First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

1. Restricts the amount of food the stomach can hold
2. It induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass.
Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with maintenance of >50%
3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)
4. Involves a relatively short hospital stay of approximately 2 days
5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety

1. Is a non-reversible procedure
2. Has the potential for long-term vitamin deficiencies
3. Has a higher early complication rate than the AGB

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach.

Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

1. Produces significant long-term weight loss (60 to 80 percent excess weight loss).
2. Restricts the amount of food that can be consumed.
3. May lead to conditions that increase energy expenditure.
4. Produces favorable changes in gut hormones that reduce appetite and enhance satiety.
5. Typical maintenance of >50% excess weight loss.

1. It is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates.
2. It can lead to long-term vitamin/mineral deficiencies, particularly deficits in vitamin B12, iron, calcium, and folate.
3. Generally has a longer hospital stay than the AGB.
4. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance.

The common explanation of how this device works is that with the smaller stomach pouch, eating just a small amount of food will satisfy hunger and promote the feeling of fullness.

The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.

1. Reduces the amount of food the stomach can hold.
2. Induces excess weight loss of approximately 40 – 50 percent.
3. Involves no cutting of the stomach or rerouting of the intestines.
4. Requires a shorter hospital stay, usually less than 24 hours, with some centers discharging the patient the same day as surgery.
5. It is reversible and adjustable.
6. It has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures.
7. Has the lowest risk for vitamin/mineral deficiencies.

1. Slower and less early weight loss than other surgical procedures.
2. Greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed.
3. Requires a foreign device to remain in the body.
4. Can result in possible band slippage or band erosion into the stomach in a small percentage of patients.
5. Can have mechanical problems with the band, tube or port in a small percentage of patients.
6. Can result in dilation of the esophagus if the patient overeats.
7. Highest rate of re-operation.

The technique that Dr. LUIS PASTEN prefers involves the use of a singular access device that permits the ingress of 3 or 4 instruments through a single opening in the umbilicus into which the device is first inserted also inserted through an incision measuring anywhere between 17 and 50 mm depending on the port and the organ to be accessed/removed, for example in a cholecystectomy (Gallbladder removal).

The average incision for a GASTRIC SLEEVE is about 20-35 mm. It makes sense to take slightly bigger incisions and get more play between the instruments when the organ to be removed is larger. In order to qualify for this kind of procedure it is required to have a LOW BMI, that means your BMI needs to be 35 or lower.

In BMIs higher than 35 the belly button gets further from the site of action which results in a harder procedure to be done, increasing the risks for possible complications.

1. SILS only requires one small incision, which minimizes scarring compared to traditional laparoscopic surgery.
2. Patients who undergo SILS generally experience less pain and require less time to recover than those who undergo traditional laparoscopic surgery.
3. Because SILS only requires one small incision, there is a reduced risk of infection compared to traditional laparoscopic surgery, which requires multiple incisions.

1. SILS can be more challenging for the surgeon because they have to work through a smaller incision, which can limit their visibility and range of motion.
2. SILS can take longer to perform than traditional laparoscopic surgery because the surgeon has to work through a smaller incision and maneuver the instruments carefully.
3. SILS may increase the risk of complications such as bleeding, organ injury, and hernias due to the smaller incision and limited visibility.

It has been advocated that a Hiatal Hernia found at the time of bariatric surgery SHOULD BE REPLACED as failure to do so may worsen GERD symptoms over time. The concomitant hiatal hernia repair at the time of a Sleeve Gastrectomy and Roux-en-Y gastric bypass (RYGB) is safe, well-tolerated, and with minimal additional cost.

A hiatal hernia found at the time of sleeve gastrectomy should be repaired during the index operation, otherwise the upper portion of the stomach that has been slide through the thorax will act as a stretch pouch ending in weigh loss failure. Crural repair with sleeve gastrectomy provides control of gastroesophageal reflux disease (GERD) and weight loss.

In some cases where patients suffer from severe acid reflux might get better control for GERD symptoms choosing a Bypass Roux-en-Y rather than having a sleeve gastrectomy, GERD symptoms are caused by multiple reasons such overweight, hiatal hernia, alcohol, medication, etc.

Please contact us to find out which procedure suits you best if you are suffering from acid reflux.

Epidemiological studies have found that the lithogenic risk of obesity is strongest in young women, and that slimness protects against cholelithiasis. Obesity and rapid weight loss are major risk factors for the development of cholelithiasis (gallbladder stones).

Patients after bariatric surgery are at an increased risk for gallstones formation and subsequent cholecystectomy. The risk of developing gallstones is from 20-30% during the first 6 months after surgery and about 20% the next 6 months with an incidence of 55.4% in total no matter which procedure you went through, but it is well known that is slightly more frequently in post Gastric By-Pass
patients.

Rapid weight loss is associated with occurrence of sludge and gallstones in 20-30% of patients in a few weeks of initiating the slimming procedures.

If a person loses weight tissue stores.

In fasting associated with severely fat restricted diets, gallbladder contraction is reduced, and the accompanying gallbladder stasis favors gallstone formation.

Dr. Luis Pasten recommends in a prophylaxis approach to remove the gallbladder at the same time that weight loss surgery is performed.

Preventing the high probability of having to be intervened, because of gallstones interfering with the patient's routine and the uncomfortable recovery time period. For a minimal additional cost.

If there’s previous family members who have already suffered from gallstones, you might consider on choosing this option as a form of prevention.