Weight Loss Procedures

There are a variety of surgical options available today for the treatment of obesity. Before drawing any conclusions on what is best for you, it’s important to understand that all weight loss surgeries are not alike. Each one carries its own set of risks and benefits. By becoming educated on the pros and cons of each, you’ll have a better understanding of the surgery and what to expect.

It is the philosophy of BayChoice Bariatrics that “one size DOESN’T fit all.” Although most (9 out of 10) obese individuals are well suited for bariatric surgery, there are many variables to consider. Our goal is to provide the correct operation at the optimal time for every patient.

If you have any questions about the weight loss surgery options or wish to schedule an initial consultation, please contact us today. We look forward to providing you with the personalized care you deserve!

How it works to help you lose weightSleeveGastrectomy_labeled

A sleeve gastrectomy is a procedure that limits the amount of food you can eat by reducing the size of your stomach. Like other metabolic surgeries, it also helps to establish a lower, healthier body fat set point by changing the signals between the stomach, brain, and liver.

Vertical sleeve gastrectomy can be the first step before other surgical procedures (eg, gastric bypass) or it may be employed as a single procedure for weight loss.

  • The surgeon creates a small stomach “sleeve” using a stapling device. This sleeve will typically hold 50 mL to 150 mL and is about the size of a banana. The rest of the stomach is removed.
  • This procedure induces weight loss in part by restricting the amount of food (and therefore calories) that can be eaten without bypassing the intestines and absorbed.
  • Weight loss and improvement in parameters of metabolic syndrome are connected with the resection of the stomach and subsequent neurohormonal changes.
  • If vertical sleeve gastrectomy is used as the first step before gastric bypass, in the second step the surgeon attaches a section of the small intestine directly to the stomach pouch, which allows food to bypass a portion of the small intestine.


  • Limits the amount of food that can be eaten at a meal.
  • Allows the body to adjust to its new, healthier set point.
  • Food passes through the digestive tract in the usual order, allowing vitamins and nutrients to be fully absorbed into the body.
  • No postoperative adjustments are required.
  • In clinical studies, patients lost an average of 66% of their excess weight.
  • Shown to help resolve high blood pressure (49%), obstructive sleep apnea (60%), and to help improve type 2 diabetes (45%) and high cholesterol (77%).


The following are in addition to the general risks of surgery:

  • Complications due to stomach stapling, including separation of tissue that was stapled or stitched together and leaks from staple lines.
  • Gastric leakage
  • Ulcers
  • Dyspepsia
  • Esophageal dysmotility
  • Nonreversible since part of the stomach is removed

How it works to help you lose weight

The gastric bypass surgical technique, which limits food and keeps it from being absorbed completely, is the most frequently performed bariatric and metabolic procedure in the United States. This technique alters the complex relationship your body has with food and its metabolism. This positive change helps reset your body’s ability to effectively manage weight. The surgery allows the body to establish a new, lower, healthier body fat set point.

  • The surgeon creates a stomach pouch that significantly reduces overall stomach size and the amount of food it can hold.
  • The pouch is surgically attached to the middle of the small intestine, thereby bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).
  • The smaller stomach size helps patients feel full more quickly, which reduces food intake.
  • Bypassing part of the intestine limits calorie absorption.
  • Gastric bypass also produces positive metabolic changes in many organs as a result of surgical anatomic manipulation.


  • Limits the amount of food that can be eaten at a meal and reduces the desire to eat.
  • Allows the body to adjust to its new, healthier set point.
  • Average excess weight loss is generally higher than with gastric banding or sleeve gastrectomy.
  • No postoperative adjustments are required.
  • An analysis of clinical studies reported an average excess weight loss of 62% in 4204 patients.
  • Shown to help resolve type 2 diabetes (68%), high blood pressure (66%), obstructive sleep apnea (76%), and to help improve high cholesterol (95%).
  • In a study of 608 gastric bypass patients, 553 maintained contact for 14 years; the study reported that significant weight loss was maintained at 14 years.


The following are in addition to the general risks of surgery:

  • 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. Women 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.
  • Chronic anemia due to vitamin B12 deficiency can occur. This can usually be managed with vitamin B12 pills or injections.
  • When removing or bypassing the pylorus, 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.
  • 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 15cc to 30cc.
  • Rerouting of bile, pancreatic and other digestive juices beyond the stomach can cause intestinal irritation and ulcers.
  • The lower stomach pouch 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.

