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Choosing a Bariatric Surgery Procedure

Bariatric surgery is a type of surgery to help you lose weight when diet and exercise alone has not been successful.

To qualify for bariatric surgery, you must have:

  • A BMI of 35 or greater and health problems, such as diabetes, heart disease, and sleep apnea

  • A BMI of 40 or greater with/without obesity-related health problems

BMI is a way of measuring obesity. It consists of height and weight measurements and can be easily calculated online or through your health care provider. BMI is a way of measuring obesity. It consists of height and weight measurements and can be easily calculated online or through your health care provider. Click here for a BMI calculator.  

Surgery vs. medical treatment

Long-term success of diet and exercise alone is under 20%. People who have bariatric surgery tend to lose more weight than people who get medical treatment for their weight loss, and keep it off. Surgery is more likely to help with health conditions linked with obesity. Long-term survival is also longer in patients who have had bariatric surgery versus those who received medical treatment for obesity.

There are newer medical methods of weight loss such as the intragastric balloon or medicines. But weight loss tends to be less than with bariatric surgery. 

Types of bariatric surgery

Most bariatric surgeries are done laparoscopically. This means they are done through small incisions with the help of a small camera. The most common bariatric surgery done in the U.S. today is the sleeve gastrectomy. While there are several methods used in bariatric surgery, your surgeon will discuss the method of surgery that is best for you. Each method has its own advantages and disadvantages. The type of bariatric surgery that works best for you will depend on several factors which include your:

  • General health

  • Medical needs

  • Personal preference

Not all bariatric procedures are performed at the VA. It is important to discuss with your surgeon the types of surgeries available to you.

Front view of stomach and duodenum. Stomach has been cut and stapled to form pouch. Cut end of small intestine has been brought up to connect to stomach pouch. Duodenum has been cut and reattached to small intestine. Arrow shows food passing from stomach into shortened small intestine. Another arrow shows path of digestive juices from stomach through duodenum and into small intestine. Digestion begins in small intestine.
Gastric bypass

Front view of stomach showing vertical sleeve gastrectomy. Arrows show path of food and digestive fluids.
Sleeve gastrectomy

Front view of stomach and duodenum. Stomach has been cut and stapled. Cut end of small intestine has been brought up to connect to stomach. Duodenum has been cut and reattached to small intestine. Arrow shows food passing from stomach into shortened small intestine. Another arrow shows path of digestive juices from stomach through duodenum and into small intestine. Digestion begins in small intestine.
Biliopancreatic diversion with duodenal switch (BPD/DS)

The types of surgery are:

  • Gastric bypass. This is also called a Roux-en-Y gastric bypass. During this surgery, your surgeon separates part of the stomach to create a small pouch. The pouch is then attached to a part of your small intestine. The gastric bypass reduces the amount of food you can eat at one time as well as decreases your hunger and makes you feel full faster. It also reduces the number of calories and nutrients you can absorb from the foods you eat. The gastric bypass also works by gut hormones, that results in less hunger and faster fullness.

  • Sleeve gastrectomy. This is also called the gastric sleeve. This is a type of surgery that removes up to 80% of the stomach. The surgery turns the stomach into a narrow tube that looks like a banana. The sleeve holds much less food, and you feel full faster. The sleeve also works by gut hormones that change how full or hungry you feel.

  • Lap banding. This surgery is also known as laparoscopic adjustable gastric banding or LAGB. During lap banding, your surgeon places an adjustable band around the top of your stomach. Your surgeon also places a small device called a port under the skin of your stomach. A thin tube leads from the band to the port. Fluid is injected into the port and flows to the band to make it squeeze tighter around the top of the stomach. Or fluid can be removed through the port to loosen the band. The band around your stomach reduces the amount of food that you can eat at one time. This operation does not affect your gut hormones in the same way the sleeve or bypass do. It has fallen out of favor in many places due to the high number of bands that must be removed.

  • Biliopancreatic diversion with duodenal switch (BPD/DS). This is a less common type of weight-loss surgery. In this surgery, your surgeon removes part of the stomach to create a gastric sleeve, as with the sleeve gastrectomy. The sleeve is then attached to a part of the lower small intestine. The sleeve holds much less food, and your body absorbs far fewer calories and nutrients from food. This operation leads to the highest amount of weight lost.

