There are several weight loss surgery options from which you may choose to treat morbid obesity. So how do you know which weight loss surgery option is right for you? This brief guide is a starting point. Know your options and from here, you will want to do further research on each weight loss surgery option, interview bariatric surgeons, and discuss with patients whom have undergone weight loss surgery. Two online patient communities that I recommend for such discussions are ThinnerTimes and BariatricPal.
Two weight loss surgery types are malabsorptive procedures and restrictive procedures.
Malabsorptive procedures divert food from the stomach to a lower part of the digestive tract where the normal mixing of digestive fluids and absorption of nutrients cannot occur.
Restrictive procedures restrict the size of the stomach and decrease intake.
Some bariatric surgery options combine both malabsorptive and restrictive approaches. Read: How Safe is Bariatric Surgery?
Weight Loss Surgery Options
The gastric bypass achieves weight loss by gastric restriction and malabsorption. Reduction of the stomach to a small gastric pouch (30 cc, or about the size of an egg) results in feelings of satiety even after eating only small meals. This small pouch is connected to a segment of the jejunum, bypassing the duodenum and very proximal small intestine, thereby reducing absorption. Gastric bypass weight-loss procedures can be open or laparoscopic.
The duodenal switch achieves weight loss by gastric restriction and malabsorption. The stomach is partially resected, but the remaining capacity is generous compared to that achieved with the gastric bypass. As such, patients eat relatively normal-sized meals and do not need to restrict intake radically. The most proximal areas of the small intestine (i.e., the duodenum and jejunum) are bypassed and substantial malabsorption occurs. The partial duodenal switch surgery is a variant of the biliopancreatic diversion procedure. It involves resection of the greater curvature of the stomach, preservation of the pyloric sphincter, and transection of the duodenum above the ampulla of Vater with a duodenoileal anastomosis and a lower ileoileal anastomosis. Duodenal switch weight loss procedures can be open or laparoscopic.
3. Adjustable Gastric Band – Lap-Band, Realize Band
The adjustable gastric band achieves weight loss by gastric restriction only. A band creating a gastric pouch with a capacity of approximately 15 to 30 cc’s encircles the uppermost portion of the stomach. The band is an inflatable doughnut-shaped balloon, the diameter of which can be adjusted in the clinic by adding or removing saline via a port that is positioned beneath the skin. The bands are adjustable, allowing the size of the gastric outlet to be modified depending on the rate of a patient’s weight loss. The gastric band weight loss procedures are laparoscopic only.
Sleeve gastrectomy, or gastric sleeve, achieves weight loss by gastric restriction only. This stomach undergoes a 70%-80% greater curvature gastrectomy (sleeve resection of the stomach) with continuity of the gastric lesser curve being maintained while simultaneously reducing stomach volume. It may be the first step in a two-stage procedure when performing the gastric bypass. Sleeve gastrectomy weight loss procedures can be open or laparoscopic.
5. Intestinal Bypass Surgery
The Intestinal Bypass achieves weight loss by malabsorption only. The safety of this surgery for treatment of obesity has not been demonstrated. Severe adverse reactions such as steatorrhea, electrolyte depletion, liver failure, arthralgia, hypoplasia of bone marrow, and avitaminosis have sometimes occurred as a result of this procedure. It is an older form of bariatric surgery and generally not performed anymore. Read one patient’s story with intestinal bypass surgery.
The gastric balloon is a medical device developed for use as a temporary adjunct to diet and behavior modification. It will help to reduce the weight of patients who fail to lose weight with diet and behavior modification alone. It is inserted into the stomach to reduce the capacity of the stomach and to affect early satiety. The long term safety and efficacy of the device in the treatment of obesity has not been established at the time of this writing.
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Photo: Mehta Obesity Center