MEDICAL ANIMATION TRANSCRIPT: Your surgeon will perform bariatric surgery if your weight loss efforts through lifestyle changes and medications have been unsuccessful. There are two types of bariatric surgery. Restrictive procedures decrease the size of the stomach so a person feels full quickly. After surgery, the stomach holds about one cup of food. A normal stomach holds four to six cups. Malabsorptive procedures decrease the absorption of calories in the small intestine. Before your procedure, an intravenous line will be started. Bariatric surgery requires general anesthesia, which puts you to sleep for the duration of the procedure. A breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the operation. Gastric bypass, technically referred to as Roux-en-Y gastric bypass, is both a restrictive and malabsorptive procedure because it reduces the size of the stomach and decreases the absorption of calories in the small intestine. Your surgeon will use one of two methods for gastric bypass surgery. The open method requires an eight to ten inch incision in the abdomen. The laparoscopic method only requires several small keyhole incisions, through which your surgeon will pass a laparoscope and surgical tools. A laparoscope is a thin, lighted instrument that projects images of the surgery on a monitor in the operating room. During a Roux-en-Y gastric bypass procedure, your surgeon will use surgical staples to create a small compartment which will serve as your new stomach. This pouch will hold about one cup of food. The lower portion of the stomach continues to secrete digestive juices, but does not receive food. Next, your surgeon will cut the small intestine well beyond the stomach and bring one free end up and attach it to the pouch. He or she will then attach the other free end lower down on the small intestine, creating a Y shape. By bypassing the lower stomach and the first part of the small intestine, fewer calories will be absorbed as food passes through this new pathway. Banding techniques are restrictive procedures. They help decrease food intake in two ways-- by shrinking the stomach to a small pouch, and by making a tiny opening from the pouch to the rest of the stomach. Food moves slowly through this opening. These factors make you feel full quicker and for a longer time. In vertical banded gastroplasy, also known as VBG or stomach stapling, your surgeon will cut a window in the upper part of your stomach. He or she will place staples in your stomach around the window and toward the esophagus to create a small pouch on top. Next, your surgeon will pass a rigid plastic band through the window and wrap it around the small outlet of the pouch, which will prevent stretching. Food will move from this pouch through a tiny opening into the lower stomach and the rest of the digestive tract. During an adjustable gastric banding procedure, also known as AGB or lap band, your surgeon will wrap an inflatable ring around the upper part of the stomach. As the band is inflated, it will squeeze the stomach to create a small, upper pouch and a narrow opening into the larger, lower portion. This may be done through tiny incisions using a laparoscope. The band may be adjusted at any time. Biliopancreatic diversion is a malabsorptive procedure that decreases the amount of calories absorbed in your small intestine. Your surgeon will begin by removing part of the stomach, leaving only a small pouch behind. Next, he or she will sew the small intestine to the pouch. This creates a direct route from the pouch to the end of the small intestine. The duodenum and jejunum are bypassed, so few calories and nutrients are absorbed. For all methods of bariatric surgery, your surgeon will close your incisions with staples or stitches. After your procedure, your breathing tube will be removed, and you will be taken to the recovery area for monitoring. You will be given pain medication, and your diet will be gradually advanced over several days.