MINIMALLY INVASIVE WEIGHT LOSS SURGERY
Laparoscopic Bariatric Surgery is an innovative option and is referred to as minimally invasive surgery. It has replaced the traditional open surgery in our weight loss surgery program.
Because laparoscopic surgery is minimally invasive and requires only small incisions, the surgical risks are lowered. Benefits of this approach include faster healing times, less scarring, less blood loss during surgery, reduced postoperative pain and fewer wound complications including infection and hernias.
Laparoscopic bariatric surgery requires a high level of skill to be performed properly and safely. These procedures are technically advanced and complex requiring surgeons to obtain extensive specialty training. When performed by DHMR Clinic's experienced specialists, laparoscopic bariatric surgery is a safe treatment option and offers definite advantages to our patients.
In this method of weight loss surgery small, ½ inch incisions are made to insert surgical instruments and a telescope (laparoscope), which is connected to a video camera. This telescopic system maintains an enhanced visual field and allows the operation to be viewed on a video monitor while the surgery is performed using small laparoscopic instruments.
DHMR Clinic's program also offers robotic assisted bariatric surgery using the da Vinci® Surgical Robot System. Using this cutting edge technology the surgeon views the operative area on a monitor with high-resolution images relayed through a high-definition 3-D camera, then performs the surgery with hand movements that are translated from the controls of the robot to small robotic instruments that precisely carry out the surgeon’s movements.
SURGICAL WEIGHT LOSS OPTIONS
Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy is a minimally invasive, restrictive procedure that permanently reduces the size of the stomach by 70 to 80 percent, limiting food intake. It further diminishes cravings for food by removing the section of the stomach that produces the “hunger hormone” Ghrelin.
The removal of the section of the stomach that contains this hormone also results in an increase in the body’s metabolic rate and its fat burning capabilities, as well as it decreases the appetite. The elimination of Ghrelin, coupled with the physical reduction in the stomach’s capacity to store food takes some or the effort out of the weight loss process allowing it to occur seemingly naturally.
Laparoscopic Gastric Bypass
In Roux-en-Y Gastric Bypass surgery the stomach is divided close to its upper end leaving a small pouch as the functional stomach. By creating this small stomach pouch, food intake is restricted. The small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine).
This reduces huger, cravings the amount of food that can be digested and absorbed. The gastric bypass results in rapid weight loss and a reduction or elimination of certain health conditions, such as Type II Diabetes, Acid Reflux, High Cholesterol and Sleep Apnea.
Laparoscopic BilioPancreatic Diversion with Duodenal Switch
This complex surgical procedure combines limiting food intake by removing 60% of the stomach and limiting digestion and energy absorption by excluding part of the small intestine from the digestive process.
This procedure is generally recommended for individuals with high Body Mass Index (over 50) and who are suffering from metabolic problems such as diabetes, high lipids and cholesterol and hypertension.
Laparoscopic Adjustable Gastric Banding
A silicone band is placed around the upper part of the stomach creating a narrow passage to the lower portion, causing slow movement of food through the digestive system.
Since the food passes through the system slowly it helps to eat less and increases the time food gets digested. The tightness of the band can be adjusted through a port that is placed under the skin of the abdominal wall by adding or removing fluid from the system.
Laparoscopic Revisional
Surgery
Revisional surgery is done for patients who previously had weight loss surgery and did not succeed with weight loss or who gained weight years later. These procedures could be used to reduce the size of the stomach if it has stretched out over time.
Revisional surgery can be done to correct complications or side effects of previous weight loss surgeries, such as ulcers, reflux or absorption issues. Laparoscopic conversion surgery is used to change one type of weight loss procedure to another, for instance a Lap Band to Sleeve Gastrectomy or to Gastric Bypass.
Laparoscopic Revisional surgeries require greater degree of expertise compare to first time surgery. The patients at DHMR Clinics can feel assured that they will receive best option for revision surgery with the best possible outcomes.
Endoscopic Revision Procedure is done by passing an instrument through patient’s mouth while completely is under anesthesia. Then, actual procedure can be done through endoscope such as minimizing the size of anastomosis between small intestine and gastric pouch as well as minimizing the size of the pouch. The benefit of this approach is no incision is made and also has almost no pain and very fast recovery time.
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PRE-OPERATIVE TESTING
All patients are required to have the following completed before the date of the surgery:
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Medical evaluation and clearance by your primary physician.
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Cardiology evaluation in selected patients to uncover potential heart disease and to determine treatment as necessary.
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Pulmonary evaluation including a pulmonary function test and when indicated, a sleep apnea test as needed.
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Psychological or psychiatric evaluation to be sure that you are able to cope with the major lifestyle changes that will occur and to uncover and treat any mental health problem.
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Dietary evaluation and pre surgical Nutrition education
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Upper GI endoscopy
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Blood work
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Abdominal ultrasound
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EKG
If you do not have your own specialists, DHMR Clinics can provide the names of expert professionals who can perform pre-operative evaluations.
DAY OF SURGERY
On the day of your procedure, you will need to arrive at the hospital at least 90 minutes prior to the time of surgery. Your surgeon and the anesthesiologist will meet you in the preoperative area to answer any additional questions you may have. Just before you are taken into the operating room, you’ll be given antibiotics to minimize the risk of infection and a blood thinner to prevent blood clots from forming.
Pneumatic leg pumps will be placed around your calves or feet before surgery. These will inflate and deflate to keep the blood circulating in your legs in order to prevent clots. It is important that you keep the feet pumps on while you are in bed during your entire hospital stay.
Immediately after surgery, you will be taken to the recovery room, also called the Post-Anesthesia Care Unit (PACU). Once you have recovered from the anesthetics, you will be transferred to the Surgical Unit. On rare occasions, a patient may require Intensive Care (ICU) monitoring for significant respiratory problems.
If you use a continuous positive air pressure (CPAP) machine at home, you should bring your CPAP machine with you on the day of the surgery for use during your hospital stay. You will be required to get out of bed as soon as possible to improve your lung function and to prevent blood clots from forming in your legs and you’ll be shown breathing exercises that will lessen your risk of pneumonia. It’s very important to follow instructions regarding these exercises.
The day after surgery all patients will receive an upper gastrointestinal X-ray study (UGI) to detect possible leaks or blockage. Following the X-ray you will be started on a special bariatric liquid diet and you may be able to leave the hospital that day.