Gastric Surgery

Laparoscopic Sleeve Gastrectomy

What is laparoscopic surgery? During this minimally invasive surgery, your surgeon removes part of your stomach, creating a long and slender sleeve shape – hence the gastric sleeve name. This reduces intake but allows you to absorb all the nutrients from the foods you eat.

This procedure is usually done after typical attempts to lose weight via diet and exercise are unsuccessful, and is an option for candidates whose Body Mass Index (BMI) is 40 or more (classified as extreme obesity) OR your BMI is above 35 and you have a serious health problem related to weight.

How It’s Done

Large segment of the stomach is removed through a small incision. Minimally invasive laparoscopic technique. Part of stomach that creates hunger-producing hormone is removed. Patients experience diminished appetite.

Benefits

No device is implanted with the gastric sleeve. Simpler procedure than gastric bypass. Fewer food intolerances than with gastric band. No intestinal rerouting. Faster weight loss than gastric banding. Appropriate for teenagers from age 14 and up.

Expected Weight Loss

30 to 50 percent of excess weight in the first six to 12 months, with a total of 50 to 70 percent excess weight loss over two years.

Gastric Band

The least invasive bariatric procedure, it attaches adjustable gastric banding around the top part of the stomach to help limit the amount of food the stomach holds and slow the digestive process.

Patients who are qualified for a gastric band differ from the prior listed weight-loss options, as this is only approved for candidates with a BMI between 35 and 39.9.

How It’s Done

Gastric band is placed around the stomach to create a small stomach pouch. Minimally invasive laparoscopic technique. Port accessible at the skin’s surface allows for easy adjustments. Works by limiting food intake, reducing appetite and slowing digestion.

Benefits

One of the safest, least invasive surgical weight loss options. No stomach stapling or intestinal rerouting. Outpatient procedure. Adjustable and reversible bariatric surgery option. Fast recovery time. Appropriate for teenagers from 14 and up.

Expected Weight Loss

50 percent of excess weight over 2 years.

Laparoscopic Gastric Bypass

Creates a small pouch from the top segment of your stomach and connects it to the small intestine. This bypasses the majority of the stomach, making you feel full after eating significantly less.

The requirements for those qualified for Laparoscopic gastric bypass are the same as those for laparoscopic sleeve gastrectomy. This procedure is usually done after typical attempts to lose weight via diet and exercise are unsuccessful and is an option for candidates whose Body Mass Index (BMI) is 40 or more (classified as extreme obesity) OR your BMI is above 35 and you have a serious health problem related to weight.

How It’s Done

Stomach is made smaller by creating a small pouch; intestines are rerouted. Minimally invasive laparoscopic technique. Post-surgery, patients absorb fewer calories and nutrients.

Benefits

Rapid weight loss from gastric bypass. Patients have experienced resolution of diabetes, hypertension, sleep apnea, and coronary artery disease. Increased weight loss compared to gastric banding. Appropriate for teenagers from age 14 and up.

Expected Weight Loss

65 to 80 percent of excess weight over 18 months.

Gastric Bypass Revision

Ideal Candidates

Former gastric bypass patients who have regained weight. Patients who did not lose weight after gastric bypass.

How It’s Done

Incisionless procedure returns the stomach pouch to the size achieved after gastric bypass. A small, flexible endoscope is inserted through the mouth.

Benefits

Outpatient procedure. Fast recovery time. No scarring. Minimal post-operative pain.

Expected Weight Loss

Loss of one to two pounds a week, starting immediately after surgery.

Endoscopic Plication

Ideal Candidates

BMI of 30 or more for several years. Serious nonsurgical weight-loss attempts unsuccessful. Willingness to make significant lifestyle changes.

How It’s Done

Stomach is made smaller by folding the stomach in on itself and stitching it closed. Minimally invasive laparoscopic technique. Works by limiting food intake.

Benefits

No intestinal rerouting. No implanted device left in the body. May be reversible as the stomach is not removed. Minimal post-operative pain.

Expected Weight Loss

20 percent of excess weight after 1 month. 50 percent of excess weight over 2 years.

Gastric Balloon

Ideal Candidates

Have a BMI between 30-40. Nonsurgical weight loss attempts unsuccessful. Have one or more health issues related to obesity.

How It’s Done

A thin, deflated balloon is placed in the stomach through the mouth. Once in place, it’s filled with a saline solution.

Benefits

No incisions required. Temporary, balloon is only in for six months or less. Outpatient procedure done under mild sedation.

Expected Weight Loss

10 percent of excess weight over 6 months.

Liposuction

Liposuction is a surgical procedure that uses a suction technique to remove fat from specific areas of the body, such as the abdomen, hips, thighs, buttocks, arms or neck. Liposuction also shapes (contours) these areas. Other names for liposuction include lipoplasty and body contouring.

