higher after the laparoscopic approach. Open surgery is
likely safer in this group of patients.
Results of Gastric Bypass
- One-two years after surgery, weight loss averages 65-80% of excess
weight.
- 10 years after surgery, weight loss averages 55% of excess weight.
- Associated medical problems, such as diabetes, hypertension, sleep apnea,
joint pain, and heartburn are improved or resolved in more than 90% of patients.
Risks of Gastric Bypass
- Vitamin and mineral deficiency (usually can be prevented by taking
supplements).
- The bypass portion of the stomach, duodenum and segments of the small
intestine cannot be easily visualized using x-ray or endoscopy if problems
such as ulcers, bleeding or malignancy should occur.
- Risks of surgery include infection, bleeding, blood clots, leaks,
strictures, and bowel obstructions. In general, the benefits of gastric
bypass outweigh the risks for people with BMI > 40, and for people with BMI
35-40 In the presence of medical problems associated with obesity.
...more about the risks of Gastric Bypass
Adjustable Gastric Banding (LAP-BANDŽ)
Adjustable gastric banding operations have been performed for the treatment
of obesity in Europe and Australia for many years with proven effectiveness
and safety . The
LAP-BANDŽ, a type of adjustable gastric band, was recently
approved (June 2002) for use in the United States. It is an attractive
procedure because it is less invasive than a gastric bypass, adjustable, and
reversible.
Operation
 The LAP-BANDŽ consists of a silicone inflatable band and an attached access
port (see picture). The band is placed around the top part of the stomach
(like a belt) to form a narrow constriction. This functionally divides the
stomach into a small (15cc) proximal gastric pouch and the large remainder
of the stomach. Eating small amounts fills the pouch and causes a feeling of
fullness. The access port is implanted under the skin of the abdomen and
connected to the band via a small tube. After surgery the tightness of the
band can be adjusted for optimal weight loss by injecting or removing saline
from the access port. The operation is performed laparoscopically using five
small incisions. The operation takes about an hour and patients can usually
go home the day of surgery or the morning after.
Results
- Long-term weight loss 40-60% of excess weight
- Weight loss 1-2 pounds per week after surgery
Risks
- Vitamin and mineral deficiencies (usually can be prevented by taking
supplements)
- Infection, bleeding, blood clots, band slippage, and band erosion
...more about the risks of LAP-BANDŽ
More information:
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