Find a Weight Loss Surgeon
San Francisco, California
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Location and Contact Details
Laparoscopic Associates of San Francisco
2100 Webster Street, Suite #518
San Francisco, California 94115
Phone: 415-561-1310
Bariatric Surgeons
Dr. Gregg H. Jossart
Dr. Paul T. Cirangle
Dr. John J. Feng
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Types of Weight Loss Surgery Performed
1. Roux-en-Y Gastric Bypass
2. Biliopancreatic Diversion/Duodenal Switch
3. LapBand
Laparoscopic Roux-en-Y Gastric Bypass
The Roux-en-Y gastric bypass operation has been performed more than any
other weight loss procedure. This operation has been performed in the
United States for more than 20 years. It is the procedure that Carnie
Wilson had and is known by the common name of “gastric bypass.”
A very small gastric pouch or “new stomach” is created –
usually about 15-20cc (3-4 teaspoons) in size. A normal stomach is about
1000cc in size, therefore this greatly reduces the amount of food you
can eat after this surgery. In addition, approximately 3-4 feet of the
small intestine are bypassed (normally a person has about 20 feet total),
and the new stomach pouch is connected to the bypassed segment of small
intestine. Digestion (and therefore absorption of calories) cannot take
place if the food that you eat does not come into contact with the digestive
juices. This operation, therefore, works primarily by limiting or restricting
the amount of food that you can eat and, to a much lesser extent, the
amount which is absorbed or digested by your body. We routinely perform
this surgery laparoscopically using 5 very small incisions (less than
1/2 inch) in all of our patients. It generally takes about 2 hours to
perform the surgery, and most people stay in the hospital about 2 or 3
days. By the time you are released, you will be walking without difficulty
and eating a liquid diet.
Laparoscopic Duodenal Switch
The Duodenal Switch procedure for weight loss was first developed by Doug
Hess, MD in Bowling Green, Ohio in 1988. It achieves moderate restriction
by reducing stomach volume and moderate malabsorption by allowing food
and digestive juices to pass through the intestinal tract separately.
About 80% of the stomach is removed leaving a 150cc new stomach pouch.
The average amount that a normal stomach can hold is about 1000cc –
so the capacity of the stomach is greatly reduced by this operation. The
beginning part of the small intestine, known as the duodenum, is cut or
divided just beyond where the stomach meets the small intestine. The distal
or furthest part of the small intestine, known as the ileum, is then cut
or divided about 7 feet before it enters into the large intestine. The
ileum is then connected to the duodenum and the section of bypassed intestine
which carries the digestive enzymes (bile and pancreatic juices) is connected
to the small intestine 100 centimeters (about 3 feet) before the small
intestine becomes the large intestine or colon. This portion of the bowel
is known as the common channel or common limb because it becomes the only
part of the small intestine where both food and digestive enzymes mix,
limiting digestion to only a small portion of the total calories that
are eaten. We routinely perform this operation laparoscopically in all
of our patients. The surgery generally takes approximately 2.5-3 hours
to perform and patients stay in the hospital for 3 days after surgery.
LapBand
The LapBand is the newest and simplest surgical weight loss procedure.
Approved for use in the United Sates by the FDA in June of 2001, the LapBand
has been in use in Europe, Central America, and Australia since the early
1990s. In addition to being simple to place, it is fully adjustable to
allow an optimal weight loss for each individual patient. The band, which
is actually a silastic (plastic) balloon that looks like a belt, is wrapped
around the top of the stomach and secured in place with sutures.
The band serves three functions:
- to limit the amount of food that is consumed
- to delay emptying of the new small pouch and
- to create the sensation of being “full” all of the time so
that the desire to eat is decreased.
The band is connected to a reservoir which sits under the skin on the
abdominal wall. Saline solution (salt water) can either be added or removed
from the reservoir to make the band tighter or looser. This allows each
patient to have an individualized weight loss program which can be customized
to their personal situation. The procedure is performed laparoscopically
and takes approximately 30–40 minutes. Following the procedure, patients
generally only need to stay in the hospital 1 night (less than 24 hours!).
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