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Restrictive weight loss surgery works by reducing the amount of
food consumed at one time. The theory is simple; due to the
restriction created, you feel satiated with small amounts of food
and because of a smaller outlet, food stays in the stomach for a
longer time. The net result is - a reduction in daily caloric
intake without a feeling of deprivation.
 Procedure
Entails laparoscopic implantation of a Silastic band around
the stomach just below the gastro-esophageal junction to section
off a small portion called as stomach pouch creating an hour-glass
effect. A small outlet, about the size of a pencil eraser, is left
at the bottom of the stomach pouch.
Effects
The hour glass configuration only constricts the upper stomach
thus acting as a pure restrictive operation. Since the outlet is
small, food stays in the pouch longer and one also feels satiated
for a longer time.
In a cooperative and compliant patient, the reduced stomach
capacity, along with behavioral changes, can result in
consistently lower caloric intake and consistent weight loss.
Patients who see the best results from a restrictive procedure are
those who learn to eat slowly, eat less, and avoid drinking too
many caloric fluids, particularly carbonated beverages. If the
patient fails to follow these guidelines, they can stretch the
stomach pouch and/or the stoma outlet and defeat the purpose of
the surgery. The effectiveness of a restrictive procedure is
reduced by constant snacking or by drinking high-calorie, high-fat
liquids.
Possible Complications
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 Procedures
that alter digestion are known as malabsorptive procedures.
Malabsorptive techniques reduce the length of intestine that comes
in contact with food so that the body absorbs fewer calories.
According to the American Society for Bariatric Surgery and the
National Institutes of Health, Roux-en-Y gastric bypass is the
current gold standard procedure for weight loss surgery. In this
procedure, stapling creates a small (15 to 20cc) stomach pouch.
The remainder of the stomach is completely stapled shut and
divided from the stomach pouch. It is not completely removed. The
outlet from this newly formed pouch empties directly into the
lower portion of the jejunum, called the Roux limb, thus
eliminating the duodenum and a small portion of the jejunum from
the absorptive circuit. The omitted segment is connected into the
side of the Roux limb of the intestine creating the "Y" shape that
gives the technique its name. The length of either segment of the
intestine can be adjusted to produce lower or higher levels of
malabsorption.
Risks
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The duodenum being bypassed, poor absorption of iron and calcium
can result in the lowering of total body iron and a predisposition
to iron deficiency anemia.
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A chronic anemia due to Vitamin B12 deficiency may occur. The
problem can usually be managed with Vitamin B12 pills or
injections.
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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 or large amounts of
food are 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.
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Metabolic bone disease in some patients, resulting in bone pain,
loss of height, humped back and fractures of the ribs and hip
bones.
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All the above listed deficiencies can be easily managed through a
proper diet and vitamin and calcium supplements. It is mandatory
for patients undergoing gastric bypass to consume a multivitamin
and calcium supplement daily.
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