Bariatric or weight loss surgery is a catch-all term that includes any surgical procedure performed on the stomach or intestines with the goal of inducing significant weight loss. It is one of the only weight loss treatments with a proven track record of success and, for many people, it is the only option for achieving durable weight loss. While any surgical procedure carries some level of risk, bariatric surgery is a safe treatment option for patients struggling to maintain a healthy weight.
Talking with your doctor
The first step in preparing for bariatric surgery is to consult with your physician. You and your physician will need to discuss your personal and family medical history, weight loss goals, and weight loss/gain history to determine whether or not bariatric surgery is right for you. One of the most important factors they will consider when determining your eligibility for bariatric surgery is your willingness and ability to comply with the necessary diet and lifestyle changes following surgery. Bariatric surgery is not a cure-all for obesity; it requires commitment and effort from patients to ensure optimal outcomes. Therefore, it is very important for your physician to confirm that you are physically and emotionally prepared for the procedure when deciding whether or not to proceed.
Deciding which surgery is best for you:
After determining that bariatric surgery is in your best interest, the next step is deciding which surgery is right for you. This is a complicated process that can only be successfully accomplished by working closely with your surgeon. When choosing a procedure there are multiple factors that must be taken into consideration, such as degree of obesity, number and severity of obesity-related co-morbidities, your preferences, and the interventions that you have undertaken to date on your weight-loss journey. Ultimately, the approach that is chosen should be tailored to your individual needs and goals, and account for all pertinent risk factors that might be present in your medical history.
There are multiple surgeries for you and your physician to choose from:
- Sleeve Gastrectomy – a laparoscopic procedure during which up to 80% of the stomach is removed, significantly decreasing the size of the stomach and the amount of food patients can eat before feeling full. The procedure also alters gut hormones in such way that decreases hunger and promotes satiety.
- Gastric Bypass – also known as “Roux-en-Y gastric bypass,” gastric bypass is a laparoscopic procedure performed by creating a small pouch from the upper portion of the stomach and rerouting the small intestine to it, bypassing a large portion of the stomach. Similar to sleeve gastrectomy, production of gut hormones decreases to help promote weight loss.
- Gastric Banding – performed by placing an adjustable, balloon-like band around the top portion of the stomach. This creates a smaller, pouch-like stomach above the band that fills up quickly and allows patients to feel “full” sooner, thereby restricting the amount of food and calories they consume. The band can be adjusted by injecting sterile saline through a small port placed underneath the skin during the initial procedure, changing how full patients feel during and after meals.
- Duodenal Switch – duodenal switch is a laparoscopic procedure performed by creating a small, tubular stomach similar to sleeve gastrectomy; rerouting the small intestine to decrease its overall length; and removing the gallbladder. The procedure restricts food consumption by decreasing the size of the stomach and reduces the amount of calories that can be absorbed from food by rearranging the small intestines and removing the gallbladder.
- Revision Surgery – while complications from surgery, suboptimal weight loss, and weight regain are not common, they can happen. If they do, corrective or revision surgery may be required to get weight loss back on track. The most common revision procedures are performed laparoscopically and seek to decrease the size of the gastric pouch, shrink the opening between the stomach and the small intestine (known as the “stoma”), and/or transition one bariatric procedure into another (i.e., convert a Roux-en-Y gastric bypass into a duodenal switch).
Understanding what changes are coming
The final step in preparing for bariatric surgery is to fully come to terms with the changes that you are about to experience. Bariatric surgery requires a great deal of commitment and effort from patients to be successful, so understanding the extent of the lifestyle changes that are required is essential. Patients often find it helpful to begin dieting and a moderate exercise regimen in the weeks leading up to surgery so as to better prepare themselves for their life following the operation. This is also the ideal to time to ensure you have the appropriate physical and emotional support system in place to help you work towards your post-surgery weight loss goals.