Obesity Academy

Gastric Band Surgery

The adjustable gastric band is a form of weight loss surgery designed to aid those with obesity in reducing weight by limiting food intake. It is classified as a type of restrictive weight loss surgery, which is aimed at limiting the amount of food a person can consume. The adjustable gastric band reduces the size of your stomach without permanently dividing it as other surgeries do.

How does the gastric band work?

The adjustable gastric band is a flexible, inflatable tube made of soft silicone that is positioned around the upper part of your stomach, forming a ring. The band is connected to a port that is implanted beneath your skin. Your surgeon can adjust the band by injecting saline fluid into the port to make a small outlet between the upper and lower portions of your stomach. This will cause the upper stomach pouch to fill up quickly when you eat, resulting in a feeling of fullness more quickly.

Who is gastric band surgery for?

In general, if you have health issues related to obesity and other weight loss methods have not been effective, you may be considered for bariatric surgery. The gastric band may be recommended by your healthcare provider if you prefer a less invasive and reversible intervention than other weight-loss surgeries.
Compared to other bariatric procedures, the gastric band has the lowest complication rate after surgery and does not involve the division of stomach or intestines. However, it may result in less weight loss than other bariatric surgeries and requires multiple follow-up visits for adjustments during the first year.

How much weight can you lose with gastric band?

The average weight loss with gastric band is about 40% of excess weight over two years. That means if you were 100 lbs. overweight, you’d lose 40 lbs. Results can vary, depending on how much you change your habits after surgery. Weight loss with the gastric band is typically less than with other bariatric surgeries.

Can gastric banding help treat obesity-related health conditions?

Just losing weight can do a lot to improve obesity-related health conditions, including:

• High cholesterol
• High blood pressure
• Heart disease
• Type 2 diabetes
• Obstructive sleep apnea
• Non-alcohol related fatty liver disease

The gastric band doesn’t have the same effects on metabolism and hormones as other weight-loss surgeries. It’s considered a purely “restrictive” procedure, meaning that it works primarily by limiting the amount of food you can eat at one time.

What are the requirements to qualify for Gastric Band surgery?

Your healthcare provider may recommend bariatric surgery if you have:

• A BMI of 40 or higher. The Body Mass Index (BMI) is a way of estimating how much body fat you have based on your height-to-weight ratio. A score of 40 or higher is associated with a higher risk of obesity-related diseases.
• A BMI of at least 35 and at least one obesity-related disease. A BMI of 35 without a related disease is considered class II obesity. With a related medical problem, it qualifies as clinically severe, or class III obesity.

You’ll also have to undergo medical screening to make sure you’re healthy enough for surgery. You may have physical exams, blood tests, or imaging tests of your abdomen. If you smoke or overuse alcohol or opioids, you’ll have to quit before qualifying for surgery.

What happens during the Gastric Band procedure?

• You’ll be put under general anesthesia, so you’ll be asleep and unaware during the operation.
• Laparoscopic surgery begins with a single keyhole incision in your abdomen. Your surgeon will use this first keyhole to install a tiny pump and inflate your abdomen with carbon dioxide gas. This allows for your surgeon to see, and for there to be room to perform the surgery.
• Your surgeon will install the laparoscope — a tiny lighted video camera. The laparoscope will project your organs onto a screen. Your surgeon will use long, narrow tools to access your stomach through additional keyholes.
• Your surgeon will secure the gastric band around the top portion of your stomach and tighten it to form a pouch. Your stomach will look a bit like an hourglass, with a narrow channel between the top and bottom portions.
• The gastric band has a hollow channel that can be filled with fluid. This is what makes it adjustable. Your healthcare provider will be able to adjust the pressure of the gastric band by adding or extracting fluid through this port.
• The gastric band is attached to a small plastic tube that will run just under your skin and into a port. After surgery, your healthcare provider will be able to access the port with a special fine needle to inject or extract fluid as needed.
• When everything is in place, your surgeon will release the gas from your abdomen and close your keyhole incisions. The procedure takes about 30 to 60 minutes.

What will my diet be like after gastric band surgery?

Your healthcare provider will give you specific dietary instructions. You’ll be on a liquid diet for the first several weeks, gradually progressing from pureed foods to soft foods and finally, solid foods. This is to give your stomach time to heal. When you do return to solid foods, you’ll have to limit your portions to fit your new stomach pouch. Overeating will likely cause nausea and vomiting. You’ll have to choose high-quality foods to make sure you get enough nutrients and chew your food well.

What kind of follow-up care will I have?

You'll visit your healthcare provider often in the first year after surgery to make adjustments to your gastric band. As you lose weight, your Gastric Band may need to be tightened in order for you to sustain your weight loss. You’ll also have regular blood tests to make sure you’re getting enough nutrients on your new diet. You may have nutritional counseling to help you learn new ways of eating. If necessary, your healthcare provider may prescribe supplements.

How many years does a Gastric Band last?

The Gastruc Band is designed to last a lifetime, but whether it does isn’t yet proven. Studies show that 35% to 40% of people may have their gastric bands removed after 10 years.
There are many reasons why the gastric band may be removed, including:

• Inadequate weight loss
• Complications such as esophageal dilation
• Severe heartburn/reflux
• Inflection
• Slippage of the band
• Erosion of the band
• Obstruction

Some people eventually move on to a more permanent bariatric surgery with a higher success rate.

