Simplified Gastric Bypass

What is the Simplified Gastric Bypass?
The Gastric Bypass is considered by the American Society of Bariatric Surgeons and the National Institutes of Health the gold standard of weight loss surgery. The gastroplasty with an intestinal Bypass can be done by laparoscopy ore conventionally by open surgery. This technique involves a gastric stapling and division (forming the gastroplasty or new gastric chamber) reducing the gastric capacity in 90% (20-30cc)and a intestinal bypass with 1,5 to 2m (the small bowel have anything between 4 to 7m), at the end the gastroplasty is communicated with the deviated small bowel (gastrojejunostomy) by the means of stapling and suture, allowing the food to pass again.
The technique developed by Dr. Almino called Simplified Lap Bypass is nothing more than simplifying and standardize the steps of the traditional Gastric bypass (considered by the SAGES and ASBS the most complex procedure to be done by laparoscopy) in the way that it can be done with less operative time (average of 65minutes) and efficiency (more than a thousand patients operated by this technique)

Who should do the Gastric Bypass?
Despites the indication for bariatric surgery (Am I a candidate to Weight Loss Surgery?) the Bypass have its remarks.
Bypass fits to / combines with...
o Sweet eaters
o Any degree of binging eaters
o Moderate risk patients
o High expectations / needs to loose weight
o Low / moderate patient commitment
o Not that close follow-up
o T.P.C. at his beginning
o Up to 80% EWL (excess weight loss)

How it Works?
This kind of operation mix restriction with malabsorption. The restriction is predominant over malabsorption and the gastrojejunostomy is calibrated to 11mm. The food arrives at the new stomach (gastroplasty) and promotes distention on the walls of this pouch inducting satiety and fullness with small amounts of food. Than the food passes slowly trough the calibrated gastrojejunostomy and goes to make the digestion 1,5 to 2m after the pouch on the bypass. If the restriction caused by the small chamber was exceeded the fullness sensation will get worse and vomiting can occur. If the patient continues or initiate drinking liquids with high concentration of carbs it will wont be totally absorbed and can causes bowel irritation leading to abdominal pain and diarrhea.

How is the post-op?
Most of our patients go home within 30 to 36 ours after the operation, during 4 weeks they go on a liquid diet and advance in a stepwise way to a puree/baby food type diet for one or more additional weeks and evolving to a almost normal diet after that. The complete return to normal activities occurs in about one week. In this operation there is a minimum need to supplement vitamins and minerals if necessary. Iron must be followed by regular I.V. tests and reposition may be needed


What are the results in weight loss with the Gastric bypass?
With the bypass, the mean % of excess weight loss is about 70 to 85%. For example, one patient with 140Kg of weight, 1,70m of height and a 48 of BMI, has an average excess weight of 65Kg. With the Gastric band he should loose an average of 60Kg going to 80Kg and a BMI of 27.
The Gastro Obeso Center between December of 2001 and October of 2005 operated 1395 patients with the Simplified Lap Bypass and. The mean BMI comes from 45 to 27,4 and the %EWL goes to 75% with a mean drop of 40% of the initial total weight in a two years follow-up in a T.P.C. environment

What are the risks in gastric bypass surgery?
International literature describes an average of 10% in complications and a mortality rate between 1 and 2%. Our numbers goes to a 7,5% complication rate and 0,2% overall mortality rate with no deaths in the last 1000 cases of this series.

Links for surgical videos
Simplified Gastric Bypass 01
Simplified Gastric Bypass 02
Simplified Gastric Bypass 03
Simplified Gastric Bypass Full


Vertical Banded Gastroplasty with Bypass/ Fobi – Capella operation

What is the so called Fobi- pouch operation or Capella operation or Vertical Banded Gastroplasty with bypass?
It is a weight loss surgery done by laparoscopy ore conventionally by open surgery and also a variation of the traditional Gastric Bypass. This technique involves a gastric stapling and division (forming the gastroplasty or new gastric chamber that is larger than in bypass) reducing the gastric capacity in 80% (50cc), followed by placing a silastic ring around the gastroplasty with 5,5 to 6,2cm. After that, a intestinal bypass with 1 to 1,5m (the small bowel have anything between 4 to 7m) is done and at the end the gastroplasty is communicated with the deviated small bowel (gastrojejunostomy) by the means of stapling and suture, allowing the food to pass again

