The stomach is a muscular sac that lies between the esophagus and the small intestine in the upper abdomen. The stomach is not the only part of your digestive system that absorbs food but rather is a part of the digestive system and important for churning food into a consistency that is easier to digest for the rest of your intestines.

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.

The waist-to-hip ratio (WHR) is the ratio of the circumference of the waist to that of the hip. The proportion of fat stored in the abdominal area to that stored in the hip region is an important indicator of the risk for a number of conditions. These conditions include major health risks such as diabetes, hypertension, and heart disease. A high WHR increases the chances of acquiring these conditions.

Classified as a restrictive procedure, laparoscopic sleeve gastrectomy involves modification of the gastric fundus, which expresses various hormones associated with hunger and satiety, insulin secretion and energy balance, and is known to induce rates of type 2 diabetes remission comparable to those observed following malabsorbtive procedures such as the Roux-en-Y gastric bypass (RYGB).

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.

Roux-en-Y gastric bypass (RYGB) surgery is one of the most commonly performed bariatric procedures, offering significant long-term benefits in terms of weight reduction and remission of obesity-related conditions including type 2 diabetes. These changes are thought to be induced via a combination of mechanisms including reduction in stomach capacity and reduced absorption of fat, in addition to the restrictions placed on consumption of highly osmolar foods such as those high in simple sugars, which can trigger symptoms including nausea, vomiting and dizziness if ingested in excessive quantities. However, these factors alone do not fully account for the success of the procedure. Various hormonal changes have been observed following RYGB surgery, prior to significant weight loss, and it is thought that such endocrine effects could also contribute towards the mechanism of action in RYGB.