Bariatric Surgery

Clinic

Feel healthier in your skin. At UNLV Health Bariatric Surgery, we help you take control of your health and confidently move toward a stronger, healthier future. If you’ve struggled to lose weight through diet and exercise alone, or even with the use of GLP-1 medications, bariatric surgery may be a life-changing option.

Gastric Sleeve

What Is It?

Gastric sleeve surgery is a restrictive type of procedure that permanently reduces the size of the stomach, thereby limiting food intake as well as the sensation of hunger. This gastric sleeve procedure does not involve intestinal rerouting or malabsorption unless followed by Roux-en-Y gastric bypass and uses only the client’s own natural tissues. 

Gastric sleeve is performed laparoscopically or robotically and removes approximately 80 percent of the client’s stomach along the greater curvature, leaving only a long tube (or “sleeve”) for the new – much smaller – stomach pouch. The new stomach pouch is then stapled, and the small intestine is left intact. As the removed portion of the stomach is where the hunger-stimulating hormone ghrelin is produced, the surgery drastically reduces your hunger (even on an empty stomach) and simultaneously reduces the volume of food it takes to feel full. These combined effects result in a vastly different approach to eating and fueling your body. You are no longer ruled by your hunger!

Why Gastric Sleeve?

The gastric sleeve combines many of the benefits of both the gastric band and the gastric bypass; but without a foreign object and the many complications of the gastric band, including the following:

  • Performed laparoscopically or robotically. Many patients are candidates for outpatient, same-day surgery. Others require an overnight stay. This will be determined by your doctors based on your personal medical and surgical history.
  • Avoids the technical and long-term difficulties of the gastric bypass
  • No maintenance problems or artificial implants like those associated with gastric banding
  • Weight loss is comparable to that of the gastric bypass.
  • Significant improvements in diabetes, hypertension, cholesterol, sleep apnea, and other weight-related medical problems.
  • Recommended by the American Society for Metabolic and Bariatric Surgery

Gastric Bypass

What Is It?

 The Gastric Bypass was historically the most popular bariatric surgery in the United States.  This procedure is still performed today, but is primarily reserved for those with both morbid obesity AND difficult to control acid reflux in the absence of an anatomical problem (i.e Hiatal Hernia). The reason for this is that the bypass has inherent risks (marginal ulceration, dumping syndrome, internal hernia(s)) that make other malabsorptive procedures (SIPS, see below) more favorable and with less long term risk for the patient.

During this malabsorption type procedure, Dr. Apel creates a small stomach pouch and then constructs a “bypass” for food. The bypass allows food to skip the large excluded stomach and the first part of the small intestine limiting the absorption of calories and nutrients. The small pouch holds less food than the normal stomach. As such, you consume less volume, feel full on less volume, and absorb less of the food you do eat, thus providing both restrictive and malabsorptive weight loss. Gastric Bypass weight loss is used as a method to treat morbid obesity, type 2 diabetes, high blood pressure, sleep apnea, and other comorbidities.

Many patients are inspired by our gastric bypass before and after results, which showcase the transformative impact of the procedure. Additionally, patients are provided with a tailored gastric bypass surgery diet plan designed to maximize results. Before scheduling surgery, it’s important to meet specific gastric bypass surgery requirements to ensure the best outcomes. Our expert team in Las Vegas is here to help guide you on your weight loss journey

SIPS / Loop Duodenal Switch / SADI-S

We offer this procedure as both a primary operation and as a revisional option. After a vertical sleeve gastrectomy some clients experience weight regain – or they never met the weight loss goal they originally set out for. This does NOT make you a failure!

We are excited to offer SIPS surgery, our single-anastomosis intestinal pylorus sparing surgery (also known as the SADI-S and Loop DS), for those patients who need additional assistance achieving their desired weight loss. Our SIPS surgery combines the benefits of both gastric sleeve and gastric bypass for enhanced, long-term weight loss maintenance.

What Is the SIPS Procedure?

The single-anastomosis duodenal switch, also called stomach intestinal pylorus sparing surgery (SIPS surgery) 

  • Similar to the standard duodenal switch operations, except that the small intestine is only transected at the duodenum
  • The majority of the most stretchable portion of the stomach is permanently removed (as in a standard sleeve) but basic stomach function remains the same. 
  • Roughly half of the small intestine is bypassed, resulting in a significant decrease in calorie absorption 

Weight loss is achieved both through restriction of food consumption (via the sleeve component) and malabsorption (via the intestinal bypass component), which results in very good long-term weight loss maintenance. The SIPS procedure combines many of the benefits of both the gastric sleeve and the gastric bypass, including the following:

  • Approximately 70% of excess weight loss. The SIPS procedure is the strongest weight loss procedure available today, but with less overall complications and risk relative to the gastric bypass.
  • Improvement/resolution in all major weight-related comorbidities
  • Little risk of “dumping syndrome,” marginal ulcers, or internal hernias typical of a gastric bypass.
  • Provides predictable weight loss with great long-term success
  • Minimal side effects typical of the duodenal switch

Who Is a Candidate for The SIPS Surgery?