What are the advantages of gastric band surgery over other types of bariatric surgeries?

The main advantage of the adjustable gastric band is that it has a lower risk of complications immediately after surgery. While sleeve gastrectomy and gastric bypass are both considered very safe, the gastric band is estimated to have an even lower risk of complications. There’s no division of your stomach or intestines involved. Additionally, it can be removed if necessary.

What are the disadvantages of gastric band surgery?

There are several disadvantages to gastric band surgery. First, it leads to less weight loss than the other bariatric surgeries. It also may require frequent adjustments, especially during the first year after placement.
Over time, there may be additional issues that arise. For example:

• Studies suggest the risk of complications after a gastric band to be as high as 50%.
• The rate of repeat procedures to fix or remove the gastric band may be as high as 35%.
• The rate of failure due to inadequate weight loss or regaining weight is higher with gastric band than with other bariatric procedures.
• Additional surgery means additional expense and risk.

What are the possible complications or side effects of the Gastric Band?

• Nausea and vomiting. This is a common side effect in the early days after the surgery. It usually resolves over time, as you learn new ways of eating: smaller, more nutrient-dense meals, smaller bites and thorough chewing.
• Constipation. Some people develop constipation with the gastric band because they find it difficult to drink enough fluids. Your stomach won’t be able to hold much fluid at once, and your healthcare provider will direct you not to drink fluids while eating in order to leave room for your food. Hydration is very important after any type of bariatric surgery.
• Difficulty swallowing. Sometimes your body may react to the smaller stomach pouch and slower gastric motility by making it hard to swallow food. Loosening the band, or slowing down and eating smaller bites can help. If it doesn’t help, it could indicate an intolerance to the band.
• Gastroesophageal reflux. A tight band can trigger acid reflux (GERD), also called heartburn. Loosening it to relieve symptoms may interfere with weight loss. But, persistent GERD may damage the walls of your esophagus, causing acid erosion. GERD can often be treated with medication, but some severe cases may require removal of the gastric band.
• Port problems. The port that your healthcare provider uses to access and adjust your Gastric Band can malfunction in various ways. It can become dislodged from its original location or flip upside down, making it inaccessible from the outside. The port or tubing can leak, making it impossible to fill the gastric band. If you lose a lot of weight quickly, the port can stick out of your skin, causing tenderness or skin erosion at the site. These malfunctions may require minor operations to fix or replace the port. Infections at the port site can also happen, which may require antibiotics or an additional procedure to correct.
• Outlet obstruction. Food can get stuck in the outlet between your stomach pouch (stomach above the band) and lower stomach, causing a blockage. You’ll notice when you can’t eat anymore. Your healthcare provider can try to clear the blockage by deflating the band, but it might need surgery to fix.
• Band slippage. The band is secured in its position during the surgery. However, the band could slip from this position. When this happens, the stomach pouch (stomach above the band) becomes bigger. If this happens slowly, this may affect your weight loss benefits, or cause symptoms such as reflux. Sometimes it can happen very quickly, which can cause stomach necrosis (dying of stomach tissue). This would require emergency surgery and removal of the band.
• Esophageal dilation and/or pouch dilation. Pressure from food building up above the gastric band can cause your stomach pouch — and sometimes your esophagus — to dilate or widen. This allows more food to back up above the band, causing nausea, reflux and vomiting. It may take surgery to correct, and/or removal of the band.
• Band erosion. Friction from the band rubbing against your stomach or your esophagus over time may cause the band to erode through your stomach. This makes the band ineffective and can also cause infection. The solution is usually removal.
• Band intolerance. Some people have adverse reactions to a foreign implant in their bodies. They may develop excessive scar tissue around the band, or feel persistent nausea and discomfort. In these cases, the band may have to be removed.

Gastric Bypass Surgery

The Gastric Bypass Surgery, also known as Roux-en-Y, is a weight loss and metabolic procedure that involves modifying your digestive system. This involves reducing the size of your stomach and shortening the length of your small intestine, which leads to a reduction in calorie consumption and absorption.

Who is gastric bypass surgery for?

People who have clinically severe obesity are often recommended to undergo gastric bypass surgery, which is proven to help alleviate a range of health issues associated with obesity, such as type 2 diabetes, hypertension, obstructive sleep apnea, and GERD (chronic acid reflux).

What does gastric bypass surgery do?

The Roux-en-Y procedure is called that way because of the way it alters your digestive system, with "Roux-en-Y" meaning "in the shape of a Y". The operation divides both your stomach and small intestine, and then reconnects them to create a Y-shaped configuration.

How does Roux-en-Y surgery work?

First, the surgery creates a small pouch in your stomach, using surgical staples to separate it from the remaining part. This results in a limited capacity of the stomach to hold food.
Then,, the new stomach pouch is connected to a lower section of your small intestine. Consequently, most of the stomach and the initial part of the small intestine are now bypassed during the digestion process. As a result of this bypass, your body will not absorb all the nutrients or calories from the food you consume.

