Surgical operations for the control of clinically severe obesity are based on one or both of two principles. The first is restriction, whereby the amount of calories or food ingested is controlled by limiting space available. The second principle is malabsorption, whereby the absorption of food is controlled or reduced.
Since the advent of bariatric surgery in 1959, operations have been improved and modified again and again, undergoing many changes while overcoming a questionable early history. Early failures were associated with techniques which have since been abandoned, such as the jejunal-ileal bypass, simple gastric stapling, and the horizontal gastroplasty procedure. Surgeons have continued to modify and improve surgical procedures in view of the ineffectiveness of most non-surgical methods. Further enhancements are in process as new technologies and surgical methods become available.
Our nationally recognized bariatric surgeons perform three options for weight-loss surgery.
Adjustable Gastric Band
Missouri Bariatric Services is proud to offer both Lap-Band® and Realize® brand adjustable gastric bands. Both are adjustable, restrictive surgical procedures. A silicone band is placed around the upper part of the stomach to create a small pouch and narrow passage into the larger remaining portion of the stomach.
For more information about Lap-Band® and Realize® brand bands, follow the links below:
One tiny incision, no visible scars
Missouri Bariatric Services is one of the only programs in the United States to offer single site incision adjustable gastric band placement for both Lap-Band® and Realize® brand bands. For qualifying patients, our surgeons can also use single incision laparoscopic techniques to place the adjustable gastric band with virtually no visible scarring.
Single-incision surgery leaves almost no visible scar on the patient's abdomen. Once the wound heals, it is virtually invisible. Patients also experience less pain and a faster recovery, since the surgery involves fewer incisions. The adjustable gastric band is a silicone band that is surgically placed around the top part of the stomach to reduce the amount of food a patient can hold in the stomach. The band helps obesity patients gain the ability to control portion size and realize long-term weight loss.
Traditional laparoscopic gastric banding surgery involves a surgeon making as many as six small incisions in the patient's abdomen. Single incision laparoscopic surgery (SILS) technique requires only a single incision in the patient's navel. Through that incision, the surgeon surgically places the gastric band device in the standard location inside the patient's stomach.
Roux-en Y Divided Gastric Bypass Surgery
The divided gastric bypass with Roux-en-Y gastro-jejunostomy consists of separating the stomach into two sections using parallel rows of titanium staples, with many of the staples additionally over-sewn or secured with sutures as needed. The staples remain fixed and do not migrate. The small upper segment connected to the esophagus remains the food-functional portion of the stomach, while the large lower segment connected to the duodenum, though still functional, does not deal with food eaten by the patient.
In the next phase, the surgeon disconnects the continuity of the small intestine (upper jejunum) and brings the lower end up to the small gastric pouch still connected with the esophagus. This section of the intestine is still functional. The intestine is connected to this small stomach pouch by means of an opening about the size of a dime. This allows food to pass directly into the intestine where it is digested. This is called a gastro-jejunostomy
When the small functioning upper stomach pouch is full (at first this will occur with only a nibble or two), patients experience a sense of fullness. In this way, and because the appetite will also be reduced, the intake of food is dramatically limited. This is what enables weight loss. What food is eaten is handled by the body quite well.
On average, patients will lose about 100 lbs. or up to two thirds of their excess weight in one year. Some people lose a little more, some a little less. Weight loss will continue during the second year at a less rapid rate.
As with any surgery, these procedures carry risks and possible side effects, but the amount of weight loss can be significant and dramatic.
Read more about possible complications and postoperative steps:
Vertical Sleeve Gastrectomy
The vertical sleeve gastrectomy procedure generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption. It is a purely restrictive operation.
Facts about vertical sleeve gastrectomy
- The portion of the stomach that produces the hormone that stimulates hunger (Ghrelin) is removed.
- The stomach is reduced in volume but tends to function normally.
- No dumping syndrome because the pylorus is preserved.
- Minimizes the chance of an ulcer occurring so the use anti-inflammatory drugs such as aspirin, Motrin, Aleve and ibuprofen should not be a problem.
- No intestinal bypass and therefore little chance of nutritional deficiencies
- Safer alternative for high body weight (>400 pound) or medically high-risk patients.
- No foreign body or implanted devices.
- Can be done Laparoscopically in virtually all patients.
- 99% leave the hospital within one day.
Please check with your insurance company if the vertical sleeve procedure is a covered benefit for you.
Revision of Previous Weight Loss Surgery
In most cases, a single weight loss surgery is sufficient to provide the desired results for adequate weight loss. However there are cases where patients have received previous bariatric surgery and significant weight gain or unanticipated adverse events are experienced.
Missouri Bariatric Services does accept revision surgery candidates on a case by case basis. Each revision case is reviewed by the Missouri Bariatric Services Clinical Committee, consisting of our surgical and medical team.
With the unique nature of revision surgery, criteria for candidacy depend on the individual circumstance of each patient. In order to qualify as a candidate for a revision surgery in our program, and to maximize your safety, a number of tests may be required prior to consideration. For patients who have experienced significant weight gain after surgery, participation in our Back-on-Track™ weight loss program may be required.
If you have received previous weight loss surgery, please complete the online form for consideration.
Get started by filling out our Revision of Previous Surgery form.