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Patients who are morbidly or severely obese are at increased risk for health problems and tend to have a shortened life span. There is also added potential risk from continued weight increase. The risk of severe obesity is greater than that of its surgical treatments. Persons eligible for weight loss surgery include the following:

  • Persons at least 70 pounds above ideal body weight.
  • Persons who are at least 50 pounds over weight and have life-threatening obesity related problems such as diabetes, hypertension, sleep apnea, etc.
Surgery has become an acceptable method of treatment for clinically severe obesity because it appears to be the only option which can provide long-term maintained weight loss in-patients with clinically severe obesity. In fact, the number of patients having surgical treatment of obesity has doubled in recent years. Stomach, or gastric operations, have been preformed since 1969. Currently, the two leading approaches to weight-loss surgery in the United States are Roux-en-Y gastric bypass and adjustable gastric banding. Vertical banded gastroplasty, or stomach stapling, is less commonly performed today. Obesity surgeons should be skilled in more than one surgical approach as the specific procedure needs to be carefully matched to the individual patient.
Gastric Band

Gastric banding, which is performed laparoscopically, is one of the least invasive approaches to obesity because neither the stomach nor the intestine is cut. It is now the most common weight loss procedure performed in the world today. It is also the safest weight loss surgery option and the only procedure endorsed for the FDA.

The amount of weight you lose with gastric banding depends on your motivation and commitment to a new lifestyle and eating habits. Gastric banding can help you achieve longer lasting weight loss by:

  • limiting the amount you can eat
  • reducing your appetite
  • slowing digestion.

How It Works

Laparoscopically placed around the upper part of the stomach, the band divides the stomach into a small upper pouch above the band and a larger pouch below the band. This small pouch limits the amount of food that a patient can eat at any one time, and will result in a feeling of fullness after eating a small amount of food.



Band Adjustment

Adjusting the size of the opening between the two parts of the stomach controls how much food passes from the upper to the lower part of the stomach. This opening (stoma) between the two parts of the stomach can easily be decreased or increased, by injecting or removing saline from the band. The band is connected by a tube to a reservoir placed beneath the skin during surgery. The surgeon or nurse practitioner can later control the amount of saline in the band by piercing the reservoir through the skin with a fine needle. The ability to adjust the band is a unique feature of gastric banding and is a normal part of follow-up.

Benefits

Because the band is removable, adjustable and does not permanently alter the anatomy, it provides an option for patients who may not otherwise consider surgery for treatment of their obesity. Other advantages include a shorter hospital stay and no effects on the absorption of nutrients.

Expected Weight Loss

Estimated weight loss is approximately 80 to 150 pounds over two years.

In general, most patients find they are unable to easily tolerate red meat, pasta, rice, fresh bread and fibrous foods. You will be asked to eat three meals a day with one to three planned snacks, chew your food very well and swallow slowly. You must drink only calorie-free or low caloric beverages and wait at least one hour after eating to drink.

The Lap-Band procedure also results in an effective resolution of major illnesses that ordinarily accompany obesity. Nearly 85 to 90 percent of overweight patients suffering from hypertension, diabetes, sleep apnea and other major illnesses will see a significant improvement or resolution after undergoing Lap-Band.

Gastric Sleeve

Sleeve gastrectomy is a new procedure that induces weight loss by restricting food intake. With this procedure, the surgeon removes approximately 60 percent of the stomach laparoscopically so that the stomach takes the shape of a tube or "sleeve." This procedure is usually performed on superobese or high risk patients with the intention of performing another surgery at a later time. The second procedure can either be a gastric bypass or duodenal switch.

Expected Weight Loss

This combined approach has tremendously decreased the risk of weight loss surgery for specific groups of patients, even when the risk of the two surgeries is added. Most patients can expect to lose 30 to 50% of their excess body weight over a 6 - 12 month period with the sleeve gastrectomy alone. The timing of the second procedure will vary according to the degree of weight loss, typically 6 - 18 months.

Gastric Bypass

Nearly 140,000 of these procedures are performed in America every year. Gastric bypass works in two ways: restriction and malabsorption.

Restriction of large amounts of food

The stomach is stapled to create a small ‘gastric pouch’ that is connected to the rest of the small intestine. This reduces the actual size of the ‘functional’ stomach from about 400 ml to a mere 15 to20 ml and limits the amount of food consumed at one time, therefore ‘restricting’ food intake.

Malabsorption of nutrients

Bypassing the stomach and about 75 centimeters of the small intestines results in the malabsorption of fats and carbohydrates, which further adds to the efficacy of the procedure. The combination of malabsorption and restriction make gastric bypass an effective procedure for surgical weight-loss.

Gastric bypass also results in an effective resolution of major illnesses that ordinarily accompany obesity. Nearly 85 to 90 percent of overweight patients suffering from hypertension, diabetes, sleep apnea and other major illnesses will see a significant improvement or resolution after undergoing gastric bypass.



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