  • The ideal candidate for the SIPS surgery meets the following criteria:
  • For Revisional consideration: Prior Gastric Sleeve Surgery, a minimum of 1 year post-op, and BMI 30+
  • For primary surgical consideration, BMI 50+
  • Non-smoker
  • Generally healthy
  • Does not rely on NSAIDs for pain relief
  • Ability to take supplements for life post-surgery, and ability to draw labs 4 times a year for the first year, twice yearly for year 2, then yearly thereafter
  • Ability to follow instructions and medical advice.

Adjustable Gastric Banding

What Is It?

Adjustable Gastric Banding (also known as Lap Band) is a purely restrictive surgical procedure in which a small band is placed around the uppermost part of the stomach. This procedure is no longer offered given the surgical data and patient outcomes weighed against more effective, lower risk procedures. We do perform lap band removals, and revisions of lap band surgeries to more durable procedures (sleeve, bypass, SIPS), but no longer recommend this procedure for patients seeking a weight loss operation.

Hiatal Hernia Surgery

What is a hiatal hernia?

A hiatal hernia is a condition where the upper portion of your stomach (or other organs) bulges through the diaphragm muscle separating your abdomen from your chest. This condition, which often leads patients to consider hiatal hernia repair surgery, can affect people of any age, size or gender. Most often this is the stomach herniating into the lower chest, but can include other intra-abdominal organs as well. Understanding hiatal hernia recovery time is crucial for planning your return to normal activities and ensuring a smooth healing process.

This most commonly occurs as the natural opening is stretched beyond normal limits from weight gain, pregnancy, smoking, weightlifting or chronic constipation. Any sudden acute or chronic increase in pressure within the abdomen increases risk of developing a hernia, making timely hiatal hernia surgery essential for many patients. These hernias are common in patients seeking weight loss surgery and are often repaired during the same operation for weight loss.

What are the symptoms?

The symptoms of people with a hiatal hernia vary from person to person. The size of the hernia may or may not produce more severe symptoms. The most common symptom of a hiatal hernia is gastroesophageal reflux disease (GERD), aka acid reflux. GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of a hiatal hernia may include:

  • Heartburn
  • Bitter or sour taste in the back of the throat
  • Bloating and belching
  • Hiccups
  • Discomfort or pain in the stomach or esophagus
  • Regurgitation of food or liquids in mouth or throat
  • Difficulty swallowing
  • Shortness of breath
  • Chest or abdominal pain*
  • Dry cough
  • Asthma
  • Repeated lung infections such as pneumonia or bronchitis
  • Postprandial fullness
  • Early satiety

*Chest pain can also be a symptom of a heart attack, it’s important to contact your healthcare provider or go to the emergency room if you experience any chest pain.

How is surgery for a hiatal hernia performed?

Hiatal hernia repair surgery involves:

  • Reducing and/or removing the herniation from above the diaphragm opening
  • Closing the hole in the diaphragm muscle

Long term effects if left untreated?

  • Esophageal erosions from unchecked acid reflux
  • Vocal cord damage (VCD)
  • Lung aspiration/injury
  • Barrett’s Disease
  • Side effects from medications used to treat GERD (long term use of PPI and/or H2B medications are major considerations and must be weighed against surgical intervention)

SASI-S

What is it?

A sleeve gastrectomy removes roughly three‑quarters of the stomach. With a much smaller stomach, a person feels full sooner, and levels of ghrelin—the hormone that triggers hunger—drop significantly. In an intestinal bypass, the lower portion of the stomach (the antrum) is connected directly to the ileum, which is the last segment of the small intestine.

Because of this rerouting, about half of the eaten food skips the upper section of the small intestine. This decreases the body’s ability to absorb fats, sugars, and calories. Appetite also declines because undigested food reaching the lower small intestine triggers the release of “intestinal brake hormones,” signals that tell the brain that enough food has been consumed. The amount of small intestine bypassed can be adjusted depending on the degree of weight loss needed. Essential vitamins and minerals are still taken up efficiently because part of the food stream continues to move through the upper small intestine, where these nutrients are absorbed. 

Advantages of the SASI-S Procedure

Research suggest that the SASI-S operation may achieve greater overall weight loss compared with a standard sleeve gastrectomy and results that are at least comparable to a traditional Roux-en-Y gastric bypass. Key benefits include:

  • Integrates the advantages of both a sleeve and a bypass procedure
  • Typically produces more weight loss than a sleeve alone and outcomes similar or better than a gastric bypass
  • May reduce the likelihood of medium-term weight regain compared with sleeve surgery
  • Strong metabolic effects, with significant improvement in type 2 diabetes, cholesterol, and lipid levels (beyond what is usually seen with sleeve surgery alone)
  • Lower risk of staple-line leaks compared with SADI-S due to fewer staple lines
  • Reduced leak risk at the sleeve outlet because the pylorus is bypassed
  • Can improve reflux symptoms by lowering stomach pressure and enhancing gastric emptying
  • Lower long-term risk of nutritional deficiencies since the duodenum remains in the digestive pathway
  • Preserves access to the bile duct for procedures such as ERCP to treat gallstones
  • Reduced risk of internal hernia
  • Decreases hunger through release of intestinal “brake” hormones when undigested food reaches the lower small intestine and stomach remnant is removed
  • Potentially reversible to standard sleeve by closing the surgical connection

Disadvantages of the SASI-S Procedure

  • Higher risk of bile reflux into the stomach
  • Possibility of developing an ulcer at the connection between the stomach and small intestine, particularly in smokers and NSAID users.