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The Roux-En-Y gastric bypass procedure has long been held as the "gold standard" for weight loss surgery. A restriction of food intake is achieved by dividing the stomach into two portions, the smaller of which is approximately 30ml in size. The small intestine downstream is divided, and a Roux limb is attached to the stomach pouch to allow it to empty. The excluded stomach and upper portion of the small intestine is bypassed, providing a small component of malabsorption. However, the main effect of the procedure is to provide a sense of fullness with eating smaller portions of food, allowing the patient to gradually adjust to smaller, more appropriate meals.
Laparoscopic adjustable gastric banding, using the LAP-BAND® system, is an alternative method of weight loss surgery that is less complicated than gastric bypass surgery. It involves placement of a silicone band around the top of the stomach, which can be adjusted to achieve an appropriate sensation of fullness with eating smaller portions of food.Unlike gastric bypass surgery, the procedure does not involve re-routing of the GI tract, and the band is removable. Weight loss is more gradual than with gastric bypass surgery, and the band is adjusted according to weight loss progress and sensation of fullness.
Sleeve Gastrectomy is a restrictive bariatric procedure where the surgeon creates a small, sleeve out of the stomach by removing most of the stomach. The gastric reservoir is larger than the stomach pouch created during Roux-En-Y gastric bypass and is the shape and size of a banana. Some surgeons use the sleeve as a primary bariatric operation and some use it as the first part in a staged approach to treating very high-risk patients. Because sleeve gastrectomy removes the majority of the stomach, it can not be reversed. If a leak occurs following a sleeve operation, the complications from the leak can be much more severe than a laparoscopic banding or even a gastric bypass. The advantage to sleeve gastrectomy is that it does not bypass the duodenum and therefore calcium and iron absorption may be improved when compared to gastric bypass.
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