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Laparoscopic Operations

The Newest and Most Exciting Breakthrough in Obesity Surgery is the use of Laparoscopic Techniques

Laparoscopic Surgery Benefits:
  • Tiny Incisions
  • Less Discomfort
  • Shorter Hospital Time
  • Quick Recovery


What is Laparoscopy?

Laparoscopic surgery began to be performed widely in the United States in the early 1990's, when it first began to be used for removal of the gallbladder. Using a thin tubular telescope and a tiny high-resolution video camera, the surgeon can see, on a TV monitor, what the camera sees inside the abdomen, through a pencil-sized "portal" passed through the abdominal wall. Other "ports" are placed, through which long, slender instruments can be inserted, to do the actual surgery. The surgeon must learn to move the instruments, based upon what he sees on the screen, not what he feels. Sometimes lasers are used as well, although many operations are accomplished just as well, without the need for lasers. Although the operation achieves the same result, there is no large and painful incision. Patients who have undergone Laparoscopic Gallbladder surgery can attest to reduced discomfort and rapid recovery, and excellent cosmetic results that are usually achieved with this method.

In just a few years, a wide variety of instruments have been developed, including sophisticated stapling and suturing devices, which permit laparoscopy to be applied to many other types of surgical operations. The use of laparoscopy for more complex operations, in which the stomach or bowel is cut and re-connected, is called "Advanced Laparoscopy".

Laparoscopic Gastric Bypass, Roux en-Y

Gastric Bypass, Roux en-Y has been the "gold standard" operation for the treatment of Morbid Obesity, for several years. It is, in our opinion, the procedure with the best combination of benefits and risks, for most patients. The operation is complex and difficult, and can be organized into three steps:

  • Division or partitioning of the stomach into two parts - an upper small pouch, and a lower, large pouch.
  • Creation of a Y-connection in the small bowel, to make a new end to connect to the stomach.
  • Connection of the new small bowel end to the upper stomach pouch, to bypass the stomach.
    You can read more about the effects of this operation, in Surgical Operations for Morbid Obesity.
    We have recreated the Gastric Bypass, Roux en-Y as an advanced laparoscopic procedure, using the same anatomy and connections, and varying only the instruments used to perform it laparoscopically.

The results of this operation, which we have published and presented internationally, show:

  • Operating time is slightly longer than the open operation (about 75 -120 minutes laparoscopically, versus 60 - 90 minutes open).
  • Recovery time is shorter: typically 2 days in the hospital, and 10 -14 days to return to full activity.
  • Weight loss is excellent, averaging 80% of excess body weight after one year, and maintained at 80% for over five years following surgery (for as long as the operation has been done this way).
  • Over 95% of all weight-related health problems (co-morbidities), such as high blood pressure, diabetes, sleep apnea, gastroesophageal reflux, stress incontinence, and degenerative arthritis pain, are relieved by one year after the operation - often much sooner.
  • Mortality rate has been less than 0.07%, in our series. This compares with reported mortality rates of 0.5 to 2.5 % in other bariatric surgery series.
  • Complication rate has been similar to that with the open operation, except that no incisional hernias (hernias occurring through the scar of the incision) have occurred, with the laparoscopic technique. We emphasize that one should not think of the laparoscopic operation as reducing the risks of bariatric surgery. It reduces pain and discomfort, inconvenience, recovery time, and scarring.
  • Cosmetic results have been an added benefit for some of our younger patients, who now are proud to wear a two-piece bathing suit.
  • Laparoscopic Gastric Bypass can be performed on all but the very severely obese, where length of the instruments may limit the technique. We advise against attempting the technique when patients have had prior open operations in the upper abdomen, especially on the stomach.

Laparoscopic Adjustable Silicone Gastric Banding

The Laparoscopic Adjustable Silicone Gastric Band (LASGB) is a device designed to produce a small upper gastric pouch, and a narrow opening from it into the lower stomach. It causes a sense of fullness after only a few bites of food, and it helps the decision to reduce food intake, and to lose weight.

The LASGB has several potential advantages, if it can be shown to be safe:

  • It is inserted laparoscopically, without a major incision., with a short hospital stay - usually just overnight.
  • There is no opening made into the GI (gastrointestinal) tract, so the risk of leakage and infection is likely to be reduced.
  • There is no staple line (like in the gastroplasty, the nearest other procedure) to potentially break down.
  • It is adjustable.
  • It is readily convertible to another operation, if the procedure fails to maintain the desired weight loss.

This operation is especially attractive to persons who can spare only a small amount of time, and who need to return quickly to full activity. With one to two days hospitalization, a busy executive can return to his desk, and gain control over troublesome weight problems.

A more accurate evaluation awaits the final results of the FDA protocol study, which will not be available for about 3 more years. Until then, a person who choses this technique must accept the possibility of some uncertainty about the ultimate safety and results of the operation.

The Laparoscopic Decision

The bottom line on the laparoscopic approach:

  • Laparoscopic Gastric Bypass, Roux en-Y: a proven effective operation, with dramatic weight loss, 2 - 3 day hospital stay, and low risk of morbidity and mortality.
  • Laparoscopic Adjustable Silicone Gastric Banding: a 1-2 day hospital stay, and (probably) the lowest risk of morbidity and mortality.

If shorter hospital stay, reduced discomfort and disability, and superior cosmetic results are important to your decision, the choice of Laparoscopic Gastric Bypass or Laparoscopic Adjustable Silicone Gastric Banding is one you should consider.

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