How common is gastric bypass surgery?

The Roux-en-Y procedure has been practiced, studied and refined for over 50 years. It was once the most common weight loss surgery, but in recent years it’s been overtaken by the gastric sleeve. Today the gastric bypass represents about 18% of all bariatric surgeries.

Is gastric bypass a serious surgery?

Yes. Although a gastric bypass is regarded as a secure operation that is similar in risk to other frequently performed surgeries, it is a significant procedure that will permanently alter your digestive system. Even after the recovery period, you will need to give it extra attention for the remainder of your life.

How much weight can you lose with gastric bypass surgery?

Weight loss in the first year or two after surgery is often significant. On average, this amounts to around 70% of the excess weight. While some individuals may regain some weight in the following years, the typical long-term weight loss is about 50% of the excess weight. This percentage stays relatively constant for up to 20 years.

What conditions can gastric bypass surgery help manage or improve?

If you have medically significant obesity, just losing weight can do a lot to improve your health. But gastric bypass surgery does more than that. It makes lasting changes to your metabolic system to help you manage your blood sugar, blood pressure and hunger.
Conditions improved by gastric bypass surgery include:

• Hyperglycemia
• Hyperlipidemia
• Hypertension
• Heart disease
• Diabetes
• Fatty liver disease
• Gastroesophageal reflux
• Sleep apnea
• Osteoarthrosis

What are the requirements to qualify for gastric bypass surgery?

Gastric bypass surgery requirements are similar to those of other bariatric procedures. You must be recommended for surgery by a qualified healthcare provider. In general, you may be a candidate for gastric bypass surgery if you:

• Have been diagnosed with class III obesity. This is determined by your BMI (body mass index). Class III obesity means a BMI of at least 40 kg/m2
• Have a BMI of at least 35 with at least one obesity-related condition.
• Have obesity-related type 2 diabetes. Because of its positive effects on blood sugar regulation, you may qualify for gastric bypass surgery to help manage your type 2 diabetes, if it’s unmanaged and you have a BMI of 30 or higher.

If you’ve met these benchmarks, you may be recommended for surgery. But your surgeon will have additional requirements. Before scheduling your surgery, you’ll meet with a team of healthcare specialists for counseling and screening. They’ll want to know:

• That you're committed to lifelong lifestyle changes. Surgery is a powerful tool for weight loss, but it won’t work if you won’t work with it. You’ll have to change the way you eat forever. If you don’t, you could regain the weight you lose.
• That you’re physically and mentally fit for surgery. You’ll likely take some standard medical tests to make sure the procedure will be safe for you. You may also be screened for mental health and for alcohol or tobacco use.
• That you’ve tried to lose weight by other means. Health insurance companies may ask you to prove that weight loss surgery is medically necessary. They may require that you try a supervised diet and exercise program first.

How is gastric bypass surgery performed?

The majority of Roux-en-Y surgeries performed today utilize laparoscopy, a minimally-invasive surgical technique that has become the standard of care for most patients. This approach involves making three to five small incisions in the abdomen, each around half an inch in length. Smaller incisions mean lower risk of complications, less bleeding, reduced pain, and faster healing times. The surgeon performs the procedure using long, narrow instruments passed through these incisions.
Occasionally, laparoscopic Roux-en-Y surgery may be performed with the assistance of robotic arms controlled by the surgeon via a computer. However, around 10% of these procedures may require open surgery, depending on the patient's specific conditions. In rare cases, a laparoscopic procedure may need to be converted to an open surgery to ensure the patient's safety.

What happens during the Roux-en-Y procedure?

• All laparoscopic surgeries begin with a single “keyhole incision” in your abdomen. Your surgeon uses this first keyhole to inflate your abdominal cavity with carbon dioxide gas. This helps separate your abdominal wall from your organs and makes everything easier to see.
• Then your surgeon will place a tiny lighted video camera called a laparoscope through the keyhole to visualize your organs. The laparoscope will project onto a computer screen. Your surgeon will use additional keyhole incisions to access your organs.
• The first step in the Roux-en-Y procedure is to divide the top portion of your stomach from the remainder with a surgical stapler. The resulting pouch is about the size of an egg. The remainder of the stomach is still attached to your small intestine.
• The next step is to divide your small intestine several feet down its length and bring the lower segment up to attach to your new stomach pouch. Your food will now pass from your stomach pouch into this segment of your lower small intestine.
• The final step is to reattach the upper branch of your small intestine to the trunk further down. Now your small intestine has two branches attached to the trunk: one leading from your stomach pouch, and the other leading from the remainder of your stomach.
• The right side of this “Y” is the new branch, the one that your food will pass through. The left side is the original upper part of your small intestine (your duodenum). This is the part where your liver, gallbladder and pancreas deliver their digestive juices.
• The left branch will deliver these juices into the new trunk of your small intestine, where they will mix with your food. This will enable you to properly digest your food, even though your shortened intestinal pathway will absorb fewer nutrients from it.

How long does gastric bypass surgery take?

The procedure itself takes between two to four hours. Afterward, you’ll probably remain in the hospital for two days. You won’t be able to eat solid foods yet.

