Bariatric surgery is surgery designed for the purpose of weight loss. Bariatric surgery uses a variety of methods to decrease how many calories you consume and absorb each day, making it a powerful option to help you lose weight and keep it off.
There are eight types of weight loss surgery that are currently approved: gastric bypass surgery, the sleeve gastrectomy, the loop duodenal switch (SADI-S or SIPS), the duodenal switch with biliopancreatic diversion, the laparoscopic adjustable gastric band (LAP-BAND® Surgery), the gastric balloon, the AspireAssist, and vBloc therapy. The most common, safest, and most effective bariatric surgeries are the gastric bypass the sleeve gastrectomy and the loop duodenal switch. Weight loss for these 3 procedures ranges from 60-100% of your excess weight.
In this blog we’ll review each option for weight loss surgery in detail so that you understand how they work, how much they cost, and what you can expect both short-term and long-term in regards to weight loss and safety.
Weight loss surgeries work in two ways. Many surgeries for weight loss remove or section off part of your stomach to make it smaller, meaning that you won’t be able to eat more than a small portion at every meal. This is called restriction because it restricts your dietary intake. Some surgeries also bypass a portion of your small intestine, which decreases the amount of calories you absorb from meals. This is called malabsorption. The most effective options for weight loss surgery are both restrictive and malabsorptive.
Common Options for Weight Loss Surgery
The most common options for weight loss surgery are:
1. Roux-en-Y Gastric Bypass Surgery
2. Gastric Sleeve Surgery
3. Loop Duodenal Switch
4. Laparoscopic Adjustable Gastric Banding (LAP-BAND® Surgery)
Gastric Bypass Surgery
What it is: Gastric bypass surgery was historically the gold standard option for weight loss surgery. In gastric bypass surgery, a portion of the stomach is rearranged. This involves stapling off a 1-ounce stomach pouch, about the size of your thumb. This smaller pouch becomes your new stomach, and fills up rapidly; which makes you less hungry. The surgery also bypasses part of your stomach and small intestine, which means that you’ll absorb fewer calories.
Pros: Gastric bypass surgery is both restrictive and malabsorptive, making it very effective at enabling long-term weight loss. Gastric bypass surgery is also effective at curing Type II diabetes and resolving reflux.
Cons: Gastric bypass surgery requires that you be diligent about taking vitamins and minerals post-surgery. It can also exacerbate pre-existing vitamin and mineral deficiencies. Gastric bypass surgery can also exacerbate poor nutrient absorption stemming from Chron’s disease and can lead to non-healing stomach ulcers when any medical condition requires the use of prednisone or other anti-inflammatory medications.
Risks: Side-effects may rarely include dumping syndrome, gallstones, hernias, and internal bleeding at surgical sites. These complications are generally very rare if you’re working with a skilled surgeon and a comprehensive support team. But risk can increase if you have had several previous abdominal operations.
Expected weight loss: 65-90% of your excess body weight.
Gastric Sleeve Surgery
What it is: Also known as a sleeve gastrectomy, gastric sleeve surgery is the most common weight-loss surgery. This procedure involves removing approximately 85% of your stomach, leaving only a small finger caliber tube of stomach, or “sleeve”. Those who undergo gastric sleeve surgery eat smaller meals and feel full after only a small quantity of food. This surgery reduces hunger for a second reason as well. The removed portion of your stomach produces a hunger hormone known as ghrelin. Ghrelin is partly responsible for feelings of hunger, so this anatomical rearrangement also decreases your hunger hormonally.
Pros: Gastric sleeve surgery can lead to weight loss by restricting your food intake and making you feel full after smaller meals. Because it’s not malabsorptive, there’s minimal risk of you developing protein and vitamin deficiencies. The sleeve is ideal if you have existing vitamin/mineral deficiencies, suffer from Chron’s disease, or suffer from medical conditions that require prednisone or anti-inflammatory medications.
Cons: Unlike the gastric bypass and duodenal switch surgeries, the gastric sleeve is not as effective at curing Type II diabetes. The sleeve can also worsen heartburn, so if you suffer from severe heartburn or reflux, then you should consider another surgery like the gastric bypass.
Risks: Risks may rarely include worsened heart burn, dehydration, bleeding, infection, and blood clots. However, when you work with a careful surgeon specialized in bariatric surgery, these risks are very small; in fact, gastric sleeve surgery is as safe as the most minor outpatient surgery like gallbladder surgery.
