Theory and Preparation

Ernest Hemingway stated “Never mistake motion for action.” Applied to bariatric surgery, this adage reminds us that a decision for an operation does not mean a guarantee for success. True action requires education and the proper support with both internal and external motivations.

The human microbiome comprises all the microorganisms living on and in the human body. Though the significance of microbes as mediators of health and disease has long been established, recent advances in genetic sequencing are providing new insights into the function and composition of what is now recognized as an additional human organ. In particular, the microbial inhabitants of the gut (the gut microbiota) are thought to play a part in the development of obesity, insulin resistance and diabetes.

Current thinking is that revisional operations do not work very well and for that reason they are reserved for unique cases. As with many things in surgery, much depends on the circumstances and the available options, some of which we’ll describe below. In any case, I strongly suggest that patients return to their original surgeon who performed their first operation, as every surgeon individualizes the digestive arrangements in a particular manner. The only revisional operation I regularly perform is for patients who have a failed laparoscopic gastric banding. Those patients may benefit from having the band removed and then converting to a gastric bypass or a gastric sleeve.

Anyone who has lived with obesity for any length of time will be well aware that the negative effects of carrying excessive weight are not limited to physical appearance. Overweight and obesity can impact upon every system in the body, leading to a host of health problems that limit quality of life and life expectancy. The social stigma carried by obesity can have a significant detrimental effect upon self-esteem and psychological wellbeing, whilst the physiological changes associated with the condition can lead to multiple life-threatening co-morbidities.

Laparoscopic Sleeve Gastrectomy requires changing the stomach from the size of a football to the size and shape of a banana. A small gastric reservoir is created that reduces the stomach size to 60-150 ml. 

How Does a Gastric Sleeve Affect Dieting and Help Weight Loss?

The goal of all bariatric surgery is to provide a physical change in the digestive system that helps people lose substantial weight.

Laparoscopic sleeve gastrectomy is a restrictive procedure that reduces the size of the stomach but does not alter the gastrointestinal tract or the pylorus. Because the route of ingested food through the gastrointestinal tract is not altered, nutrients are better absorbed. The patient is less dependent on vitamin supplements as the food is absorbed in a more natural manner.

This video demonstrates Dr. Belsley performing a laparoscopic retrocolic, retrogastric gastric bypass with a hand-sewn gastrojejunostomy. Please note that this video contains scenes from a real operation and therefore contains images that could be unsettling. Please watch at your own discretion.

This new stomach pouch is then attached to a piece of cut small intestine that is connected directly onto the pouch. When you eat after a gastric bypass, food enters into this small pouch of stomach and then passes directly into your small intestine. Food bypasses most of your stomach and the first section of your small intestine, and instead enters directly into the middle part of your small intestine.