Understanding Different Types of Bariatric Procedures

You know you’re ready to lose the weight and keep it off. But how? You’ve heard about bariatric surgery, but is surgery right for you? If so, how do you decide between all of the different types of bariatric surgery?

In this blog post we’ll walk through these questions together. 

What Is Bariatric Surgery?

First, we need to answer the question: what is bariatric surgery? Bariatric surgery, or weight loss surgery, is a powerful set of procedures that have helped many people just like you to lose weight, keep it off, and get their lives back. It works by rearranging your anatomy so that you feel full faster. Two surgeries also work through a second pathway: they reduce the amount of nutrients that your body can absorb from eating, which further helps you to lose weight.

What Are the 4 Types of Bariatric Surgery?

There are four common types of bariatric surgery that are practiced today: gastric bypass surgery, gastric sleeve (or sleeve gastrectomy) surgery, LAP-BAND^® surgery, and duodenal switch surgery. Of these, duodenal switch surgery is considered to be the gold standard for maximum weight loss and ability to  cure type 2 diabetes. Gastric bypass and sleeve gastrectomy surgery can both be very effective as well. The LAP-BAND^® procedure is widely considered to be unsafe and ineffective, and for this reason we do not offer it at the Bariatric & Metabolic Center of Colorado.

Gastric Bypass Surgery

What it is: gastric bypass surgery involves taking the patient’s current stomach and stapling off a small one-ounce pouch about the size of your thumb. This smaller pouch gets full quickly, which will limit how much food you can eat in one sitting and also how full you feel after eating. Gastric bypass surgery also reroutes the patient’s stomach and intestines to reduce the amount of nutrients that the body will absorb from food. This means that in addition to feeling full faster, you’ll absorb fewer calories when you do eat. This powerful 1-2 punch can help you to lose weight faster and also works to prevent weight regain.

Pros: Gastric bypass surgery was considered the gold standard of bariatric surgery for 30 years. It is still considered to be safe and very effective. Most of our gastric bypass patients lose 65-90% of their excess body weight. This type of surgery is also very effective at resolving type 2 diabetes and heartburn. For some of our lower risk patients, this can be an outpatient surgery, and depending on recovery they can go home on the same day as they receive the surgery.

Cons: Gastric bypass surgery can be very effective, but it is not right for every patient. Due to the anatomical rearrangement of intestines described above, patients will need to be very dedicated to a lifelong vitamin and mineral regime in order to get enough nutrients. If you know in advance that you will struggle with this kind of regime, then this surgery may not be right for you. For the same reason, if you have current vitamin or mineral deficiencies (including anemia) and this cannot be corrected prior to surgery, then we may recommend sleeve gastrectomy surgery instead. Gastric bypass surgery may also not be best for you if you suffer from Chron’s disease or have had several previous abdominal operations or infections.

Gastric Sleeve Surgery

What it is: Gastric sleeve surgery is an extremely effective surgery that involves removing about 85% of the patient’s stomach, leaving a thin tube-like sleeve about the diameter of your index finger. Removing most of the stomach ensures that you will get full faster and stay full longer, reducing the amount of food that you eat. The surgery also reduces your stomach’s production of the appetite-stimulating hormone ghrelin. When your body doesn’t produce as much ghrelin, you don’t feel as hungry between meals which can help many of our patients enjoy the freedom of no longer being a slave to an out-of-control appetite.

Pros: Sleeve gastrectomy surgery is a very effective weight loss surgery that can help patients lose an average of 60-80% of their excess body weight. It is ideal for patients who: don’t suffer from severe heartburn or reflux, want a more natural approach to weight loss, or do not feel that they can commit to a strict lifetime regime of vitamin and mineral supplements. Like gastric bypass surgery, sleeve gastrectomy surgery is very safe and is an outpatient procedure for most of our patients.

Cons: Unlike gastric bypass or duodenal switch surgery, sleeve surgery is not as effective at curing type 2 diabetes. If you suffer from significant heartburn or reflux, this surgery may also not be right for you; because around 20% of patients with reflux may experience worsened symptoms after surgery. Finally, for patients with a higher starting BMI, the less aggressive sleeve may not produce as high of a percentage of weight loss as a procedure that includes intestinal bypass.

LAP-BAND^® Surgery

What it is: the LAP-BAND^® is an outdated and ineffective bariatric procedure. It used to be far more common than it is now, but in recent decades surgeons have realized that it can cause substantial complications and is often ineffective at enabling durable long-term weight loss. The procedure works by placing an inflatable band around the upper part of the stomach. This band is inflated and locked into place, which creates a small stomach pouch, designed to limit the amount of food that the patient can eat. The band also slows gastric emptying, so that the patient feels full longer.