Who should do the Vertical Banded Gastroplasty with Bypass?
Despites the indication for bariatric surgery (Am I a candidate to Weight Loss Surgery?) the Bypass have its remarks.
Like Bypass, it fits to / combines with...
o Sweet eaters
o Any degree of binging eaters
o Moderate risk patients
o High expectations / needs to loose weight
o Low / moderate patient commitment
o Not that close follow-up
o T.P.C. at his beginning
o Up to 80% EWL (excess weight loss)

How it Works?
This kind of operation mix restriction with malabsorption. The restriction is even more predominant than the traditional gastric bypass over malabsorption caused by the silastic ring passed around the gastroplasty who reduce the gastroplasty distension. As the some way of bypass, the food arrives at the new stomach (gastroplasty) and promotes distention on the walls of this pouch inducting satiety and fullness with small amounts of food. Than the food passes slowly trough the calibrated gastrojejunostomy and goes to make the digestion 1,5 to 2m after the pouch on the bypass. If the restriction caused by the small chamber was exceeded the fullness sensation will get worse and vomiting can occur (more frequently than in non-banded gastric bypass). If the patient continues or initiate drinking liquids with high concentration of carbs it will wont be totally absorbed and can causes bowel irritation leading to abdominal pain and diarrhea

How is the post-op?
The some way of the Bypass, most of our patients go home within 30 to 36 ours after the operation, during 4 weeks they go on a liquid diet and advance in a stepwise way to a puree/baby food type diet for one or more additional weeks and evolving to a almost normal diet after that. The complete return to normal activities occurs in about one week. In this operation there is a minimum need to supplement vitamins and minerals if necessary. Iron must be followed by regular I.V. tests and reposition may be needed


What are the results in weight loss with the Vertical banded Gastroplasty?
With the vertical banded gastroplasty, our results are the closed to the Bypass, the mean % of excess weight loss is about 70 to 85%. For example, one patient with 140Kg of weight, 1,70m of height and a 48 of BMI, has an average excess weight of 65Kg. With the Gastric band he should loose an average of 60Kg going to 80Kg and a BMI of 27.
The Gastro Obeso Center between July of 2000 and October of 2005 operated 1080

patients with the Vertical Banded Gastroplasty. The mean BMI comes from 46 to 27 and the %EWL goes to 75% with a mean drop of 40% of the initial total weight in a three years follow-up in a T.P.C. environment.

What are the risks in gastric Vertical banded Gastroplasty?
International literature describes an average of 10% in complications and a mortality rate between 1 and 2%. Our numbers goes to a 6,7% complication rate and 0,1% overall mortality rate with no deaths in the last 500 cases of this series.

Links for surgical videos
Fobi – Capella operation 01
Fobi – Capella operation 02
Fobi – Capella operation 03
Fobi – Capella operation 04
Fobi – Capella operation Full


Adjustable Gastric Band

What is the adjustable gastric Band surgery ?
It is a weight loss surgery, done by laparoscopy in witch a inflatable silicone band is placed around the stomach without cutting or stapling it on its superior third in reducing the capacity of the stomach to an average of 15 to 20ml, which restricts the amount of food that can be consumed. The band is connected by the means of a catheter to a porth placed in patients subcutaneous space with allows band inflation to modulate the food intake

Who should do the gastric band?
Despites the indication for bariatric surgery (Am I a candidate to Weight Loss Surgery?) the band have its remarks.
Band fits to / combines with...
o Less pain / Less complication
o Early discharge and return to regular activities
o Teens / Aged
o “Volume” eaters
o High risk patients
o Moderate expectations to loose weight
o High patient commitment
o Surgeons with “Gastric Band Culture”
o Close follow-up
o T.P.C. fully operational
o Almost Zero Mortality

How it works?
This is a restrictive procedure in witch the food arrives at the reduced stomach or pouch distending the walls of this chamber promoting satiety and fullness with small amounts of food. The food passes slowly trough the “big’ stomachs were the digestion takes place. If the restriction caused by the small chamber was exceeded the fullness sensation will get worse and vomiting can occur.
In this kind of operation only the excess of solid food is not tolerated by the restriction. Liquids can pass almost freely and cause of this, if the patient continues or initiate drinking liquids with high concentration of carbs this operation can be cheated and the patient stops loosing weight.

