Deciding which bariatric surgery is right for you is a complicated process that can only be successfully accomplished by working with your physician. 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, patient preference, and the interventions that have already been undertaken on your weight-loss journey to date. Ultimately, the approach that is chosen is tailored to the individual’s needs and goals, and accounts for all pertinent risk factors.
Types of Bariatric Surgery
Generally speaking, bariatric surgery works by decreasing the volume of a patient’s stomach, thereby restricting the amount of food they can consume (restrictive procedures), or altering the digestive tract itself to decrease the amount of calories that can be absorbed from digested food (malabsorptive procedures). Some procedures only aim to decrease the size of the stomach and some just decrease the length of the digestive tract, but there are some procedures that do a combination of both; in any instance, the end result of bariatric surgery is drastic weight loss in a short period of time.
Bariatric surgery is most commonly performed using minimally-invasive laparoscopic techniques, in which the surgeon works through small incisions in the abdomen using an instrument called a laparoscope. There are a number of surgical procedures that fall under the umbrella of bariatric surgery. The most common procedures under the bariatric surgery umbrella are sleeve gastrectomy, gastric bypass, gastric banding, and duodenal switch. Regardless of which procedure your surgeon chooses, the extent of the procedure’s success is largely dependent on the patient’s adherence to post-surgery diet and exercise regimens.
Sleeve Gastrectomy
Sleeve gastrectomy is a laparoscopic procedure during which up to 80% of the stomach is removed, significantly decreasing the size of the stomach and the number of food patients can eat before feeling full. The procedure does not require intestinal bypass. Sleeve gastrectomy also makes the remaining, smaller stomach secrete fewer hunger-causing hormones, which in turn makes patients feel less hungry throughout the day. Weight loss comes rapidly following sleeve gastrectomy. Within six months, patients can typically expect to lose roughly half of their excess weight; ultimately, the procedure allows patients to lose 60-70% of their excess weight within one to two years. Furthermore, the procedure has the ability to improve or outright cure many obesity-related co-morbidities, like diabetes, sleep apnea, hypertension and heart disease.
Gastric Bypass
Gastric bypass, also known as “Roux-en-Y 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. Patients experience weight loss due to restriction of food intake and decreased absorption of calories. Furthermore, changes in gut hormones similar to those produced by sleeve gastrectomy promote satiety, suppress hunger, and improve glucose control. Similar to sleeve gastrectomy, patients experience weight loss very quickly following gastric bypass. Patients can expect to lose up to 65% of excess weight and resolve a number of their obesity-related co-morbidities within one year.
Gastric Banding
Laparoscopic adjustable gastric banding (“gastric band” or “LAP-BAND”) is 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. Tightening or loosening the band in this manner will adjust how full patients feel during and after meals. While weight loss occurs quickly following gastric banding, the results are not as extreme as with other bariatric procedures. Patients can expect to lose up to 55% of their excess weight within two years, and improve or reverse many obesity-related co-morbidities. However, they do not lose as much weight or as aggressively improve co-morbidities as patients who undergo gastric sleeve, gastric bypass or duodenal switch. Furthermore, gastric banding does nothing to decrease the level of hunger-causing hormones present in the stomach, so the procedure does nothing to change how hungry patients feel.
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 number of calories that can be absorbed from food by rearranging the small intestines and removing the gallbladder. The procedure allows patients to shed weight at a rapid rate, ultimately leading to 70-80% excess weight loss within two years. Duodenal switch also has a unique ability to help patients keep the excess weight off long after their surgery. While most bariatric procedures result in some weight regain in the years following surgery, the duodenal switch has one of the highest long-term success rates of any bariatric procedure.
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).
What do these have in common?
All the above listed procedures attempt to induce massive weight loss by some combination of restricting the amount of food that can be consumed by patients, limiting the absorption of calories from the food that is consumed, and altering gut hormone levels to decrease hunger and appetite and promote satiety. They are also most commonly performed using laparoscopic techniques and all have the potential to induce rapid, significant weight loss in patients.