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Glossary of Terms

Adjustable Gastric Band - Restrictive gastric operations, such as an adjustable gastric banding procedure, serve only to restrict and decrease food intake and do not interfere with the normal digestive process. In this procedure, a hollow band made of special material is placed around the stomach near its upper end, creating the small pouch and a narrow passage into the larger remaining portion of the stomach. This small passage delays the emptying of food from the pouch and causes a feeling of fullness. The band can be tightened or loosened over time to change the size of the passage.

Anesthesia - The loss of sensation and feeling. Also refers to the process or drugs used to produce this effect. Anesthesia is commonly employed prior to surgery so that a patient will not feel any pain or discomfort.

Bariatric - Related to the branch of medicine that deals with the prevention and treatment of obesity.

Bariatric Surgeon - A surgeon who specializes in the surgical treatment of obesity.

Bile - A fluid discharged by the liver into the intestines that helps in the digestive process.

Biliopancreatic Diversion (BPD) - A surgical procedure used to treat obesity that removes approximately two-thirds of the stomach and re-arranges the intestines so that digestive enzymes have less contact with the foodstream. This procedure serves to impair nutrient absorption and thus dramatically reduce caloric intake, even when average-sized portions are consumed. While this procedure produces rapid weight loss that is more significant than with other obesity surgeries, it also carries a substantially higher risk of post-operative nutritional problems (including malnutrition). Also called the Scopinaro procedure.

Body Mass Index (BMI) - The most widely used measurement for obesity. The BMI approximates body mass using a mathematical ratio of weight and height [(weight in kg ÷ height in meters2) or (weight in pounds ÷ height in inches2 x 703)]. A BMI of 30 or more is regarded by most health agencies as the threshold for obesity. A BMI of 40 or more generally qualifies as morbid obesity. However, note that BMI measurements in body-builders and athletes may not be accurate determinants of obesity because the BMI does not distinguish between muscle and fat.

Cancer - An umbrella term for more than 100 life-threatening diseases characterized by the uncontrolled, abnormal growth of malignant cells. These harmful cells may spread locally or through either the bloodstream or lymphatic system. One of the comorbidities associated with morbid obesity.

Comorbidity - A medical condition that exists in addition to and is caused or worsened by obesity or any other primary disease being studied or treated. With sufficient weight loss, obesity-related comorbidities such as type 2 diabetes, hypertension and sleep apnea generally improve or completely resolve.

Contraindication for Surgery - A factor that renders the carrying out of a surgical procedure inadvisable.

Diabetes Type 2 - A chronic endocrine disorder characterized by the inability to properly utilize sugar, specifically glucose, a simple carbohydrate. This results in excessively high glucose levels in the blood. Diabetes involves either a relative or an absolute shortage of insulin, a hormone that regulates the body's breakdown of carbohydrates. A higher percentage of obese individuals has type 2 diabetes than does the general population.

Dumping Syndrome - A physiological reaction frequently seen following gastric bypass surgery. This operation is designed to alter the function of the stomach and intestines and interrupt normal digestion. Therefore, whenever patients eat certain foods, such as sugar and sweets, they may experience "dumping," characterized by symptoms of nausea, flushing and sweating, light-headedness and watery diarrhea. This complication has been reported by most gastric bypass patients, while PacLap patients do not suffer from it.

Duodenal Switch - LapDS reconfigures the intestines so fewer calories are absorbed and reduces the capacity of the stomach so that food intake is restricted resulting in progressive, sustained weight loss. The stomach is reconstructed into a cylindrical tube, allowing more room for food compared to purely restrictive bariatric procedures thus permitting an eating pattern and diet much closer to normal. Our surgeons developed a method of using the laparoscope to perform this procedure, resulting in smaller incisions, minimal scarring, less discomfort, faster recovery and shorter hospital stay.  The Laparoscopic Duodenal Switch achieves an average loss of 50 percent of excess body weight at six months and 90 percent at two years.  By combining moderate restriction and moderate malabsorption, the LapDS minimizes complications associated with older bariatric procedures and limits weight regain seen with other procedures.

Gastric Bypass - A surgical procedure for the treatment of obesity where a thumb-sized stomach pouch is created using stapling techniques to divide the stomach and then connect the outlet of the pouch directly to the intestine (also known as the bowel), essentially "bypassing" the lower stomach. The flow of digestive juices is preserved, however. This procedure achieves its effect by restricting the volume of food consumed and also the type of food consumed. Sugars and fats may cause discomfort known as the "dumping syndrome." Gastric bypass surgery can be performed via open surgery (one large incision) or less invasively with laparoscopic techniques (several tiny incisions), although laparoscopic gastric bypass is performed infrequently. Produces rapid and significant weight loss but is associated with higher complication rates and more side effects. Also known as Roux-en-Y or RNY.

Gastroesophageal Reflux - The backward flow of stomach contents into the esophagus due to a malfunction in the sphincter at the end of esophagus. This can cause heartburn and discomfort. When it occurs repeatedly, it may become gastroesophageal reflux disease (GERD), where stomach acid can eventually cause scarring of the esophagus and other chronic problems.

Heart Disease - Any of a number of diseases related to the heart and blood vessels. Also known as coronary artery disease. When grouped together, these diseases are the leading cause of death in the United States.

