Monday, November 5, 2012

Ask Us Anything: Do You Perform Lap Band Surgery on Patients Who Have Had Gastric Bypass?

"Do you perform lap band surgery on patients who have had gastric bypass?"

Dr. Dang Tuan Pham Responds:

Gastric bypass whether done laparoscopically or open is an excellent surgical procedure for the treatment of morbid obesity (defined as Body Mass Index >40 kg/m2 alone or >35 kg/m2 with significant co-morbidities) and constitutes the standard of care in the United States to which all other bariatric procedures are compared.

Unfortunately, a few patients despite their initial success, may regain some, if not all, of their weight. There is much debate in the medical community about why these patients regain weight, and the answer is still not clear, but some reasons such as poor eating habits, grazing, stretching of the stomach pouch, widening of the opening between the stomach pouch and the small intestine (gastrojejunostomy stoma), or adaptation mechanism of the small intestine, have more proponents than others.

The evaluation of a patient for revision is a comprehensive process consisting of a careful review of the patient's weight loss history, a detailed history and physical examination to eliminate an endocrinologic disorder, a multidisciplinary nutrition, behavioral health and gastroenterology specialist evaluation, as well as ancillary testing such as an upper GI radiographic examination to review the anatomy etc.

Then, if indicated, we might propose one of  three options:
  1. A laparoscopic band over bypass
  2. A laparoscopic gastric pouch stapling or suturing to reduce the volume of the gastric pouch
  3. Transposition of the jejunojejunostomy anastomosis more distally along the intestinal tract
A fourth option is the ROSE procedure, a transoral, endoscopic outpatient procedure consisting of suturing the GJ stoma to narrow the opening between the pouch and the small intestine but this is not currently offered at my practice.

In the lapband over bypass procedure, an adjustable gastric band is placed laparoscopically (through small openings) around the stomach pouch, providing the restriction that is currently missing from the patient's gastric bypass due to the dilated pouch and stretched stoma. An appropriately adjusted gastric band will keep food in the pouch producing satiety for the patient.

The band over bypass requires an overnight stay in the hospital and has a low complication rate but necessitates a high level of commitment from the patient.

Repeat weight loss varies from patient to patient but may go as high as 50-70 lbs. after one to two years.

– Dr. Dang Tuan Pham

Dr. Pham practices at Buffalo Minimally Invasive Weight Loss Surgical Solutions, PLLC. His entire practice is dedicated to helping the obese lose weight and start leading a healthier lifestyle. He makes it a priority to establish long-lasting personal relationships with his patients so that they can more easily maintain their new, healthier lifestyle.

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1 comment:

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