Expected weight loss: 60-80% of your excess body weight
Loop Duodenal Switch Surgery (SADI-S or SIPS)
What it is: During duodenal switch surgery, part of your stomach is removed and your intestines are rearranged. The duodenal switch removes a majority of your stomach, forming a sleeve gastrectomy on top. The small intestine is also rerouted so that food bypasses about half of the small intestines on its way through your body, reducing the amount of calories that you’ll absorb from meals.
Pros: The duodenal switch is the most powerful weight-loss surgery available today, and is ideal if you have a BMI >50. It is also the most effective cure for Type II diabetes, curing up to 98% of patients.
Cons: The duodenal switch is a longer and more complex surgery than the gastric bypass or gastric sleeve. It also requires that you be extremely dedicated to taking vitamins and mineral supplements post-surgery, and not have any vitamin or mineral deficiencies pre-surgery. This surgery can also make your bowel movements looser and more frequent, so if you have irritable bowel syndrome or diarrhea than this surgery may not be ideal for you. Like the sleeve it can also increase heart burn in some patients.
Risks: Gallstones and nutritional deficiencies (like anemia or osteopororis) may be rare side-effects of duodenal switch surgery especially when patients are not consistent taking vitamins following surgery. Like the sleeve, the duodenal switch can also cause worsened heart burn in some patients. At the BMCC we have a team dedicated to helping you manage these risks with vitamin and protein supplementation and the right diet.
Expected weight loss: 80-100% of your excess body weight
What it is: Laparoscopic adjustable gastric banding, also known as LAP-BAND® surgery, involves securing a band around the stomach, separating it into a smaller portion up top and a larger portion below the band. The gastric band often helps patients feel full faster because the top portion of the stomach fills up quickly. These changes can lead to eating smaller meals due to feeling full more rapidly. The LAP-BAND® is a restrictive surgery, but it’s not malabsorptive.
Pros: Most people who formerly pursued LAP-BAND® surgery did so because they believed that was a less invasive surgery than the gastric bypass, gastric sleeve, or duodenal switch. However, this is deceptive, because the LAP-BAND® often causes complications that require additional surgeries. 25-40% of patients who have had a gastric band placed end up experiencing problems significant enough to need LAP-BAND® removal surgery in just the first five years after surgery. When you factor in those complications, the LAP-BAND® is often more invasive than other bariatric surgeries.
Cons: There are lots of LAP-BAND® complications that are related to the fact the band is a foreign body, ranging from band slippage and band erosion to GERD and even stomach necrosis. Vomiting is also a big drawback: one study found that patients feel nauseous an average of 1.4 times per week and vomited once a week. Another study found that the rate of complications increased by 3-4% every year this device was in a person’s body. Additionally, the LAP-BAND® produces less weight loss than other bariatric surgeries.
Risks: LAP-BAND® surgery comes with many risks, primarily the high risk of complications and sub-optimal long-term weight loss. Because of this it is no longer offered in many clinics.
Expected weight loss: 35% of your excess body weight.
At the Bariatric and Metabolic Center of Colorado, we do not offer the LAP-BAND® surgery because of the high risk of complications and the low expected weight loss. Because we care about you, we strongly recommend that you should not consider this option, for your own health benefit.
Less Common Options for Weight Loss Surgery
The above four surgeries are the most common options for weight loss surgery. The procedures below are experimental, and may not be effective or safe in the long-term. It is important to stress that for each of the procedures below, more study is necessary in order to determine their long-term safety and efficacy:
1. Gastric Balloon
3. vBloc therapy
What it is: The gastric balloon procedure involves the insertion of 1 to 3 silicon balloons into your stomach. Once placed, they are inflated, which reduces the space in your stomach for food and prevents you from eating too much at one time.
Pros: The gastric balloon is relatively non-invasive, because it doesn’t surgically alter your stomach. Unlike some bariatric surgeries, the gastric balloon doesn’t require strict dietary changes or lead to vitamin and mineral deficiencies.