Hypertension - The medical term for high blood pressure. Usually, this means that a patient has a blood pressure of 140/90 or higher. In older adults, this number is adjusted upwards slightly. The top number is systolic pressure (pressure in blood vessels when heart is pumping out blood), while the bottom number represents diastolic pressure (when heart is at rest). This condition is also associated with obesity due to the excess weight that the heart has to sustain.

Ideal Weight - Generally, this term refers to what a person of a given height and body frame should weigh. In other words, the desired weight for optimal health and fitness. There are several problems, however, with current calculations of ideal weight: a) body fat percentage or distribution is not accounted for; b) only some of the tables account for different body frames or ages; and c) most importantly, there is no consensus about which formula or table to use. Thus, ideal weight remains subjective. To illustrate the variation, a height of 56" plus a medium body frame for a female has an ideal weight of between 124 and 149 pounds, depending on the source. This booklet uses the 1983 Metropolitan Life Insurance Company tables for ideal body weight basis in BMI calculations.

Laparoscopic Surgery - A minimally invasive surgical approach where the surgeon makes several small incisions to access the interior of the body. A long, slender camera attached to a light source and chopstick-like instruments are used to perform the operation. Compared to the large incision of conventional open surgery, there is typically less pain and scarring following this operation. Usually, hospital stay and overall recovery time are also reduced.

Laparoscopic Gastric Bypass - A minimally invasive method of performing gastric bypass surgery. (See full definition of "Gastric Bypass.") Surgical risks, however, are comparable to that of standard gastric bypass.

Morbid Obesity - A disease in which excess weight begins to interfere with basic physiological functions such as breathing and walking. Generally, it can be defined as weighing 80-100 pounds more than your ideal weight. A more precise indicator, however, is a Body Mass Index (BMI) of 40 or greater. In addition, a BMI of 35-39.9 with significant comorbidities can qualify.

Obesity - A condition where there is excess body weight due to an abnormal accumulation of fat. Defined objectively as a Body Mass Index (BMI) of 30 or more, obesity is associated with markedly increased health risks.

Osteoarthritis A degenerative joint disease that occurs when joint cartilage wears down and apposing bone surfaces rub against each other. Osteoarthritis does not result from inflammation like rheumatoid arthritis. It is usually accompanied by pain and stiffness. Although the condition tends to occur in the elderly, it is also associated with obesity, which places undue stress on weight-bearing joints.

Overweight - A condition of increased body weight compared to established standards. The weight may result from bone, fat, muscle, and/or water. Defined objectively as a Body Mass Index (BMI) of 25-29.9.

Pancreatic Enzymes - Proteins released by the pancreas that help break down food during the digestive process. This process creates energy that can be carried through the body by the blood.

Saline - A salt solution (sodium chloride) similar to tears, the body's natural liquid. Used to fill the adjustable gastric band to adjust the degree of restriction and the rate of weight loss.

Satiety - A state of being satisfied or gratified to the fullest extent. Satiety is equated with complete fullness, in which the person is unable to eat any more food.

Sleep Apnea - The temporary cessation of breathing during sleep. Typically, the sufferer will awake gasping for breath. Sleep apnea may occur repeatedly, resulting in a poor night's sleep and daytime drowsiness. One of the comorbidities associated with morbid obesity.

Stoma - The outlet to the stomach created by stapling or placing an adjustable band around its upper part, which divides the stomach into two parts – the small upper stomach pouch and the lower stomach – resulting in restriction of the amount of food the stomach can hold and increasing the time it takes to empty. The adjustable gastric band allows the stoma to be adjusted by inflating or deflating the inner surface of the band in order to modify the degree of restriction.

Stroke - A sudden loss of brain function due to a blockage or rupture in a blood vessel that supplies oxygen to the brain. Depending on the affected area of the brain, a stroke may lead to muscular coordination problems, slurred speech, blindness, paresis (weakness), unconsciousness, paralysis, coma or death. One of the comorbidities associated with morbid obesity.

Vertical Banded Gastroplasty (VBG) - An older surgical procedure for the treatment of morbid obesity that staples the stomach and reduces its size to a thumb-sized pouch. The outlet to the pouch is reinforced with a synthetic mesh band. The result is a marked restriction in the volume of food that can be consumed, inducing the feeling of satiety after only a few bites. VBG is a technically simple operation but is rarely performed through the minimally invasive approach. Staple line disruption results in weight regain. Also known as "Stomach Stapling" or "Gastric Stapling."

Vertical "Sleeve" Gastrectomy - This is a purely restrictive procedure. The stomach volume is reduced limiting the volume of food eaten. The greater curvature of the stomach is removed leaving a banana shaped tube stomach between 2-3 ounces in size. The pyloric valve and function remains intact and no intestinal bypass is performed. Benefits of this procedure include the restriction of volume of food, liquids and nutrition eliminating dumping or malabsorption. This is a less complex bariatric procedure. Weight loss has been excellent in most patients. Reports suggest that substantial percentage of patients regain the weight they lost.

To learn more about surgical weight loss, click here to request a consultation with Dr. John Rabkin at Pacific Laparoscopy. Or you can call our office at 415-668-3200 to schedule your appointment.

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