Competence centre for obesity surgery

Y-ROUX GASTRIC BYPASS
How it works:
With the Y-Roux gastric bypass, the stomach is separated, leaving a small portion (pouch) intact. A loop of small intestine is sutured to this pouch to bypass the stomach. This is followed by a further connection between the intestinal loops, called the base. Here digestive enzymes are added to the food. By reducing the volume of the stomach and bypassing the first section of the small intestine, both the amount of food eaten and the absorption of nutrients from the intestine are reduced. Furthermore, a non-adjustable band (banded bypass) can be placed around the pouch to prevent this area from expanding later on. Furthermore, a non-adjustable band (banded bypass) can be placed around the pouch to prevent this area from expanding later on.

Hospitalisation:
2-4 days

Average weight loss:
50-70% of the excess weight in 2 years

Advantages:
There is very rapid weight loss, as this operation combines severe restriction with mild malabsorption. A Y-Roux gastric bypass is also suitable for eating disorders such as binge eating (uncontrolled binge eating) or sweet eating (preferably sweets or high-calorie drinks such as fruit juices and soft drinks). In contrast to gastric band surgery, no major change in dietary habits is necessary after the procedure.

Disadvantages:
Compared to other operations, the Y-Roux gastric bypass is a more complex procedure. Iron, protein and vitamin B12 deficiency symptoms are possible, so regular laboratory tests and intramuscular vitamin B12 injections every 6 months are essential. Furthermore, the residual stomach and the bile ducts can no longer be visualised by means of gastroscopy. Temporary hair loss may also occur after the operation. The intake of simple carbohydrates (sugar, white bread, etc.) can lead to temporary discomfort, dizziness and sweating (dumping). In addition, repeated dietary errors reduce the success of the targeted weight reduction even after a Y-Roux gastric bypass.

OMEGA LOOP GASTRIC BYPASS
How it works:
With the Omega Loop gastric bypass, the stomach is separated leaving a portion (pouch) intact. A loop of small intestine is sutured to this part of the stomach in order to bypass the stomach. By reducing the volume of the stomach and bypassing the first section of the small intestine, both the amount of food eaten and the absorption of food from the intestine are reduced. Furthermore, a non-adjustable band (banded bypass) can be placed around the pouch to prevent this area from expanding later on.

Hospitalisation:
2-4 days

Average weight loss:
60-80% of excess weight in 2 years

Advantages:
The Omega Loop gastric bypass is a more complex procedure compared to the gastric band, but smaller than the Y-Roux gastric bypass. This operation is suitable for eating disorders such as binge eating (uncontrolled binge eating) or sweet eating (preferably sweets or high-calorie drinks such as fruit juices and soft drinks) and, unlike gastric band surgery, does not require such a major change in eating habits.

Disadvantages:
Iron, protein and vitamin B12 deficiency symptoms are possible, so regular laboratory tests and intramuscular vitamin B12 injections every 6 months are essential. Weites können der Restmagen und die Gallenwege nicht mehr mittels einer Magenspiegelung eingesehen werden. In rare cases, bile can back up into the oesophagus, which can be corrected with a further procedure. Temporary hair loss may also occur after the operation. The intake of simple carbohydrates (sugar, white bread, etc.) can lead to temporary discomfort, dizziness and sweating (dumping). In addition, repeated dietary errors reduce the success of the targeted weight reduction even after a Y-Roux gastric bypass.

How it works:
A small pouch is formed by placing an adjustable gastric band around the upper part of the stomach. When food is ingested, the pouch expands and the feeling of fullness is reduced more quickly. The gastric band is connected to a port implanted in the lower abdominal fat tissue via a silicone tube. The inner diameter of the gastric band is changed depending on how full it is, so the band can be customised to the patient’s individual situation by injecting the port.

Hospitalisation:
1-3 days

Average weight loss:
40-60% of excess weight in 2 years

Advantages:
The application of a gastric band is the least invasive surgical method compared to the other methods. The hospital stay after this operation is just as short as with a gastric bypass or sleeve gastrectomy. In addition, no serious deficiency symptoms (iron, calcium, vitamins) are to be expected, as the weight reduction is achieved purely by restricting food intake. Further advantages are the unchanged preservation of the anatomy of the digestive tract and the complete reversibility of the operation. Injection moulding of the port allows the band to be adapted to individual requirements, for example the band can be completely removed in the event of pregnancy.

Disadvantages: 
Compared to the other methods (gastric bypass, sleeve gastrectomy), the potential weight loss is significantly lower and slower to materialise. A permanent change in eating habits is essential and absolutely necessary for sustainable weight loss. Similarly, the repeated consumption of sweets or high-calorie drinks such as fruit juices and soft drinks inevitably leads to weight gain. Numerous band adaptations are often necessary to achieve an optimal early feeling of satiety.