How painful is gastric bypass surgery?

During the initial days following the surgery, you may experience moderate discomfort, but you will have access to pain medication through an intravenous catheter. You will not be discharged from the hospital until you can manage your pain without medication and are able to move around independently without difficulty. Once you return home, you will have prescription pain relievers to use, although most individuals are able to gradually reduce their usage within a week. While your incision wounds may still be tender as they heal, the smaller laparoscopic incisions usually heal quickly.

What are the advantages of Roux-en-Y surgery?

The significant advantage of this procedure is that it has been widely practiced for several decades, making it one of the most extensively studied surgeries in modern medicine. In comparison to other weight loss procedures, it has a high success rate over the long term. Follow-up studies of gastric bypass surgeries have consistently demonstrated substantial weight loss even many years after the operation. In addition to weight loss, many associated health conditions show improvement or resolution. As a result, many people are able to discontinue medications they were taking for these conditions.

What are the possible risks of the procedure?

In the short term, gastric bypass surgery shares the same general risks as many other surgeries, including:

• Wound infection
• Excessive bleeding
• Reactions to anesthesia

Complications more specific to gastric bypass surgery can include:

• Hernias. Hernias occur when one of your organs pushes through a gap in your muscle wall.
• Small bowel obstruction. Scar tissue can cause narrowing or obstruction of your small intestine.
• Anastomotic leaks. Gastric bypass severs and reconnects your small intestine in more than one place. If the connection point leaks, it can lead to serious infection inside your abdominal cavity.

What are the possible long-term complications of gastric bypass surgery?

Surgeries that modify your digestive system can cause certain digestive complications. These include:

• Dumping syndrome. This is a collection of symptoms that can occur when your stomach dumps food too fast into your small intestine. Up to 50% of people who have bariatric surgery may have some symptoms of dumping syndrome afterward. Symptoms can include nausea, diarrhea, abdominal cramping and hypoglycemia. They usually fade with time. Your healthcare team will give you dietary guidelines to help prevent or reduce dumping syndrome while you recover.
• Malabsorption and malnutrition. Gastric bypass surgery intentionally induces malabsorption in your small intestine to reduce the calories you absorb. It can also lead to nutritional deficiencies if you aren’t careful. Your healthcare provider will prescribe nutritional supplements to help prevent this.
• Bile reflux. Surgery that affects the pyloric valve, the opening between your stomach and your small intestine, can cause it to malfunction. If the pyloric valve doesn’t close properly, one possible result is bile reflux. That means the bile that your gallbladder sends to your small intestine to help digest food can backwash into your stomach. Bile reflux can erode your stomach lining, leading to gastritis and stomach ulcers.
• Gallstones. Rapid weight loss sends a large load of cholesterol to your liver to process. When your liver sends bile to your gallbladder, it carries extra cholesterol with it. This extra cholesterol can build up in your gallbladder, forming cholesterol gallstones. Gallstones don’t always cause problems, but they can be dangerous if they travel and get stuck in your bile ducts. Your healthcare provider may give you a prescription medication to prevent gallstones after surgery.
• Ulcers. People who have gastric bypass surgery are more at risk of developing ulcers in their stomach or duodenum. To avoid this, your healthcare provider will advise you to avoid smoking or using NSAIDs (non-steroidal anti-inflammatory drugs) in the future.
• Weight regain. If you don’t commit to changing the way you eat from now on, it’s possible to stretch out your stomach again. Even the small pouch your surgeon made for you can grow to hold more and more food over time. When this happens, one possible option is gastric bypass revision surgery. Your surgeon may agree to repair or redo your Roux-en-Y.

What is the recovery time from gastric bypass surgery?

After the procedure, you will typically spend a day recuperating in the hospital and several weeks recuperating at home before feeling prepared to return to work. It is possible that you may need to avoid vigorous activities for as long as six weeks, and it may take as many as twelve weeks before you can return to consuming a regular diet.

What kind of diet will I have to follow after gastric bypass surgery?

Following the surgery, you will need to adhere to strict dietary guidelines for several months. This is essential for safeguarding your digestive system as it heals and ensuring that you receive the necessary nutrients despite consuming less food overall. Initially, you will likely begin with a liquid diet for several weeks and then gradually advance to a soft diet for several more weeks. It may take as long as two to three months before you can resume consuming solid foods, and even then, you will need to be vigilant in selecting appropriate foods.
Your healthcare team will provide you with more specific dietary guidelines, but they generally include:

• Consuming at least 64 ounces of fluids a day. This can be challenging, due to your reduced stomach size, especially since you’ll be advised not to drink while eating. But hydration is very important following surgery to avoid unpleasant side effects, such as nausea and constipation.
• Consuming at least 100 grams of protein a day. Protein is the most important macronutrient you’ll need to stay strong after surgery and prevent muscle loss. Staying focused on protein sources will help you get more mileage out of the calories you consume and avoid less nutritious choices.
• Taking vitamin and mineral supplements daily. You’ll need to take micronutrient supplements for the rest of your life. Your digestive system will no longer be able to absorb enough of them from your food alone. Vitamin and mineral deficiencies can have serious health effects.
• Avoiding foods high in sugar and starch. While this is good general advice for maintaining weight loss, there is a more important reason why you’ll need to avoid these foods following surgery. It has to do with how quickly food will pass from your stomach to your small intestine now. Concentrated doses of carbohydrates (sugars) entering your small intestine can cause uncomfortable side effects, such as indigestion and rapid blood sugar changes.

