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Bariatrics and Weight Loss

Weight Loss Procedures

The Bariatric and Weight Loss Centers at Saint Thomas Health are premier comprehensive weight loss surgery programs, recognized nationally. We provide patients with proven surgical options to correct metabolic deficiencies, both open and laparoscopic. By offering patients a choice of surgical procedures, we believe the treatment team and patient will select a procedure that will ensure your best chance for success. It is important to understand the procedures and risks associated with weight loss surgery as well as the commitment required of the patient.

For more information

Saint Thomas Midtown Hospital
CALL (615) 284-2400

Saint Thomas Rutherford Hospital
CALL (615) 396-4965

Procedures Peformed:

  • Laparoscopic Roux-en-Y Gastric Bypass (Gastric Bypass)
  • Laparoscopic Sleeve Gastrectomy (Sleeve)
  • Intragastric Balloon

Laparoscopic Roux-en-Y Gastric Bypass

Laparoscopic Roux-en-Y Gastric BypassThis is the most frequently performed weight loss procedure in the United States. It involves creating a small 1-ounce pouch from the original stomach and thereby limiting food intake. To allow food to pass intthe intestine, a new connection must be created between the intestine and the newly-formed pouch. This operation works mainly through restriction, though there is some level of malabsorption. Learn More

Advantages

  • The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
  • One year after surgery, weight loss can average 77% of excess body weight.
  • Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
  • A 2004 review and meta-analysis of studies representing 22,094 patients showed that a substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.
  • A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar is consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery. Of note, many consider dumping syndrome a complication of gastric bypass surgery; however, we feel it is a desired outcome after gastric bypass, since it discourages these eating behaviors.
Risks
  • Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
  • Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
  • A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
  • In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
  • The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

Medical and Emotional Benefits

  • Significant weight loss
  • Improvement in type 2 diabetes
  • Lower blood pressure
  • Lower cholesterol
  • Relief of sleep apnea
  • Relief of acid reflux
  • Decreased joint pain, improved mobility
  • Improved mood and self-esteem

LAPAROSCOPIC SLEEVE GASTRECTOMY

Laparoscopic Sleeve GastrectomyThe sleeve gastrectomy is a restrictive procedure in which two-thirds of the stomach is removed. A long tube or “sleeve” of stomach remains. The valve at the outlet of the stomach remains. The removal of the large portion of the stomach helps decrease hunger hormones like grehlin. If inadequate weight loss were to occur, this procedure could be converted to a Roux-en-Y Gastric Bypass. Learn More

Advantages

  • Other than restriction, the stomach continues to function normally
  • The major part of the stomach which produces hormones responsible for stimulating hunger is removed
  • Dumping is usually (but not always) avoided as the pylorus valve is left intact
  • Provides a solution for patients with conditions which place them at an unacceptably high risk from other forms of bariatric surgery
  • Doesn't require foreign body implantation, such as a silastic ring used in gastric banding
  • Mechanically decreases the stomach size and also the secretion of the hormone ghrelin which is responsible for the feeling of satiety (fullness)
  • Benefit of decreased body weight for the severely obese in preparation for a staged procedure or future surgery

Risks

  • High BMI patients may require follow-up weight loss surgery to achieve their goal
  • Patients can slow weight loss if they do not make the appropriate dietary changes after surgery
  • Complications may occur as the result of stomach stapling, bleeding, stenosis, leak
  • The procedure is not reversible as part of the stomach is permanently removed

Medical and Emotional Benefits

  • Significant weight loss
  • Improvement in type 2 diabetes
  • Lower blood pressure
  • Lower cholesterol
  • Relief of sleep apnea
  • Relief of acid reflux
  • Decreased joint pain, improved mobility
  • Improved mood and self-esteem

IntraGastric Balloon

The Intragastric Balloon is a non-invasive, weight loss procedure. The balloon is made of soft, durable silicone rubber. Under anesthesia, the empty balloon is passed through your mouth, down your esophagus, and into your stomach. Once in place, it is filled with saline. It then becomes about the size of a grapefruit. The filled balloon floats in your stomach and takes up space, giving the patient a feeling of fullness sooner. At six months the balloon is removed through the esophagus and mouth while the patient is under anesthesia. After removal, your surgeon will discuss your options such as continuing your healthy diet and exercise regimen, replacing your balloon with a new one after a minimum of thirty days, or potentially transitioning to a permanent weight loss surgery.

Advantages

  • FDA approved
  • 20 year history of helping patients outside the United States
  • Lower BMI range required
  • Average excess weight loss of 38.4% at six months
  • Among the lowest complication and mortality rates
  • Less invasive, non-surgical
  • Quicker recovery
  • Reversible
  • Fewer diet restrictions
  • Lower cost if paying out of pocket

Risks

  • Electrolyte imbalance
  • Gastric outlet obstruction
  • Gastrointestinal perforation
  • Spontaneous deflation