Am I a candidate?
Bariatric surgery is not for the casual dieter and there are several requirements that you will need to meet in order to be considered. Let us guide you through this process in a simple fashion. First, we need to know your height and weight. This will allow us to Calculate your Body Mass Index. BMI is an indicator used globally to indicate a healthy weight. Learn more about Body Mass Index
Bariatric Surgery Options
Gastric Sleeve Surgery
Originally used in high risk morbidly obese patients as the first stage of a two-stage surgical weight loss approach, gastric sleeve is now finding a new role as a single stage weight loss surgery that provides results similar to adjustable gastric band surgery without the introduction of a foreign object into the body. Further studies suggest the results are also comparable to that achieved with gastric bypass.
The first weight loss surgery procedure we are going to discuss is called gastric sleeve surgery. You may also hear this surgery referred to as sleeve gastrectomy, vertical gastrectomy, restrictive vertical gastroplasty, or vertical sleeve gastrectomy. Gastric sleeve surgery involves stapling your stomach to make it smaller and then removing the unusable portion.
In gastric sleeve surgery, no section of your intestines is bypassed so there is no nutrient malabsorption. In addition, the section of your stomach that is removed is the section that is responsible for the creation of the “hunger hormone” ghrelin. That means that you lose weight because your food intake is restricted and you feel less hungry because you no longer produce ghrelin.
Gastric sleeve is performed as a stand-alone weight loss surgery and is also used as the first part of a two-stage operation for obese people considered a high risk for surgeries like gastric bypass and duodenal switch. In this case the gastric sleeve surgery is performed first and when sufficient weight loss has occurred, duodenal switch surgery or sometimes gastric bypass is performed as the second stage.
One decision facing you and your surgeon is whether gastric sleeve or gastric band surgery is more appropriate for you. There are benefits and drawbacks to each.
- A reversible procedure
- May need to be adjusted over time
- Band may slip or erode tissues
- Soft foods with high calories may slip through the band and cause weight gain.
- Not reversible
- Needs no adjustment
- There is no band to slip or erode tissue
- Since part of the stomach is removed, foods cannot "slip through"
Studies have shown that two and four years after gastric sleeve surgery, most of the people who have had it have lost as much weight as those who have had gastric bands or gastric bypass. It continues to gain popularity.
Duodenal Switch Surgery
Duodenal switch surgery is perhaps the most complex of the weight loss surgeries but is favored by many obese individuals as it provides the greatest degree of weight loss.
Another type of weight loss surgery you can choose to have is called duodenal switch surgery. Duodenal switch, like gastric bypass, is a more invasive surgery than gastric band surgery or the sleeve gastrectomy.
During the surgery for duodenal switch, part of your stomach is removed until only a banana shaped portion is left. Then an intestinal bypass is completed which bypasses up to 70% of your small intestine. Because this large area of the intestines is bypassed and no longer contributes to the path food takes through your body, the digestive enzymes produced by your pancreas and duodenum have less time to work on the food you eat.
The key to duodenal switch’s success in helping you lose weight lies in the forced malabsorption of food. While your stomach is smaller and does help reduce your appetite, the fact that your small intestines are partially avoided and your enzymes are diverted means that you absorb and digest fewer calories of the food you do eat.
Like any surgery there are both pros and cons to consider.
Benefits of Duodenal Switch Surgery
- You could be among the 96% of people with diabetes who has duodenal switch surgery and sees a resolution or improvement.
- 90% of duodenal switch patients see an improvement in their blood pressure.
- 80% of duodenal switch patients see a resolution or improvement in their sleep apnea.
- In addition to significant weight loss, you could be among those who maintain up to 85% of their total weight loss for ten or more years after the surgery.
- Duodenal switch offers greater weight loss than other surgeries.
- You may see a marked improvement in any pain you have that is caused by osteoarthritis. You may also have gastric reflux less often.
- If you have had trouble with fertility, you may find that you are finally able to conceive after surgery. Remember to discuss conception with your surgeon before you attempt to get pregnant.
Potential Drawbacks of Duodenal Switch Surgery
- It is possible that leakages could occur immediately post operatively at the site where the stomach is reconnected to the bowel. This is monitored very carefully during your recovery.
- Pulmonary embolism, inflammation of the pancreas, infection, hernia, narrowing of the connection from the stomach to the intestines, bleeding, and occasionally death can occur during and after surgery.
- Malodorous flatus is common and most patients will have 2-4 bowel movements a day.
- You MUST take vitamin supplements daily to avoid dangerous vitamin deficiency.
It is important to remember that the risks mentioned above have a very low rate of occurrence. Successful surgery and post-surgery weight loss happen the majority of the time. When you are deciding whether or not to have surgery it is always important to keep the risks in mind but be sure to think of them in relation to the benefits. Often, the benefits far outweigh the risks. Certainly, surgical risks are less dangerous than the risk of living with morbid obesity and its comorbidities.