Duodenal Switch Surgery

The duodenal switch is a type of weight loss surgery that alters both your stomach and small intestine. This procedure involves removing a portion of your stomach, which is known as a gastrectomy, and rerouting your intestines to create a shorter pathway for food. This results in limiting the amount of food your stomach can accommodate, as well as reducing the quantity of nutrients that your small intestine can absorb from the food, classifying it as a "malabsorptive" procedure. Additionally, the surgery diminishes the production of hunger hormones that are typically produced by your stomach and small intestine.
Currently, there are two distinct types of duodenal switch procedures that are being performed. The first version is referred to as the biliopancreatic diversion with a duodenal switch, or sometimes the gastric reduction duodenal switch, and it has a more extensive history and research backing. On the other hand, the loop duodenal switch is a newer variation that was devised to streamline the procedure and decrease the likelihood of complications.

Why is it done?

If you have severe obesity (class III), which puts you at risk of or already experiencing obesity-related diseases such as high blood pressure, high cholesterol, and high blood sugar, your healthcare provider may recommend bariatric surgery. A BMI of 40 or higher, or a BMI of 35 with related diseases, could lead to a diagnosis of class III obesity. If your obesity and related conditions are more severe, with a BMI of 50 or higher or a severe form of obesity-related disease, your healthcare provider may recommend duodenal switch surgery. This procedure has the most profound weight loss effects among all bariatric surgeries and greatly improves metabolic syndromes like Type 2 diabetes. However, it also has a higher complication rate. Nevertheless, for people with severe conditions, the benefits of the duodenal switch outweigh the risks.

How does the duodenal switch compare with other common weight-loss surgeries?

Compared to other bariatric surgeries, the duodenal switch is performed less frequently because it is more complex and radical. It involves a greater amount of cutting and suturing in your digestive system and removes or bypasses more of your gastrointestinal tract than other procedures. This makes it somewhat more dangerous for complications, both during and after the procedure. However, the duodenal switch is also the most successful method for weight loss surgery, with the most significant and enduring outcomes.

What is the difference between duodenal switch vs. gastric bypass surgery?

The duodenal switch and the Roux-en-Y gastric bypass are similar weight loss procedures. Both involve decreasing the size of your stomach to limit the amount of food you can eat and bypassing a portion of your small intestine to reduce the number of nutrients and calories absorbed (weight loss through malabsorption). However, the duodenal switch places more emphasis on malabsorption, while the Roux-en-Y gastric bypass leans more towards restriction. The duodenal switch reduces stomach size by approximately 60% to 70% (compared to 70% to 80% with the Roux-en-Y), but it bypasses around 75% of the small intestine (versus approximately 30% with the Roux-en-Y).

What is the difference between the duodenal switch vs. the gastric sleeve?

The duodenal switch is a two-part surgery that begins with a gastric sleeve. In fact, the sleeve gastrectomy was initially created as the first step in the duodenal switch procedure. The gastric sleeve surgery reduces the stomach to a small, tubular “sleeve,” which is roughly 75% of its original size. The second part of the procedure, which bypasses a significant portion of the small intestine, results in greater weight loss than the gastrectomy alone but also increases the likelihood of adverse effects.

How much weight can you lose with a duodenal switch?

On average, individuals who undergo the duodenal switch procedure experience a weight loss of 80% of their excess weight within two years after surgery. This amount of weight loss is significantly higher than the average weight loss achieved with other bariatric surgeries, which usually ranges from 50% to 60%. Furthermore, people who have the duodenal switch procedure tend to maintain their weight loss for a longer period of time. Studies have demonstrated that, on average, they maintain a weight loss of 70% of their excess weight over a period of ten years. This implies that if you were 200 lbs. overweight, you could lose an average of 140 lbs and maintain that weight loss.

How effective is the duodenal switch?

Duodenal switch surgery has a 90% success rate for weight loss, meaning that 90% of people lose at least half of their excess weight, with many losing more. The success rate for remission of related health conditions is also high, with as many as 90% of people with Type 2 diabetes able to stop taking their medications after the surgery. Due to its higher success rate, some people who do not lose enough weight with other bariatric surgeries may opt for revision surgery with the duodenal switch.

What obesity-related conditions can duodenal switch surgery help treat?

Obesity raises the risk of disease in nearly every body system. Duodenal switch surgery helps reduce the risk and the effects of developing these diseases, including:

• Cardiovascular disease: hypertension, arterial disease, vascular disease, heart attack, stroke.
• Respiratory diseases: asthma, obstructive sleep apnea, obesity hypoventilation syndrome.
• Metabolic diseases: hyperlipidemia, insulin resistance and diabetes.
• Gastrointestinal diseases: nonalcoholic fatty liver disease, nonalcoholic steatohepatitis.
• Reproductive diseases: polycystic ovary syndrome, infertility.
• Musculoskeletal pain: back strain, weight-bearing osteoarthritis.
• Cancer: especially colorectal cancer and liver cancer.

