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Our experienced surgeons provide all approved bariatric surgery procedures performed today. Although each procedure is different, they are all based on the same concepts: restriction, malabsorption or a combination of the two.

  • Restriction limits the amount of food that can be
       comfortably eaten at any one time by reducing the
       capacity of the stomach.
  • Malabsorption causes food and calories to be incompletely
       absorbed through bypassing a portion of the intestine.

In order to fully understand how restriction and malabsorption promote weight loss, you must first understand how the digestive tract normally functions.

  • Food moves from our mouth, down the esophagus and
       into the stomach, which normally holds about 3 pints
       of food.
  • In the stomach, food mixes with acids and other digestive
       juices to help breakdown proteins, fats and carbohydrates for absorption.
  • The partially digested food moves into the duodenum (the first segment of the small
       intestine) where most of the iron and calcium contained in our food is absorbed.
  • The digestive process continues as food moves through the jejunum (the middle section
       of the small intestine) into the ileum (the last segment of the intestine) where fat-
       soluble vitamins A, D, E and K and other nutrients and calories are absorbed.
  • Any remaining food particles move on to the large intestine for elimination in the stool.

Gastric banding procedures are purely restrictive and work by limiting the amount of food that can be comfortably eaten at one time. Because no changes are made to the intestine, there is no interference in the digestive process and absorption of calories and nutrients.

Vertical banded gastroplasty (VBG) involves stapling the upper stomach near the esophagus to create a small stomach pouch and placing a band at the pouch's outlet. The band delays emptying of food from the stomach pouch, causing a feeling of fullness.

The adjustable gastric band or gastric lap band is the most recently developed banding procedure. The inflatable band is laparoscopically placed around the upper part of the stomach; there is a reservoir connected to the band that is implanted under the skin of the abdomen. Using this reservoir, varying amounts of fluid can be added or removed to adjust the tightness of the band.

Gastric banding procedures are technically easier to perform and involve a shorter operating time. They have a very low mortality rate and require only a short hospital stay. Other advantages include the absence of dumping syndrome, and less likelihood of malabsorptive problems. These operations are completely reversible by removing the band.

One of the most common problems associated with gastric banding is vomiting, which occurs when the patient eats too much or if the opening into the larger part of the stomach is blocked. Other disadvantages include a risk of the band slipping or eroding, a break in the tubing between the band and the reservoir, and less commonly, infection or bleeding. Long-term weight loss results with an adjustable gastric band/lap band are not yet available, but current statistics show that patients with gastric bands lose less weight (47.5%) in comparison to patients who have had a Roux-en-Y gastric bypass (61.6%).

Roux-en-Y gastric bypass is the most commonly performed procedure in the United States and is considered the "gold standard" in bariatric surgery. It is the most successful bariatric procedure in terms of amount of weight loss and long-term maintenance of weight loss. The Roux-en-Y promotes weight loss through a combination of restriction and malabsorption. Restriction is achieved by creating a very small stomach pouch, limiting the amount of food that can be eaten at one time. Malabsorption occurs when the new stomach pouch is attached to the jejunum (second segment of the small intestine) after "bypassing" the duodenum (the first segment of the small intestine).

Patients who undergo a Roux-en-Y gastric bypass typically lose weight quickly and are able to maintain a 60% to 70% excess weight loss for 10 years or more.

The Roux-en-Y gastric bypass may be performed either laparoscopically or using the traditional or "open" method. Weight loss results are the same regardless of which approach is used. To determine which approach is best for you, your surgeon will consider your individual circumstances. Consideration is given to your surgical history, your respiratory status, your BMI and other health conditions. Even if your surgeon begins your operation laparoscopically, certain situations may require the operation to be converted to an open procedure in order to complete the operation safely. Every patient must be aware of this possibility before the operation begins because the decision to convert to an open procedure is made during the operation when you are asleep. As with any major abdominal operation, the Roux-en-Y procedure has risks for potential complications, including death, whether performed laparoscopically or open. Your surgeon will discuss the potential risks with you in detail during your preoperative consultation.

Biliopancreatic diversion with duodenal switch (BPD/DS) is a complex combination of restrictive and malabsorptive procedures. This is a difficult procedure that is only available for small number of patients in very specific circumstances.

The major advantage for patients is that a larger amount of food can be eaten while the patient still loses weight. With BPD/DS, most studies report an average excess weight loss of 75% to 80%.

There are several disadvantages including a greater risk of nutritional deficits, frequent soft bowel movements, frequent passing of foul-smelling gas, change in body odor, gas pains and bloating, hair loss and intolerance of certain foods (varies from person to person). The risk of death associated with a biliopancreatic diversion with duodenal switch is 2.5% to 5%, higher than other bariatric procedures.

Sleeve gastrectomy is a relatively new restrictive procedure that is performed on a select population of people. Approximately two thirds of the stomach is removed and the remaining stomach portion takes the shape of a tube or "sleeve." The capacity of the remaining portion is generally around 200 cc, allowing a greater portion of food tolerated at any one time.

This procedure may be performed as the first stage of a two-part gastric bypass operation for individuals with a very high BMI. At some point after the sleeve gastrectomy when the patient reaches a safer weight, the second stage of the procedure can be performed. This part usually involves incorporating a malabsorptive component such as a duodenal switch or a gastric bypass.


A personal commitment to life-long follow-up is required. Bariatric Surgery can dramatically improve the quality of your health and life, but it does require personal commitment. You will be expected to see your doctor regularly, attend bariatric support groups, maintain a healthy diet, stay active and report any unusual health concerns immediately.

Learn More

If you are considering bariatric surgery or want to learn more about our bariatric surgery program, call 1-800-782-8581 extension 79220, or 715-387-9220 or email bariatric.surgery@marshfieldclinic.org

You may also click here to watch a Webcast video of an actual bariatric surgery performed by the Marshfield Clinic bariatric team.

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