Pros: the LAP-BAND^® was originally designed as a less invasive surgery, since it doesn’t require anatomical rearrangement the way that a gastric bypass, sleeve gastrectomy, or duodenal switch does. Unfortunately, because it is a foreign body, the LAP-BAND^® actually has a higher rate of complications than any of these surgeries.

Cons: The LAP-BAND^® procedure is widely recognized as unsafe and ineffective. One study found that within three years of having the procedure, an astounding 88 percent of patients reported a severe complication (such as stomach obstruction, band slippage which can require another surgery, or gastroesophageal reflux).  Another study found that worldwide, at least 25-40% of bands will need to be removed within 5 years due to complications. An additional serious risk is weight regain or insufficient weight loss. One large study of patients who kept their bands for 14 years found that the average weight loss was just 15% of the patients’ excess body weight. For these reasons and because we believe that you deserve nothing but good options, like most bariatric surgery clinics we do not offer the LAP-BAND^® surgery.

Duodenal Switch Surgery

What it is: duodenal switch surgery is widely considered the gold standard of bariatric surgery. It used to only be recommended for patients with a BMI > 50, but due to its safety and efficacy it is now widely recommended for any patient with a BMI > 40 (or over 35 with comorbidities) just like sleeve gastrectomy and gastric bypass surgery. Duodenal switch surgery involves performing a sleeve gastrectomy on top, by removing 85% of the patient’s stomach and forming the rest into a long tube like a hot dog. Additionally, the surgery divides the small intestines and forms a loop so that food bypasses about half of the small intestines. This extremely powerful combination reduces the amount of food that you can eat by shrinking your stomach and making you feel full longer; and also more significantly reduces the amount of calories absorbed by your body when you do eat. This combination is the most powerful surgical weight loss tool and can lead to substantial lasting weight loss.

Pros: The duodenal switch is the most effective bariatric procedure when it comes to facilitating weight loss and resolution of metabolic comorbidities. Most of our patients lose 80-100% of their excess body weight within the first 9-12 months after surgery. Imagine how that would feel. The duodenal switch also offers your best chance of curing type 2 diabetes (up to a 98% success rate).

Cons: Duodenal switch surgery is more complicated than sleeve gastrectomy or gastric bypass surgery, which makes some patients worry that it may lead to more complications. Thankfully, these worries are not reflective of the actual data and safety of the procedure; our complication rate is very low and on par with the bypass and sleeve and most complications are preventable by simply following our thorough safety protocols. For many low-risk patients, duodenal switch surgery can also be an outpatient procedure. 

However, there are cases in which duodenal switch surgery might not be right for every patient. Like gastric bypass surgery, you will need to be very dedicated to a lifelong vitamin and mineral regime in order to get enough nutrients. If you know in advance that you will struggle with this kind of regime, then this surgery may not be safe for you. For the same reason, if you have current vitamin or mineral deficiencies (including anemia) that cannot be corrected before surgery, then we will typically recommend sleeve gastrectomy surgery instead. Duodenal switch surgery may also not be the right fit for you if you suffer from severe reflux, Crohn’s disease, have had several previous abdominal operations, or struggle with irritable bowel syndrome or frequent diarrhea as the switch may increase the softness and frequency of stools.

How Much Weight Will I Lose With Bariatric Surgery?

As you can see from the numbers quoted above, the amount of weight you lose will depend substantially on which bariatric surgery you choose. It will also depend a lot on your own habits and ability to use all of the lifestyle tools that we will teach you consistently after surgery. Bariatric surgery is not a magical pill, and after surgery you will need to stick to a healthy diet and exercise plan in order to maximize your long-term weight loss. Our team will work with you to help you to develop a diet and exercise plan that works for you and that will help you to achieve your weight loss goals.

(If you want to compare the efficacy of weight loss surgery vs weight loss medications, see our blog on The Metabolic Benefits of Bariatric Surgery Over Weight Loss Drugs.)

Taking The Next Step On Your Weight Loss Journey

Bariatric surgery is a life-changing solution that has helped many of our patients to lose weight, keep it off, and get their life back. if you have any further questions, please feel free to browse our site or call our front office and our friendly office staff will walk you through whatever you need.

Many of our patients say that surgery was the best decision they ever made.

“We were no longer prisoners in our own bodies, we were no longer handicapped by our weight, we were living and moving and feeling better than we had felt in so many years.”–Lisa and Chris Chesrown, duodenal switch surgery patients.

If you’re suffering, don’t wait. Contact our Denver office today.