What happens before duodenal switch surgery?

If your healthcare provider believes you are a good candidate for surgery, you will enter a screening process. This will likely involve:

• Standard medical testing to make sure you are in good condition for surgery.
• Screening for alcohol, tobacco and drug use and therapy to help you quit if necessary.
• Psychological screening or counseling to make sure you are mentally and emotionally prepared for the big life changes ahead and the discipline that your new digestive system will require.
• Demonstrating that you have tried and failed to lose weight by other means.
• Enrolling in a seminar on bariatric surgery to make sure you understand what’s involved.

Once you’ve met these benchmarks and scheduled your surgery, your healthcare provider will put you on a preoperative diet for a couple of weeks. Losing a little weight before your procedure will make it safer.

How is a duodenal switch done?

• Open vs. Laparoscopic: Duodenal switch surgery can be done as a traditional open surgery or laparoscopic surgery. The laparoscopic method is less invasive, using narrow tools through small “keyhole” incisions instead of opening your abdominal cavity. Surgeons and patients often prefer to use minimally invasive surgery techniques, when possible, but some people may require open surgery to manage their conditions. Sometimes a surgery that begins as laparoscopically may need to convert to open surgery.
• Two steps: The duodenal switch is a two-step surgery that begins with a sleeve gastrectomy. Some people have the sleeve gastrectomy as a standalone procedure, but if you have it as part of a duodenal switch, your surgeon will remove slightly less of your stomach — about 65%. The next step in the process, the intestinal bypass, can be done in the same surgery or as a second surgery sometime later. Your surgeon may advise two separate surgeries if they believe this would be safer for you based on your conditions.
• Two methods: There are two methods to the duodenal switch: the original (biliopancreatic diversion) and the modified (loop) duodenal switch. The differences are in the second part of the surgery — the intestinal bypass. Both versions begin the bypass by dividing your small intestine near the top, in the section called the duodenum. Then they bring a lower section of your small intestine up to attach to the top, bypassing the middle. In this way, the duodenum is “switched” with a lower part of your small intestine.

The original duodenal switch bypasses most of your small intestine — about 80-90%. This drastically reduces how much nutrition your small intestine can absorb from your food, leading to significant weight loss but also a high risk of malnutrition. The modified (loop) version bypasses only about 50-60% to reduce this risk. The other difference is that the original duodenal switch divides and reconnects your small intestine in two different places. The modified duodenal switch is simpler, with only one division and reconnection.

What happens after duodenal switch surgery?

Your healthcare provider will schedule regular follow-up appointments with you for the first one to two years after your duodenal switch surgery, and periodic appointments thereafter for the rest of your life. The initial two-year period will be the time of most significant weight loss, and your provider will monitor your progress and health closely during this time. You will need to have regular blood tests to check for any nutritional deficiencies and take nutritional supplements every day for the rest of your life to prevent malnutrition.

Is duodenal switch surgery safe?

The risks of duodenal switch surgery are similar to those of any other abdominal surgery. They include:

• Wound infection
• Excessive bleeding
• Reactions to anesthesia
• Blood clots

Complications more specific to gastric bypass surgery can include:

• Hernias. Hernias occur when one of your organs pushes through a gap in your muscle wall.
• Small bowel obstruction. Scar tissue can cause narrowing or obstruction of your small intestine.
• Anastomotic leaks. The intestinal bypass involves surgically severing and reconnecting your small intestine (anastomosis). If the connection point leaks, it can lead to serious infection inside your abdominal cavity.

These are rare. Minimally invasive techniques reduce these risks, and so does the modified version of the duodenal switch. The risk of death from duodenal switch surgery is a little over 1%.

What are the advantages of the duodenal switch?

• Highest success rate of all bariatric surgeries with greatest overall weight loss.
• Improves hunger, metabolism, blood lipid and blood sugar levels long-term.
• Total remission of Type 2 diabetes.
• Slightly larger gastric sleeve than other procedures, allowing for slightly larger meals.
• Rarely causes dumping syndrome, so you don’t have to completely avoid sugar or fats.
• Longer life with significantly reduced risk of death by any cause.

What are the possible long-term complications or side effects of duodenal switch surgery?

• Malnutrition. This is the most important risk of duodenal switch surgery. However, it is preventable and treatable as long as you and your healthcare provider stay attentive to the risk. Now that your small intestine will not be able to absorb as much nutrition from your food, you’ll have to take nutritional supplements daily. Your healthcare provider will also continue to test you periodically for nutritional deficiencies for the rest of your life. Deficiencies are possible even when you do take supplements, but as long as your healthcare provider catches them, they can treat them.
• Diarrhea. This is another side effect of malabsorption in your small intestine. Your small intestine won’t be able to digest your food as thoroughly as before or extract as much water. This can make for loose, smelly stools and gas. It can also make stools more frequent. Some people find that these side effects level out after their digestive systems adjust to the surgery.
• Bile reflux. Surgery that affects the pyloric valve, the opening between your stomach and your small intestine, can cause it to malfunction. If the pyloric valve doesn’t close properly, one possible result is bile reflux. That means the bile that your gallbladder sends to your small intestine to help digest food can backwash into your stomach. Bile reflux can erode your stomach lining, leading to gastritis and stomach ulcers. Bile reflux is more of a risk with the modified duodenal switch (although a low risk). The original is designed to prevent it.
• Gallstones. Rapid weight loss sends a large load of cholesterol to your liver to process. When your liver sends bile to your gallbladder, it carries extra cholesterol with it. This extra cholesterol can build up in your gallbladder, forming cholesterol gallstones. Gallstones don’t always cause problems, but they can be dangerous if they travel and get stuck in your bile ducts. Your healthcare provider may give you a prescription medication to prevent gallstones after surgery.

