Are you considering weight loss surgery? Educate yourself on the different types of surgery available as there are multiple options.
Weight loss surgery, also known as bariatric surgery, is an extreme method of weight loss that may be appropriate for people with a BMI greater than 40, or 35 with significant comorbid conditions such as diabetes or high blood pressure. Generally, people see more weight loss with surgery compared to other weight loss measures, but there are also risks involved. Let’s look at the main types of bariatric surgery.
Laparoscopic adjustable gastric banding, or more commonly called lap band, is a procedure in which a band is placed at the top of the stomach, creating a small pouch. This pouch is much smaller than your whole stomach, so you feel fuller faster, therefore consuming less food. The band can be adjusted by adding or removing saline solution to make it tighter or looser.
This type of surgery is the least invasive of all the weight loss surgeries and the band can be removed if desired. Unlike the lap band, all other types of bariatric surgeries cannot be reversed.
The lap band causes weight loss solely by restricting your intake. It does not cause malabsorption or alter your gut hormones at all. This means that there is less likelihood of nutrient deficiencies compared to other types of surgeries, but it also means that this type of surgery generally causes the least amount of weight loss.
Frequent follow up with the surgeon will be required after lap band surgery as it will need to be adjusted regularly in the beginning. Complications can include band erosion and slippage as well as infections and scar tissue formation. Many surgeons are moving away from this type of surgery due to the high percentage of reoperations needed and the fact that other surgeries are more effective.
A sleeve gastrectomy is where the surgeon removes about 80% of the stomach, so it goes from the size of a football to the size of a banana. Similar to the lap band, with this surgery you won’t be able to eat as much food. In addition, there are changes in gut hormones that helps satiety and further weight loss.
A sleeve gastrectomy causes more weight loss compared to a lap band as there are multiple mechanisms for the weight loss. However, it is not reversible as a large portion of the stomach is completely removed.
Roux-en-Y gastric bypass, or simply gastric bypass, is the most popular weight loss surgery in the country at this time. First, a pouch is created in the upper part of the stomach so a much smaller volume of food can be consumed at one time. Then, the pouch is attached to the middle of the small intestines so the rest of the stomach and the first part of the intestines are bypassed. Because food doesn’t go through all of the intestines, this limits calorie absorption. Just like the sleeve gastrectomy, there are changes in gut hormones which helps with weight loss.
With this weight loss surgery, the pyloric sphincter is bypassed, so food can move from the stomach to the intestines much faster than normal. If a large amount of food, or foods high in sugar are consumed, this can cause nausea, vomiting, sweating and diarrhea. This is known as dumping syndrome.
Biliopancreatic Diversion with Duodenal Switch
The first part of a biliopancreatic diversion with duodenal switch is doing a sleeve gastrectomy. In addition, similarly to gastric bypass, a significant amount of the intestines is bypassed as well.
This type of weight loss surgery is the most malabsorptive of the four described here. This means that it can cause the most weight loss but can also cause the most nutrient deficiencies.
Which surgery is right for you?
If you are considering weight loss surgery, you and your surgeon will need to discuss which one will be best the best fit for you. Generally, the more involved and malabsorptive the surgery is, the more weight you will lose, but also the greater at risk you are for nutrition deficiencies. For people with diabetes, gastric bypass or a biliopancreatic diversion with duodenal switch will generally be recommended as they affect hormones that are related to diabetes. Often people with diabetes can leave the hospital after these two surgeries on little or no medications for diabetes.