Bariatric surgery is a highly specialized field of surgery that provides care for patients who are suffering from such an extreme problem of excess weight that they are at high risk for either immediate or long-term health side effects. Bariatric surgery has been proven to be the only reliable way for sustained weight loss. At Bariatrics of Texas, we offer the two most respected procedures in obesity treatment-Laparoscopic Adjustable Gastric Banding (Lap Band) and Roux-en-Y Gastric Bypass. Patients must understand both tools in order to make an informed decision.

We soberly remind all patients that there is a risk with every surgical procedure of any type. Bariatric surgery is only recommended to patients whose weight problem is significant enough that the medical risk of continued obesity outweighs the risk of surgery. Before considering surgery, it is very important that prospective patients have exhausted all other treatment options available. To help ensure success, all patients must meet all pre-surgery requirements, including a multidisciplinary evaluation to determine eligibility for surgery.

 
   
   
 
 
     

Banding procedures have been used as a bariatric surgery alternative for many years. The latest Lap Band is a new approach to an old technique. It works by creating a restriction of the upper stomach, so that food intake is limited and the patient is able to feel satisfied after eating only a modest sized meal. This purely restrictive operation does not interfere with the normal digestive process.

Dr. Warnock performs this operation by laparoscopically placing a hollow band around the stomach near its upper end, creating a small pouch and a narrow passage into the rest of the stomach. The band is adjustable by injecting saline into a small port placed underneath the skin, so that the band can be tightened or loosened over time depending on the progress and needs of the patient. At first, the pouch holds about 1 ounce of food, and later may stretch to 2-3 ounces. The lower outlet of the pouch is usually about ½ inch in diameter or smaller. This small outlet delays the emptying of food from the pouch into the larger part of the stomach and causes a feeling of fullness.

 
     
  After the operation, patients can no longer eat large amounts of food at one time. Most patients can eat about ½ to 1 cup of food without discomfort or nausea, but the food has to be soft, moist, and well chewed. As with any bariatric surgery, to be successful long-term, patients must be compliant with proper eating, both how food is eaten and what is eaten.
   
  Click here to download a detailed, 3D, computer-generated movie of the Lap Band procedure (14.3 MB)
   
 
  The Roux-en-Y Gastric Bypass is considered the "gold standard" of all bariatric surgical procedures because it is a time-tested operation (dating back to the late 1960's). The Roux-en-Y Gastric Bypass has the most long-term scientific results compared with other bariatric procedures, because the effects have been documented for over 20 years.
 

 

During normal digestion, food moves from the mouth to the esophagus to the stomach. While in the stomach, food is broken down by gastric acid and prepared for later absorption. This process in the stomach takes about twenty to thirty minutes, after which the stomach contents move to the first segment of small intestine. Most of the iron and calcium in the foods we eat is absorbed at this time. The remaining segments of the small intestine complete the absorption of almost all calories and nutrients. The remaining food particles that are not digested in the small intestines are stored in the large intestine until eliminated.

The Roux-en-Y Gastric Bypass operation is performed by first separating the stomach into two sections, creating a small upper stomach pouch to hold about 2-3 bites of food. Next, the small intestine is cut approximately 1 ½ feet beyond the stomach and attached to the stomach pouch to provide an outlet for food, bypassing the lower larger portion of stomach and the first part of the small intestine.

   
  This modification helps enable weight loss for three primary reasons:
 
Mechanically, the stomach is smaller, restricting how much can be eaten before feeling full or feeling a sense of satiety.
Physiologically, the intestine is changed causing varying degrees of "dumping syndrome" (including nausea, flushing, cramping, and diarrhea with sugary or rich foods), changes in smell and taste perception (decreasing food indulgence), as well as other individual changes (i.e. diabetic blood sugars are more easily controlled).
Malabsorption decreases the amount of calories absorbed from food since it is not as thoroughly digested before it passes into the large intestine for release. While the Roux-en-Y is not known to cause malabsorption of protein, carbohydrate, or fat, it does decrease absorption of iron and vitamin B12. Deficiencies are best prevented by daily supplementation and consistent follow-up.
 
   
 
 

Dr. Warnock is an experienced laparoscopic surgeon. He was one of the first certified laparoscopic surgeons in North Texas, and he performs many laparoscopic procedures of the chest and abdomen annually. With his vast experience in both laparoscopy and bariatrics, he usually chooses to perform the Roux-En-Y gastric bypass open due to reduced complications and risk to the patient. Whenever a surgeon sews a portion of the gastrointestinal tract together, as in gastric bypass, one of the inherent problems is healing. If it fails to heal properly, there may be a leak, causing peritonitis and possibly death. The most common cause of death among bariatric patients is this very problem.

The national leakage rate reported amongst laparoscopically performed procedures is established between 2-7%. Our leakage rate at Bariatrics of Texas has been less than 0.01% using the open technique. This is one of the significant factors as to why Dr. Warnock's overall complication rate has been so low. His patients return to work and normal activities in a short time frame, achieve excellent weight loss results, and experience minimal scarring.

Dr. Warnock considers his open method to be extremely successful and beneficial for the patient, and considers patient options on a case by case basis.