What is the weight-loss timeline following duodenal switch surgery?

Weight loss will vary from person to person, but there are some general trends. The initial three months after the surgery will have the most rapid weight loss, where you can expect to lose approximately 30% of your excess weight. The rate of weight loss will slow down over the following three months. By the end of the first year, you may lose around 50% to 75% of your excess weight. Typically, weight loss peaks between 12 to 18 months after the surgery, where it can reach 75% to 85% of your excess weight.

What is the recovery time from duodenal switch surgery?

After the surgery, you will probably need to stay in the hospital for a few days, followed by a few weeks of recovery at home before you can resume work. During the recovery period, your body will undergo significant changes, including rapid weight loss. You will also have to adhere to strict dietary instructions for what and how you eat during your recovery period. This is to allow your digestive system to recover and adapt to the new changes. It may take one to two weeks to progress through each stage on your way back to a normal diet, including:

• Clear liquid diet
• Full liquid diet
• Pureed foods
• Soft diet

Loop Bipartition Surgery

Loop Bipartition Surgery is one of the most successful operations in the treatment of diabetes. The most important feature of this success while providing the same purpose compared to other operations performed is in protection of the natural digestive function to a great extent. It also known as Single Anastomosis Sleeve Ileal (SASI) Bypass.

Loop bipartition surgery is consisted of two steps.

• The first step is to perform a sleeve gastrectomy which is slightly larger than the standard one.
• The second step is creating a passing over bridge (bypass-anastomosis) from the antrum section at the bottom of the stomach towards the small intestine.

The connecting level from the stomach to the intestine is usually 2.5-3 meters proximal part of the small intestine-large intestine junction (ileocecal valve). Thus, having a tube stomach restricts intake of nutrients, facilitates saturation and weight loss and at same bypass surgeries with its outcome effect increase the activation of the small intestine hormone (incretin) in favour to metabolism regulation. It is a simple, low-risk operation design with successful results performing single cross-over (anastomosis). In this case, 1/3 of the food and 2/3 of the natural way pass through the new way. Approximate weight loss of patients is around 70-75%. With this operation, successful results were obtained on diabetes. On average, the effect on DM is 86%. Vitamin and mineral supplements are less needed in patients than in other bypass operations.

Transit Bipartition Surgery

The Transit Bipartition is a preferred surgical procedure for treating Type 2 diabetes and is an improved method of metabolic surgery. The surgery involves connecting the 1/3 end of the small intestine to the stomach as an alternative, which helps to regulate the hormones in the small intestine and control diabetes.

How Is Transit Bipartition Done?

Surgical procedure to help lose weight together with Transit Bipartition is preferred today. This surgical method achieves success by both restricting the amount of food that can be consumed and preventing absorption of food. If the restriction needs to be increased, this procedure can reduce up to 70% of the stomach.

Transit Bipartition Success Rate

Numerous studies have been conducted to determine the success rate of Transit Bipartition, and according to the research, 94% of individuals with obesity lost weight after the procedure. This method provides a feeling of fullness, resulting in rapid weight loss. In addition, studies have shown an 86% decrease in diabetes among patients. Transit Bipartition has also been found to be highly effective in correcting metabolic issues.

Risk Is Less and Success Rate Is More

ver the years, various treatment methods and approaches have been attempted on patients with varying degrees of success. As the world evolves and changes, new treatment methods emerge. Compared to surgeries for obesity and diabetes, this treatment method is relatively low-risk. Nevertheless, the success rate of this low-risk treatment method is extremely high. With the help of reliable expert support and in a reputable medical institution, you can eliminate your illnesses through this application that is easily administered and regarded as trustworthy.

How Is Transit Bipartition Applied

The attending physician explains in detail where and how to start the treatment process after conducting various analyses and studies. The patient is prepared for the treatment process to initiate treatment. During the operation, a portion of the stomach is removed to stop the secretion of the hunger hormone Ghrelin and eliminate the desire to eat. An intestinal passageway is created by making changes to the small intestine. Following the operation, the specialist monitors the patient for a period of time and observes how the operation is progressing and how the operation system is functioning.

Advantages of Transit Bipartition

The current medical procedure is widely recognized and recommended for its numerous benefits. Some of the benefits include the following:

• The treatment is completed by preserving the integrity of the stomach and twelve intestines with the operation anatomically.
• It provides all kinds of endoscopic procedures if needed after surgery.
• It can be easily returned to normal if requested upon the recommendation of the patient or doctor after surgery.
• By showing strong hormonal activity, the patient returns to normal life in a short time.

