At Richmond Metabolic and Bariatric Surgery (RMBS), all our surgeries are done using laparoscopic techniques, also known as minimally invasive surgery. We offer four types: VSG, RNY, BPD-DS and SADI-S. We do not offer lap bands or other types of surgeries.
Review the description of each type of surgery below before you meet the surgeons. Your surgeon will help you decide which surgery would be best for you by discussing the types of surgeries, their benefits and their risks.
You can also read patient testimonials on the Obesity Help website.
The Vertical Sleeve Gastrectomy is performed by making several small incisions in your abdomen. A vertical incision is then made to remove approximately 80-85% of your stomach. Your new stomach sleeve, which is shaped similar to a tube, holds approximately 100 -125ml in the beginning. This new smaller stomach significantly reduces the amount of food and calories that can be consumed. It also causes favourable changes in gut hormones which help to suppress your appetite, improve the feeling of satiety (or fullness) soon after eating, and improve blood sugars.
Your laparoscopic surgery will involve 6 small incisions in your abdomen. A small pouch about the size of a large egg is made at the top of your stomach and then your small intestine is divided just past your stomach. One end of the intestine is attached to your new stomach pouch and the remainder of your stomach is bypassed (food no longer travels through this remnant stomach) though remains in your body. The other end of your divided intestine (the one attached to your remnant stomach) is reattached to your small intestine a little further down. This allows for digestive juices and enzymes to meet with the food stream. This procedure not only reduces the size of your stomach but also reduces how much food you absorb by bypassing part of the small intestine. This is considered to be the Gold Standard for bariatric surgery as there is significant weight loss along with significant improvements in obesity-related illnesses such as diabetes, high blood pressure, heart disease, GERD, etc.
This procedure is a modified version of the Duodenal Switch (described in detail in the next section). The duodenum is detached just below the stomach and reattached to a loop of the small intestine about 3.6 meters downstream. This creates two separate pathways and one common channel. The shorter pathway (digestive channel) allows food to flow from the stomach to the common channel. The longer pathway (biliopancreatic channel) carries bile from the liver to the common channel. This diversion limits the amount of time that food mixes with digestive juices and reduces the number of calories that can be absorbed, leading to weight loss.
Biliopancreatic diversion with duodenal switch (BPD/DS) or simply duodenal switch (DS) is a bariatric surgery that can help patients lose up to 80% of their excess body weight. It is performed laparoscopically and often done as a single-stage surgery but can also be done for patients that have had a VSG in the past and still have significant weight to lose or struggling with comorbidities such as, DM2, HTN, dyslipidemia, etc. It can help you lose more weight and improve your comorbidities by its malabsorptive action via reducing the absorption of macro and micronutrients (vitamins and minerals).
In this surgery, the intestine is bypassed starting from below the pylorus to the ileum, 50 to 125 centimetres from the colon. The bypassed portion of the intestine (biliopancreatic limb) delivers bile and pancreatic juices to the anastomosis at the ileum, where it meets the alimentary limb (proximal duodenum, through which food passes) to form the common channel. This is where food combines with bile and pancreatic juices for the first time and most nutrient absorption occurs.