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Bariatric Surgery

"Imprisoned in every fat man is a thin one wildly signaling to be let out " - Cyril Connolly

Bariatric surgery is a surgical breakthrough to promote effective weight loss which can be divided into two categories; restrictive or malabsorptive. Restrictive procedures work by physically restricting the size and the capacity of the stomach as well as decreasing the rate of digestion. Malabsorptive procedures, on the other hand, modify the absorptive capacity of the digestive system by physically removing parts of the digestive tract which greatly limits calorie absorption. Figuring out which is the best surgical alternative for you is more than a decision but a life changing commitment that is why we strongly recommend coming in for a consultation.

Dr. Dineros is the first bariatric surgeon in the Philippines and is a prominent key opinion leader on bariatrics in Asia. He has been invited as a speaker in numerous countries such as India, Malaysia & Japan to name a few and has been actively participating in bariatric conventions worldwide in order to further improve his skill and knowledge. Dr. Dineros personally sought out and received formal training with not only the best bariatric surgeons but also the forefathers and developers of the modern bariatric surgical techniques.

Bariatric Surgery

i. Adjustable Gastric Banding

Category: Restrictive

Gastric Banding is the least invasive alternative in surgical weight loss management. The procedure is done laparoscopically and it involves the installation of an inflatable silicone device that embraces the top portion of the stomach just below the distal end of the esophagus.Once the silicone device is inflatedit molds an hourglass deformity which can only accommodate a miniscule amount of food. Also, the pouch acts like a natural funnel which only allows a small amount of food to pass per unit time. In effect, the restrictive nature of the procedure makes the patient feel full at a much faster rate and for a longer period of time.

Gastric Banding is preferred by most individuals due to its reversible properties; the band can be adjusted accordingly to fit the needs of the patient and can be removed anytime without any repercussions or permanent alterations to the anatomy of the stomach. The band is adjusted via saline injection/removal at a port dock attached underneath the skin of the abdomen.

Pros Cons Risks
  • Reversible
  • Simplest & Safest
  • Normal GI physiology
  • Less dramatic weight loss compared to other procedures
  • Requires patient compliance
  • More likely to regain weight throughout the years
  • Vomiting
  • Band may slip out of place
  • Band migration/leakage
  • Infection

Bariatric Surgery

ii. Gastric Sleeve Resection

Category: Restrictive

Gastric Sleeve Resection or Laparoscopic Sleeve Gastrectomy (LSG) is a purely restrictive procedure that involves the excision of the greater curvature of the stomach, which creates tubular sleeve in place. Unlike gastric banding, gastric sleeve resection causes a more permanent alteration in the anatomical structure of the stomach however the principle is still the same; the procedure creates a restriction in the size and the capacity of the stomach but to a milder degree as compared to gastric banding.

Another added benefit of the procedure is that the excised portion of the stomach contains numerous cells that secrete Ghrelin, a hormone that signals hunger and encourages the person to ingest more food. Gastric Sleeve Resection is a more preferred restrictive surgical intervention amongst morbidly obese patients who require a permanent intervention and a more dramatic weight loss alternative.

Pros Cons Risks
  • Less risks as compared to malabsorptive procedures
  • Decreases appetite
  • Irreversible
  • Leakage
  • Infection
  • Blood clots

Bariatric Surgery

iii. Roux en Y Bypass Procedure

Category: Combined restrictive and malabsorptive

Laparoscopic Roux-en-Y Gastric Bypass involves transecting the proximal stomach to diminish its size to about 20-30 cc capacity. A segment of the proximal small bowel is connected to it in a roux-y fashion to establish continuity of the gastrointestinal tract. The bypassed stomach and first portion of the small bowel doesnt get in contact with rerouted food anymore, digestive enzymes meet with food in the distal small bowel, hence, there is considerable malabsorption of nutrients.

This procedure is considered the gold standard for all the procedures because of its durability in terms of weight loss, its adaptability, resolution of metabolic co-morbidities and its acceptable short and long-term complications.

Gastric Bypassis indicated for the obese with Type 2 Diabetes Mellitus regardless of BMI category. The interplay of mechanisms other than restriction and malabsorption, such as lowering the insulin resistance secondary to changes in gut hormones make this surgery an anti-diabetic procedure.

Pros Cons Risks
  • Durable weight loss
  • Gold standard
  • Remarkable long-term results
  • Good for diabetes Type 2
  • Dramatic weight loss compared to other procedures
  • Requires patient compliance
  • Leaks
  • Infection
  • Bleeding
  • Marginal Ulcer

Bariatric Surgery

iv. Bilio-pancreatic Diversion w/ Duodenal Switch

Category: Mainly malabsorptive with mild restriction

Mostly indicated for the severely obese patient with diabetes and dyslipidemia, BPD-DS has shown remarkable resolution of co-morbidities. This procedure has a long history of success especially for the super-obese patients and presents with the highest excess weight loss in the long-term. Because of its malabsorptive nature, BPD-DS patients require adequate supplementation for protein and micronutrients to avoid long-term nutritional deficiencies.

Pros Cons Risks
  • Highest and most durable excess weight loss
  • Best resolution for Type 2 Diabetes and Dyslipidemia
  • Best for the severely obese, and supe-obese
  • Highly malabsorptive
  • Nutritional complications
  • Leak
  • Malabsorption