Unlike other stomach reduction surgeries, transit bipartition is performed more comprehensively and reliably by correcting not only the stomach but also the intestinal working system. It helps prevent digestive problems and enables patients to return to their normal lives in a short time. By seeking treatment in reputable health institutions that offer institutional services and using the new generation treatment method under the supervision of reliable experts, patients can find a permanent solution to their illnesses. Consulting with various health institutions and specialist physicians can lead to more informed decisions when deciding to start treatment.

Bariatric Surgery Revisions

Revisional bariatric surgery is performed to repair or change a previous weight loss surgery. It might be appropriate for you if you’ve had less-than-optimal weight loss or weight regain, or if you experienced complications from your original procedure. More common complications include ulcers, pouch enlargement or the loosening of a lap band.
While revisional surgeries are often more complex than initial bariatric surgeries, our skilled surgeons have a wealth of experience performing gastric bypass revisions and gastric sleeve revisions. We will carefully evaluate you and review your case to determine why your previous procedure failed. That way, we can take the most appropriate approach to help you achieve the best possible outcome.

Am I a Candidate for Revisional Bariatric Surgery?

You may qualify for revisional weight loss surgery if your original bariatric procedure did not result in optimal weight loss, or if you’ve regained a significant amount of your excess body weight. Regaining a small amount of weight is common after all bariatric surgeries.
A revisional surgery might also be appropriate if you experienced complications from your original procedure.

Will my Insurance Provider Cover the Procedure?

Coverage for revisional bariatric surgery is determined by your specific insurance provider and plan. Generally, if you are experiencing complications related to your original procedure, you’ll be approved because of a medical need. However, if you are seeking a revisional bariatric surgery because of less-than-optimal weight loss or weight regain, you might experience more difficulty getting approved. This depends upon your specific insurance provider and insurance plan.

What Results Can I Expect After a Revisional Procedure?

Results from revisional bariatric surgery vary, but weight loss is generally less substantial than after your original procedure.
Your results also depend on your original bariatric procedure. Many patients who initially had a lap band can expect significant weight loss after a conversion to Roux-en-Y gastric bypass.

What are the Risks of Revisional Procedures?

Revisional weight loss surgery is more complex and has a higher risk for complications than an initial bariatric procedure. However, it is a safe and effective choice when performed by experienced bariatric surgeons.

What is Your Policy if Another Surgeon Performed my Original Bariatric Surgery?

We often work with patients who had their first bariatric surgery performed elsewhere.

Pre & Post Surgery Services

Pre-operative and post-operative preparations are required for a bariatric surgery to ensure successful outcome.

Planning Your Medical Trip

Consultation:Our dedicated team will connect with you and will answer all of your questions. You will be provided with help in order to get to know what’s best for your case. Therefore, we will make sure you will be getting the results you are wishing for!
Planning:Your bookings and appointments are pre-organized by our Coordination Team, and that’s how we like to make sure that the trip goes as smoothly as possible, without any sorts of trouble or inconvenience.
Transportation:A whole fleet of modern and comfortable cars is at your disposal, both at the moment of your arrival to the Istanbul Airport and the moment you leave the country.
Accommodation:Your consultant will provide you a variety of luxurious Istanbul hotels to pick from... And It is FREE !
Medical Follow-Up:Even after the surgery, we keep in touch with you and answer your questions. In addition, we give you pieces of advice and provide medical guidance to guarantee the most satisfying and optimal results.

Pre-Surgery

Before the surgery, the patient must undergo:

• Health screening e.g. blood test, ultrasound, x-ray, electrocardiography, lung function test
• An endoscopy to inspect the stomach to ensure that the patient does not have other stomach diseases that may not suit for bariatric surgery.
• A consultation with a dietician to evaluate and preparation for post bariatric diet modification.
• A psychological assessment to ensure that the patient does not have major psychiatric disorder that prohibited bariatric surgery and patient is willing to make the necessary lifestyle changes required after the surgery
• Current medical condition assessment e.g. heart disease, diabetes, hypertension
• A STOP-BANG evaluation and a sleep test
• A consultation with a rehabilitation physician regarding physical activities and exercises, pre and post-surgery
• Stop smoking 4 weeks before the surgery.
• Refrain from eating and drinking after midnight prior to the day of the surgery. If the patient has to take any medication, follow the doctor’s instructions.
• If you are not sure whether you are pregnant, consult your doctor or nurse.
• Consult the doctor if you are taking any herbal medicine or dietary supplement.
• Inform your doctor if you have taken blood thinner or any history of venous thrombosis.
• All patient would be given blood thinner 12 hrs before surgery.

Post-Surgery

After surgery, as Obesity Academy, we will follow up our patients with required recommendations and guides. We will plan personalized diet based on our patient and on conducted surgery with our nutritionists and experts. During whole recovery processes, the patients will be under our guidence and control.

• Personalized diet plans prepared by our dieticians
• Periodical medical check ups until full recovery
• Physical exercises and recommendations by our fitness training experts
• 24/7 consulations