The outcome of bariatric surgery is generally quite good; however, not all surgeries produce the results that a patient originally anticipated. This experience is common with the more outdated operations, such as “stomach stapling” (VBG), which is no longer widely used by surgeons. For patients who have had bariatric surgery performed in the past and are unhappy with the results, revisional surgery may be an option.

Revisional bariatric surgery is a major operation which can be significantly more difficult than the original surgery. This type of surgery is performed to alter or repair a poorly designed earlier operation. The most common reasons for revisional surgery are medical complications, excessive weight gain since the initial operation and increase the rate of weight loss.

To be considered for revisional bariatric surgery you must have:

  • Regained a substantial amount of your original weight back.
  • Experienced poor weight loss in general.
  • Complications resulting from the original operation, such as:
    • Staple line compromised (as with VBG or Roux-en-Y).
    • Stomach band has dilated over time or has broken (as with VBG).
    • Persistent vomiting (as with VBG or Roux-en-Y).
    • Ulcers (as with Roux-en-Y).
    • Slipped band (as with LAP-BAND).

Because revisional bariatric surgery can be a complex operation, it needs to be carefully thought out due to the heightened risks involved. Regardless of the risks, however, revisional surgery can still be a beneficial operation for those individuals who face greater health hazards as a result of their morbid obesity. Our bariatric team will discuss in detail any concerns you might have and help you make the most informed treatment decision possible.

General Surgery (Digestive) Procedures

What is GERD?

GERD (Gastroesophageal reflux disease) is defined as chronic symptoms or damage produced by the the abnormal reflux in the esophagus which is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. Common causes include the incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia.

While GERD is commonly found in adults, it may be difficult to detect in infants and children. GERD symptoms may vary in children versus adults. Children may have one symptom or many – no single symptom is universal in all children with GERD.


Signs and Symptoms

Most Common Symptoms:

  • Heartburn
  • Regurgitation
  • Trouble swallowing (also known as Dysphagia)

Less Common Symptoms:

  • Pain with swallowing
  • Excessive salivation
  • Nausea
  • Chest pain

Esophagus Injuries Sometimes Caused by GERD:

  • Reflux Esophagitis – necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus.
  • Esophageal Strictures – persistent narrowing of the esophagus caused by reflux-induced inflammation.
  • Barrett’s Esophagus – changes of the epithelial cells from squamous to columnar in the distal esophagus.
  • Esophageal Adenocarcinoma – a rare form of cancer.

Atypical Symptoms of GERD ONLY When Accompanied by Esophageal Injury:

  • Chronic Cough
  • Laryngitis (hoarseness, throat clearing)
  • Asthma
  • Erosion of dental enamel
  • Dentine hypersensitivity
  • Sinusitis and damaged teeth

Surgical Treatment

The standard surgical treatment is the Nissen fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower esophageal sphincter (LES) to strengthen the sphincter and prevent acid reflux as well as to repair a hiatal hernia. This procedure is done laparoscopically.

What is Laparoscopic Gallbladder Surgery?

Cholecystectomy (laparoscopic gallbladder surgery) removes the gallbladder and gallstones through several small incisions in the abdomen. The surgeon will inflate your abdomen with air or carbon dioxide in order to see clearly, then insert a lighted scope attached to a video camera (laparoscope) into one incision near the patient’s belly button. The surgeon will then use a video monitor as a guide while inserting surgical instruments into the other incisions to remove the patient’s gallbladder.

Laparoscopic gallbladder surgery is the best method of treating gallstones that cause symptoms, unless there is a reason that the surgery should not be done. Laparoscopic surgery is safe and effective and is used most commonly when no factors are present that may complicate the surgery.

Surgery gets rid of gallstones located in the gallbladder. It does not remove stones in the common bile duct. Gallstones can form in the common bile duct years after the gallbladder is removed, although this is rare.


What to Expect After Surgery

You may have gallbladder surgery as an outpatient, or you may stay 1 or 2 days in the hospital.

After surgery you may have:

  • Pain in your shoulder and belly that lasts 24 to 72 hours (from gas used to inflate the abdomen during surgery). It lasts as long as a week.
  • Widespread muscle aches from anesthesia.
  • Diarrhea
  • Minor inflammation or drainage at the surgical wound sites.
  • Loss of appetite and some nausea.

Most people can return to their normal activities in 7 to 10 days. People who have laparoscopic gallbladder surgery are sore for about a week, but after 2 to 3 weeks they have much less discomfort than people who have open surgery. No special diets or other precautions are needed after surgery.

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