  • vBloc (vagal nerve blocker). This is also a less common type of weight loss procedure. In this procedure, your surgeons attaches leads to your vagal nerves around your esophagus. The leads are then connected to a pacer which is placed under your skin. The pacer is turned on and off throughout the day leading to less hunger.

Advantages and disadvantages of each type of surgery

Type of surgery

Advantages

Disadvantages

Gastric bypass

  • Tends to be a very successful surgery

  • Patients lose between 60-80% of their excess weight

  • Surgery restricts amount of food that can be consumed and leads to less hunger

  • Long-term weight loss is also very good with most patients keeping at least 50% of their excess weight loss

  • Very successful in decreasing diabetes, sleep apnea, hypertension, etc.

  • Increased risk for complications as it is more technically complex surgery

  • You are more likely to have nutritional problems with vitamin B12, folate, and iron and will need to be on vitamin supplements for the rest of your life

  • Can cause dumping syndrome

  • Generally has a longer hospital stay

Sleeve gastrectomy

  • Tends to be a very successful surgery

  • Patients lose about 50-70% of their excess weight

  • Long-term weight loss is also very good with mean weight loss of 49% at 5 years

  • Less surgically complex than a gastric bypass as it requires no foreign bodies or no rerouting of your food

  • Fewer complications than gastric bypass

  • Easier to recover from than a gastric bypass

  • Very successful in decreasing diabetes, sleep apnea, hypertension

  • Slightly less weight loss than the bypass

  • Perhaps less helpful in eliminating diabetes than the bypass

  • You may have difficulty absorbing certain nutrients

  • You may develop narrowing (strictures) in your stomach or reflux requiring other surgery

Lap banding

  • Lap banding is a simpler surgery

  • After lap band surgery, it is fairly easy to loosen or tighten the band

  • A tighter band might help you feel fuller sooner and help you lose weight

  • Your risk for serious complications right after your surgery is low

  • It can lead to loss of about half of a person’s excess body weight after 2 years

  • You may be more likely to need a follow-up surgery

  • Less patients lose up to 50% excess weight compared with other bariatric surgeries

  • Not right for you if you think you’ll have a hard time following a nutritional program

  • You may need to see your health care provider more often after this surgery

  • You may need to have band removed or replaced because of reflux or other problems

  • Band may slip out of position

  • Requires a needle to adjust the amount of fluid in the band

  • May cause nausea, vomiting, acid reflux, and trouble swallowing

General risks of bariatric surgery

All surgery has risks. Your risks may vary according to your general health, age, type of surgery you choose, and the amount of weight you need to lose. Talk with your healthcare provider about the risks that most apply to you.

The post-surgery diet

After surgery, you will get instructions about how to adapt to your new diet. You will likely be on liquid nutrition for a few weeks after surgery. Over time, you’ll start to eat soft foods and then solid foods. If you eat too much or too fast, you will likely have stomach pain or vomiting. You’ll learn how to know when your new stomach is full. After gastric bypass many people can’t eat foods with a high sugar content.

Your health care provider or nutritionist will give you more instructions about your diet. These may vary depending on the type of surgery you had. You’ll need to learn good habits like choosing healthy foods and not skipping meals. Your health care provider or nutritionist may also need to screen you for low levels of certain nutrients. This is more of a problem with gastrectomy, gastric bypass, and BPD/DS surgery.

Managing your health after surgery

You may need to work with your health care providers regularly to stay healthy. This depends on what type of surgery you have. Your medical team will keep track of your health, especially as you lose weight quickly in the first 6 months or so after your surgery. Weight loss tends to be at its peak around a year after surgery.

Talk with your health care provider about your goals

Work with your healthcare provider to see which surgery may work for you. It’s important to have sensible goals about what bariatric surgery might achieve for you. Some people may still be somewhat overweight a year or two after their surgery. Even if you don’t lose all of your excess weight, health issues such as high blood pressure should get better. You may be able to reduce the amount of medicines that you need to take.

Talk with your health care provider. Ask questions and express your concerns. Together you can decide the right treatment for your needs.

Author: StayWell Custom Communications
Last Annual Review Date: 5/1/2018
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