Liposuction isn’t typically considered an overall weight-loss method or a weight-loss alternative. If you’re overweight, you’re likely to lose more weight through diet and exercise or through bariatric procedures — such as gastric bypass surgery — than you would with liposuction.

You may be a candidate for liposuction if you have too much body fat in specific spots but otherwise have a stable body weight.

Why it’s done

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Liposuction is used to remove fat from areas of the body that haven’t responded to diet and exercise, such as the:

• Abdomen
• Upper arms
• Buttocks
• Calves and ankles
• Chest and back
• Hips and thighs
• Chin and neck

In addition, liposuction can sometimes be used for breast reduction or treatment of gynecomastia.

When you gain weight, fat cells increase in size and volume. In turn, liposuction reduces the number of fat cells in a specific area. The amount of fat removed depends on the appearance of the area and the volume of fat. The resulting contour changes are generally permanent — as long as your weight remains stable.

After liposuction, the skin molds itself to the new contours of the treated areas. If you have good skin tone and elasticity, the skin is likely to appear smooth. If your skin is thin with poor elasticity, however, the skin in the treated areas may appear loose.

Liposuction doesn’t improve cellulite dimpling or other skin surface irregularities. Likewise, liposuction doesn’t remove stretch marks.

To be a candidate for liposuction, you must be in good health without conditions that could complicate surgery — such as restricted blood flow, coronary artery disease, diabetes or a weak immune system.

Risks

As with any major surgery, liposuction carries risks, such as bleeding and a reaction to anesthesia. Possible complications specific to liposuction include:

• Contour irregularities. Your skin may appear bumpy, wavy or withered due to uneven fat removal, poor skin elasticity and unusual healing. These changes may be permanent. Damage beneath the skin from the thin tube (cannula) that’s used during liposuction may give the skin a permanent spotted appearance.
• Fluid accumulation. Temporary pockets of fluid (seromas) can form under the skin. This fluid may need to be drained with a needle.
• Numbness. You may feel temporary or permanent numbness in the affected area. Temporary nerve irritation also is possible.
• Infection. Skin infections are rare but possible. A severe skin infection may be life-threatening.
• Internal puncture. Rarely, a cannula that penetrates too deeply may puncture an internal organ. This may require emergency surgical repair.
• Fat embolism. Pieces of loosened fat may break away and become trapped in a blood vessel and gather in the lungs or travel to the brain. A fat embolism is a medical emergency.
• Kidney and heart problems. Shifts in fluid levels as fluids are being injected and suctioned out can cause potentially life-threatening kidney, heart and lung problems.
• Lidocaine toxicity. Lidocaine is an anesthetic often administered with fluids injected during liposuction to help manage pain. Although generally safe, in rare circumstances, lidocaine toxicity can occur, causing serious heart and central nervous system problems.

The risk of complications increases if the surgeon is working on larger surfaces of your body or doing multiple procedures during the same operation. Talk to your surgeon about how these risks apply to you.

Body Contouring After Weight Loss

Significant weight loss through diet and exercise or bariatric surgery can enhance your life, leading to a more active lifestyle and a healthier you. However, after losing a lot of weight, it’s common to have sagging, excess skin. Loose skin can be uncomfortable and may cause you to feel insecure.

Penn Medicine’s Body Contouring After Weight Loss Program helps alleviate conditions caused by loose skin so you can live a more comfortable and confident lifestyle. For many people, body contouring surgery for excess skin removal is the final step in their weight loss journey.

What Is Body Sculpting/Body Contouring?

Gaining a significant amount of weight can affect your skin. Over time, the skin slowly stretches to accommodate the accumulation of fat tissue. If you lose a lot of weight, that excess skin might not spring back into place. Weight loss can cause stretch marks and extra skin folds on your lower stomach, thighs, arms, chin and breasts.

Body contouring, also known as body sculpting, is a surgical procedure that removes the loose skin that is left after weight loss and improves the shape and tone of your body’s tissue.

What Are the Different Types of Body Contouring?

Our board-certified plastic surgeons offer all body sculpting surgery options, including:

• Arm lift (brachioplasty)
• Breast lift
• Facelift
• Lower abdomen lift (panniculectomy)
• Thigh lift (thighplasty)
• Upper body lift

You may be considering just one of these body sculpting surgery types or a combination. We’ll work with you to identify your goals, determine a plan tailored to your specific needs, and ensure the safest possible outcome.

Resources

Pennmedicine.org, “Body Contouring After Weight Loss.”; mayoclinic.org, “Liposuction.”; surgicalweightcontrolcenter.com, “Surgical weight-loss options.”;