How is the post-op?
Most of our patient goes home at the some day or day after the surgery. During the first 3 weeks the diet is based on liquids and after that we increase in a stepwise way to a puree/baby food type diet for one or more additional weeks evolving to a almost normal diet. The complete return to normal activities occurs in about one week

What are the results in weight loss with the gastric band?
With the band, the mean % of excess weight loss is about 50 to 60%. For example, one patient with 140Kg of weight, 1,70m of height and a 48 of BMI, has an average excess weight of 65Kg. With the Gastric band he should loose an average of 45Kg going to 95Kg and a BMI of 32.
The Gastro Obeso Center between December of 199 and December of 2005 operated 1252 patients with the adjustable gastric band. The mean BMI comes from 48 to 30,1 and the %EWL goes to 65% with a mean drop of 30% of the initial total weight in a four years follow-up in a T.P.C. environment

What type of Gastric Band we use?
There is at list 5 brands of adjustable gastric band in the market. The two most known is the Lapband made by INAMED company and the Swedish Adjustable gastric Band (SAGB) made by Ethicon company. The Lapband is an FDA approval device and the SAGB is running trials to be FDA approved, otherwise it is approved to be used in Europe (with CE mark) as the Lapband. The lapband has a high pressure low volume band filling system and the SAGB has a low pressure high volume filling system witch we prefer. Other Bands come from France (Heliogast Band made by Helioscopie company and Midband done by MID company) and Germany ( Softband made by AMI company) are approved to be used there. In Brazil the ministry of health have approved all of them. Our group is experienced with almost all types of bands and we are using the SAGB in the last 900 cases

What are the risks in gastric band surgery?
International literature describes an average of 10% in complications (most of them minor complications) and a mortality rate less than 1%. Our numbers goes to a 7,9% complication rate and zero mortality in this series

This procedure is for life? How much time does the band can be held in place?
The intention is to be a definitive procedure for life. The band do not have specific time limit to be in place. Besides, if the patients for any reason have the desire or the need, the band can be removed by laparoscopy.

Links for surgical videos
Adjustable Gastric Band mini
Adjustable Gastric Band full


Bilio Pancreatic Diversion (B.P.D.)

What is the Bilio Pancreatic Diversion (B.P.D.)?
There are two types of BPD surgery; one is the Scopinaro procedure and the other is the Duodenal Switch, both works almost in the same way. It is a weight loss surgery that can be done by laparoscopy ore conventionally by open surgery.
In the Scopinaros procedure, an average of 50% of the stomach is stapled and divided horizontally with or without a partial gastrectomy (stomach removal), followed by a very distal bypass with the ileum (end of small bowel) leaving only 50-80 cm, making a common channel were the digestion takes place, at its end, the remained stomach is connected to the small bowel (Ileum) with a 2,5m alimentary limb by the means of stapling and suturing (gastroileostomy).
In the Duodenal Switch procedure, an average of 50% of the stomach is stapled and divided vertically with a partial gastrectomy (stomach removal) preserving the pylorus and part of the duodenum followed by a very distal bypass with the ileum (end of small bowel) leaving 80-100 cm, making a common channel were the digestion takes place, at its end, the remained stomach on duodenum is connected to the small bowel (Ileum) with a 2,5m alimentary limb by the means of stapling and suturing (gastroileostomy).