Gastric Bypass Surgery
Still the most popular of the bariatric procedures, gastric bypass surgery has the longest history in the USA and is considered the standard to which other weight loss procedures are compared.
Gastric bypass is one of the most highly publicized restrictive procedures for weight loss. It is the the weight loss procedure with the longest track record and most commonly performed in the world.
What is Gastric Bypass Surgery?
During gastric bypass surgery the stomach is stapled so that the top portion forms a small golf ball sized pouch with no access to the bottom, larger portion. The intestines are then cut and one part is attached to the golf ball sized stomach to allow food to exit the stomach. The remaining portion of small intestine is reattached to a lower part of your intestines.
Because of this, your small stomach pouch—the only part of your stomach that can accept and hold food—sends its broken down food and nutrients into your modified intestines where they now spend less time being absorbed by your small intestines.
Benefits of Gastric Bypass Surgery
- Having gastric bypass surgery can result in improved sleep apnea.
- The weight loss after gastric bypass can result in improved symptoms from obesity related diseases like high blood pressure and diabetes.
- People who have gastric bypass experience better long term weight loss results than obtained with traditional diet and exercise.
- You can enjoy fewer symptoms of gastric reflux and less osteoarthritis pain after surgery and weight loss.
Drawbacks of Gastric Bypass Surgery
- If you do not eat properly after the surgery you may experience dumping, which can occur when simple carbohydrates like sugar are consumed. Because simple carbohydrates are so easy to digest they are dumped into the digestive system too quickly and can result in sweating, discomfort, diarrhea and cramping.
- Gastric bypass infrequently results in bleeding, infection, pulmonary embolism, scarring in the stomach, hernia and death as a result of surgery.
- You may be at risk for nutritional mal-absorption and will need to take supplements daily.
- Surgery is reversible, but not often encouraged.
- You could have frequent bouts of gas and increased bowel movements.
- There is no guarantee that you will not gain the weight back.
The next step is to compare all the benefits and drawbacks of gastric bypass surgery and gastric band surgery with those of the duodenal switch. It is important to remember that every weight loss surgery will have some drawbacks, but often the benefits of weight loss surgery far outweigh the drawbacks of the surgery.
Adjustable Gastric Band Surgery
Adjustable gastric band devices such as LAP-BAND and REALIZE band allows you to experience a much less invasive surgery with good weight loss results along with the benefits of being adjustable and reversible.
Of the restrictive weight loss procedures available, gastric band surgery is the simplest. During the surgery, an adjustable band is placed around the the upper stomach. This band contains a hollow tube that can be filled with varying amounts of saline through a port under your skin. The more saline that goes into the tube the tighter the band becomes around your stomach. This makes the band more restrictive which makes you feel full and eat less.
The unique and simple design of the gastric band allows you to experience a much less invasive surgery with a shorter recovery time. Unlike gastric bypass surgery or duodenal switch surgery, no portion of your intestines is bypassed. This may not sound like much, but is actually important in terms of nutrition absorption. With gastric band surgery, food is digested the same way as before and there is no concern over nutritional deficiencies as a result of mal-absorption.
Additional Benefits of Gastric Band Surgery
- Gastric bands are adjustable. If you are planning to get pregnant, you can have some of the fluid removed from your band and allow yourself to increase your caloric intake. If you want to accelerate your weight loss, you can have the band filled so that it is tighter and you feel fuller.
- Your stomach and intestines are left intact and no permanent surgical changes are made.
- You will see an improvement in your obesity related illnesses including diabetes and high blood pressure.
- You will have greater success in losing weight than you would through traditional diet and exercise and with the adjustable band, you will be able to maintain it more easily.
Potential Drawbacks to Gastric Band Surgery
Of course, there are some potential drawbacks to this or any weight loss surgery:
- You could be one of the small percentage of patients who experience gastric band erosion, tubing problems or port problems. Or, you may experience gastric prolapsed which happens when the part of your stomach that is below the band comes up through the band.
- As with any abdominal surgery there is a low risk of infection (1-2%), gastric perforation (<1%), Pneumonia (2%), Blood clots (1%), pulmonary embolism (2%), and possibly
- Complications related to the band itself may occur and range from mild to severe. The advantage of the gastric band is that it can be removed if necessary to alleviate severe
symptoms. Issues related to the band may include: port or tube issues (5%), band slippage (3-5%), and band erosion (1%).
- Your insurance company might not cover the surgery.
- You may have psychological or physical problems with the band and may need it removed.
- You may not lose weight if you make the wrong food choices.
It is important to weigh the inconvenience of the drawbacks against the benefits of the surgery. Often, it is well worth a little extra gas to lose hundreds of pounds safely and effectively. In order to really determine whether gastric band surgery using the LAP-BAND or REALIZE Band is right for you, you must consider the pros and cons of both gastric bypass surgery, sleeve gastrectomy and duodenal switch.