How it works:
When a sleeve gastrectomy is performed, the stomach anatomy is reduced to a tube. The residual stomach is removed. The resulting earlier expansion of the remaining tubular stomach leads to a more rapid onset of a feeling of fulln

Hospitalisation:
5-7 days

Average weight loss:
40-60% of excess weight in 2 years

Advantages:
Sleeve gastrectomy results in rapid weight loss, but less than with gastric bypass, as it is a milder restriction of food intake. Further advantages are the continued visibility of the upper digestive tract by means of gastroscopy, less frequent dumping and lower nutrient deficiencies, which means that regular vitamin B12 injections are not necessary. In addition, removing the remaining stomach leads to reduced production and release of the hunger hormone ghrelin, which is mainly produced in this part of the stomach, and consequently to fewer food cravings.

Disadvantages:
This operation is not suitable for eating disorders such as binge eating (uncontrolled binge eating) or sweet eating (preferably sweets or high-calorie drinks such as fruit juices, soft drinks), and especially for patients with heartburn. A higher degree of dietary discipline required.

How it works: 
By reducing the volume of the stomach and, above all, by bypassing a larger section of the small intestine compared to the gastric bypass, both the amount of food eaten and the absorption of nutrients from the intestine (malabsorption) are significantly reduced in order to achieve a significant reduction in weight. The residual stomach can also be removed after the pouch has been applied.

Hospitalisation:
3-5 days

Average weight loss:
60-80% of excess weight in 2 years

Advantages:
Biliopancreatic diversion usually results in very rapid and significant weight loss. This operation is also suitable for eating disorders such as binge eating (uncontrolled binge eating) or sweet eating (preferably sweets or high-calorie drinks such as fruit juices and soft drinks). Hormonal changes occur in the regulation of blood sugar, which significantly improves existing diabetes in a large number of patients (diabetes remission of 95.1%!).

Disadvantages:
As a result of the operation, there may be a severe nutritional deficiency, particularly of protein, iron and calcium. It is essential to take a daily iron and calcium supplement. Regular laboratory tests and an intramuscular vitamin B12 injection every 6 months are therefore essential. Furthermore, to avoid a protein deficiency, a protein-rich diet should be ensured. Temporary hair loss may also occur after the operation. A diet too rich in carbohydrates can lead to temporary malaise, dizziness and sweating (dumping).

How it works:
During this operation, a sleeve gastrectomy is performed in the same way as a sleeve gastrectomy. By creating an additional bypass, which bypasses a large part of the small intestine, there is a restriction in the amount of food eaten combined with malabsorption, the absorption of the energy sources (fat, sugar, proteins) supplied by the food.

Hospitalisation:
5-7 days

Average weight loss:
60-80% of excess weight in 2 years

Advantages:
As with biliopancreatic diversion, duodenal switch surgery results in very rapid and large weight loss. Zudem ist diese Operation auch bei Essstörungen wie Binge Eating (unkontrollierte Essattacken) oder Sweet Eating (vorzugsweise Süßigkeiten oder hochkalorischen Getränken wie Fruchtsäfte, Limonaden) geeignet.

Nachteile:
As a result of the operation, there may be a severe nutritional deficiency, particularly in protein, iron and calcium. It is essential to take a daily iron and calcium supplement. Regular laboratory checks and an intramuscular vitamin B12 injection every 6 months are essential. Furthermore, to avoid a protein deficiency, a protein-rich diet should be ensured.
Hair loss may occur temporarily after the operation. A very carbohydrate-rich diet can cause temporary discomfort, dizziness and sweating (dumping).

How it works:
The volume of the stomach is reduced by implanting a silicone balloon into the stomach. This leads to an earlier feeling of satiety.

Hospitalisation:
outpatient

Average weight loss:
30% of excess weight in 6 months

Advantages:
The gastric balloon is implanted as part of a gastroscopy under a short anaesthetic. The patient can leave the hospital again after approx. 3 hours.

Disadvantages:
The gastric balloon can only remain in the stomach for 6 months. It must then be removed or replaced during another gastroscopy. Surgical intervention may be necessary if the balloon bursts or if the bowel becomes obstructed (in rare extreme cases).

Rules of behaviour:
The patient can recognise when the balloon has burst by the green discolouration of the urine. In this case, the doctor must be contacted immediately and a gastroscopy performed to retrieve the balloon.

Increased vomiting may occur in the initial period after implantation. After implantation, you will be given medication to inhibit nausea and vomiting for the initial period. Stomach protection is absolutely essential for the entire duration of the balloon implantation. Accompanying care by a dietician is also desirable. Accompanying care by a dietician is also desirable.