Also known as obesity surgery and bariatric surgery. Weight loss surgery includes a number of different procedures. In addition to conventional surgery, there are also a number of procedures which are performed using an endoscope, without the need for surgery.
A fluid filled balloon is placed directly into the stomach using an endoscope. This gives the sensation of being full and reduces hunger. The balloon stays in for a maximum of 6 months, after which it has to be removed by a second endoscopy procedure. The Orbera balloon is a well established procedure and requires an endoscopy to place the balloon. The newly introduced Obalon balloon is swallowed rather than being introduced by endoscopy (see video)
Endobarrier is a non-porous synthetic sleeve, which is placed into the upper small bowel, just beyond the stomach, using an endoscope. This stays in position for up to a year. It stops food coming into contact with the upper bowel and results in an altered response from the gut to food. Described as an “endoscopic gastric bypass”, Endobarrier results in remarkable control of diabetes, coupled with substantial weight loss over the year.
Laparoscopic Gastric Banding
A synthetic band is applied to the upper part of the stomach, creating a small pouch of stomach just above the band. The pouch fills rapidly during eating which results in a sense of fullness with very small meals. The band has an adjustable balloon on its inner aspect, which is filled by injection into a small port under the skin. Adjustment of the band limits the ability to eat by narrowing the outlet to the pouch. The band is adjusted serially to achieve the optimal effect on weight loss. Adjustments may take place several times over the first year or so, the first adjustment being made 6 to 8 weeks following surgery.
Laparoscopic Sleeve Gastrectomy
The stomach is divided lengthwise with staplers creating a narrow tube of stomach. The rest of the stomach is removed. The tube, or sleeve which remains has a small volume and limits the amount of food which can be eaten.
Laparoscopic Roux-en-Y Gastric Bypass
Roux en Y gastric bypass involves the creation of a small gastric pouch from the upper part of the stomach, by stapling. The pouch is joined directly to the bowel, and food therefore bypasses the rest of the stomach. The length of bowel just beyond the stomach, which is rich in digestive juice, is diverted further downstream. As a result, food and the digestive juices are separated.until much further down the bowel than normal .The bypass comes together some way further down the gut so that food can be absorbed.
Laparoscopic Duodenal Switch
The duodenal switch operation includes a sleeve gastrectomy but the bowel is divided just beyond the stomach and joined to a point much further down the gut, short circuiting the normal route. The loop of bowel into which digestive juices passes (bilio-pancreatic limb) is then joined to the bottom end of the small bowel, leaving only a short length of small bowel to break down and absorb nutrients. This results in malabsorption of fat and complex carbohydrates, Protein absorption is also affected and patients need a high protein diet to stay healthy after surgery.