Cons: The gastric balloon is only FDA approved for 3-6 months, because there are serious concerns about its side-effects long-term. In most cases the gastric balloon is not covered by insurance and ends up being a self-pay procedure. Up to 20% of patients will not be able to tolerate the gastric balloon beyond the first week due to vomiting and will have to have it removed at additional expense. Once the balloon is removed, studies have shown that most patients regain their lost weight within 2 years and further balloon placements generally do not result in weight loss. Finally, the gastric balloon often increases this thickness of the stomach which can increase the risk of bariatric surgery if this is needed in the future.
Risks: Acute pancreatitis, stomach ulcers, balloon migration into the intestines resulting in obstruction, and gastric rupture (if left in place longer than 6 months) are some of the most severe side-effects. Cramping, nausea, and vomiting are common after the balloon is implemented. The balloon can also cause the lining of your stomach to thicken, which can make future bariatric surgery more risky. This last point is important: not only is the gastric balloon a temporary solution to obesity, but it’s a temporary fix that can inhibit your ability to get a more permanent solution like gastric bypass surgery.
Expected weight loss: Around 28% of your excess weight.
What it is: AspireAssist surgery involves placing a tube into your stomach through the skin. Following meals, people then connect a pump to this device and drain some of the meal that was just eaten. This can result in weight loss due to less of your food being digested.
Pros: No dietary restrictions.
Cons: Significantly less weight loss than most bariatric surgeries. The risk of complications like infections is much higher than a traditional surgical approach.
Risks: The AspireAssist carries a low risk of complications, either short-term or long-term. The most common side-effects are generally short-lived, and include nausea, abdominal pain, infection around the tube site, skin irritation, and swelling.
Expected weight loss: Around 30% of your excess weight.
What it is: vBloc therapy consists of implanting a device below the rib cage that blocks the vagal nerve, preventing hunger signals from going to the brain. These signals normally tell a person’s brain that they’re hungry; blocking them creates increased satiety, both when eating and between meals, which can leave some people feeling hungry less often.
Pros: vBloc Therapy may help reduce Type II diabetes. One study found that, after 12 months, 85% of patients maintained or reduced their current level of diabetes medications, or discontinued medication completely. Patients have also seen reductions in blood pressure and cholesterol.
Cons: The vBloc is unstudied over a longer time frame, so there may be durability issues or issues with long-term side effects. In the medium-term (18 months), about 6.8% of patients require vBloc revision surgery to reposition, replace, or remove the device.
Risks: Relatively low in studied populations. Abdominal pain and cramping, nausea and vomiting, and difficulty swallowing, can all occur. Additionally, because this device is surgically implanted on your vagal nerves (which control stomach function) and it is a foreign body, scarring of these nerves and resulting dysfunction of your stomach can occur with time.
Expected weight loss: 22-33% of your excess body weight within 1 year.
What’s the Safest Weight Loss Surgery
When you’re evaluating your weight loss surgery options, the number one thing to understand is this: obesity is a very dangerous disease.
People who suffer from obesity are much more likely to suffer from high blood pressure, diabetes, heart disease, joint problems, sleep apnea, and even cancer. According to Stanford Health Care, “Atherosclerosis (hardening of the arteries) is present 10 times more often in obese people compared to those who are not obese.” Obesity is also a major cause of type II diabetes. A study by the National Institute of Health shows that there’s a correlation between BMI and diabetes; the higher your BMI, the more at risk you are for diabetes.
What this means is that when you’re evaluating your options for weight loss surgery, the number one consideration should be which surgery can most effectively help you if you suffer from obesity. Surgeries like the vBloc may have low initial complications, but if they don’t help you to lose all or almost all of your excess weight, then they’re not effective and fail to adequately reduce your overall health risk with time.
For this reason, the safest and most effective options for weight loss surgery are: the sleeve gastrectomy, the gastric bypass, and the loop duodenal switch. These surgeries are powerful and effective enough to level the playing field in your battle with obesity and the resulting threat to your health and life. They can help you to lose weight and keep it off.
Which Weight Loss Surgery is Right for You?
There is no clear best weight loss surgery; the best surgery for you depends on your individual needs, pre-existing conditions, how much weight you want to lose, whether or not you want to make lasting changes to diet, your age, and more.
If you suffer from obesity and are struggling to lose weight, then bariatric surgery may be right for you. Weight loss surgery can help you regain control of your health and your quality of life. If you would like to learn more about the differences between these surgeries and which of these options is best for your personal needs, click the button below to schedule an appointment today.