Who should do the BPD?
Despites the indication for bariatric surgery (Am I a candidate to Weight Loss Surgery?) the BPD have its remarks.
It fits to / combines with...
o Protein (animal) eaters
o Severe degree of binging eaters
o Super obese patients (BMI >50)
o High expectations / needs to loose weight
o Low patient commitment
o Not that close follow-up
o T.P.C. at his beginning
o Up to 90% EWL (excess weight loss)


How it Works?
In this kind of bariatrc procedures, malabsorption rules over restriction. The place were the food will gone mix with intestinal enzymes and liquids and make the digestion is located near (50-100cm) to the end of the small bowel and is called common alimentary channel. So, most of the ingested food will not be digested.
Having minimum restriction allows the patient to stay in his regular diet (protein ingestion is stimulated) even with large amounts of food, because most of them will not be absorbed. The patient has to be warned that ingesting large amounts and greasy food can and probably will cause diarrhea and bad smell stools

How is the post-op?
The same way of the Bypass, most of our patients go home within 30 to 36 ours after the operation, the diet is advanced more quickly than in the bypass and after 2 weeks of a liquid diet it advances in a stepwise way to a puree/baby food type diet for one or more additional week and evolves to a almost normal diet after that. The complete return to normal activities occurs in about two weeks.
In these types of operations there is a need to supplement vitamins and minerals in a lifelong way, Iron and protein also must be followed by I.V. test and reposition may be needed

What are the results in weight loss with the BPB operations?
With the BPD, the expected mean % excess weight loss is 85 to 95%. For example, one patient with 140Kg of weight, 1,70m of height and a 48 of BMI, has an average excess weight of 65Kg. With the Gastric band he should loose an average of 63Kg going to 77Kg and a BMI of 25.
The Gastro Obeso Center between December of 2001 and December of 2005 operated 149

patients with the BPD procedure. The mean BMI comes from 49 to 26,8 and the %EWL goes to 83% with a mean drop of 44% of the initial total weight in a two years follow-up in a T.P.C. environment

What are the risks in BPD?
International literature describes an average of 15% in complications and a mortality rate between 1 and 3%. Our numbers goes to a 11,2% complication rate and a 1,1% mortality rate in this series.

Links for surgical videos
Bilio Pancreatic Diversion 01
Bilio Pancreatic Diversion 02
Bilio Pancreatic Diversion 03
Bilio Pancreatic Diversion Full


Intragastric Balloon

What is the intragastric Balloon?
The intragastric Balloon is a procedure in witch a silicone balloon is placed by upper endoscopy inside the stomach and filled with saline solution plus a biocompatible substance called methylene blue. It is placed in ambulatory bases and filled until it reaches 400 to 700ml. It’s also a temporary treatment with the balloon removed by endoscopy at 6 months

How it works?
The 400 to 700ml of liquid in the balloon take place in the stomach adding restriction to the food intake, also, fullness occurs with small amount of food, reaching by this way the weight loss

What are its indications?
Patient with BMI between 33 to 39 Kg/M2
Patients with BMI over 40 Kg/M2 that refuses surgery or can have it due to clinical restrictions
Pre-operative preparation to patients over 50 Kg/M2 (super-obese) to reduce surgical risks
Patients with BMI over 27 with co-morbid conditions such as diabetes and hypertension

What are the results of intragastric balloon ?
The Brazilian Intragastric Balloon Multicentric Study with a reference in medical literature shows at his end an average reduction of 1/3 (30%) of its initial excess weight. For example a patient with 40Kg of excess looses an amount of 12Kg within the 6 months of treatment and so. Our results in 291 cases were similar to the Brazilian Multicentric study

Is there a place for medical treatment with the balloon?
The group who make complementary diet and exercises benefits from a more consistent weight loss

Can the intragastric balloon be compared with the surgical treatment?
No, the intragastric balloon has superior results when compared with the clinical management of obesity, but when comparing with the surgical treatment it is inferior in terms of weight loss. Also remembering its temporary nature

What are the complications with intragastric balloon?
The Brazilian Intragastric Balloon Multicentric Study shows that with this method the occurrence of temporary nausea, vomiting, abdominal pain and dehydration. Gastric or personal intolerance e balloon that leads to an early balloon removal can occur but it is rare (we had two cases). Balloon deflation was related in cases that were not removed after the 6 months time .

How the balloon is removed? What happens after the removal?
The balloon is removed 6 months after its implantation. The patient can change one balloon to another (we do not recommend more than 3 changes) for more 6 months, can go to bariatric surgery or can enter in a maintenance weight program. At least 50% of the patients keep their weight after the balloon had been removed.

Links for endoscopic videos
Intragastric Balloon placement
Intragastric Balloon retrieval