Understanding Your Options For Bariatric Surgery
There are many weight loss surgery options including Roux-en-Y gastric bypass, adjustable gastric band, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. These common bariatric surgeries promote weight loss by restricting the amount of food consumed, nutrient malabsorption, or a combination of both restriction and malabsorption. All surgery options require a lifestyle change regarding diet and exercise postoperative. Learn more below to find out which procedure is suited for you.
Who is qualified for weight loss surgery
Surgically induced weight loss may become an option for someone that continues to see negative outcomes in weight loss after trying to implement lifestyle change with improved diet and exercise. Usual qualifications include, but are not limited to:
- More than 100 lbs over your calculated ideal body weight
- Body mass index (BMI) of 40 or higher
- BMI of 35-39.9 followed by type 2 diabetes, high blood pressure, or severe sleep apnea
Qualifications for surgery may also depend on other extreme weight-related health issues.
Roux-en-Y Gastric Bypass
This procedure is commonly known as gastric bypass. The idea is to cause caloric restriction by decreasing the size of the stomach, followed by, nutrient malabsorption due to part of the stomach and first section of the small intestine (duodenum) being bypassed for the outcome of weight loss. Since stomach contents empty more quickly into the intestine after this procedure, dumping syndrome is likely to occur, causing diarrhea and nausea.
The re-routing of the intestinal tract causes changes to gut hormones, as well as a decrease in food digested by the newly created stomach pouch. Additionally, malabsorption occurs when the portion of the small intestine (duodenum) that would normally absorb nutrients and calories is now bypassed. It is possible that the hormonal changes to the intestinal tract can help improve or even lead to remission of type 2 diabetes. In the end, this process allows increased weight loss.
Is gastric bypass surgery right for you?
Gastric bypass has been known to promote long-term weight loss through complex re-routing of the digestive tract to promote restriction and malabsorption while also resulting in changes to gut hormones to reduce the feeling of hunger and enhance fullness. You may qualify if you have a BMI higher than 40, but further guidelines may have to be met and extensive screening may be done. Gastric bypass surgery is usually more complex than the adjustable gastric band and sleeve gastrectomy. It is important to be aware that this surgery has a higher risk of complication, and may lead to increased hospital stay. Nutrient deficiencies are very common, so it is important to be compliant with dietary recommendations, protein intake, and a vitamin/mineral regimen for the rest of your life.
Adjustable Gastric Band
Commonly referred to as “the band” or “lap band” procedure. This surgery relies on restriction of food. The purpose is to create a smaller stomach by utilizing an inflatable band that goes around the upper portion of the stomach. The band can be adjusted and is used to control the amount of food that can be consumed, promoting a feeling of fullness when eating only a small amount. The band leaves a small opening that can result in food moving slowly through the stomach to help you stay fuller for longer. In this procedure, the volume of food is restricted while calories and nutrients/minerals are absorbed as they usually would be.
Is the adjustable gastric band right for you?
This procedure is not as complex as other surgeries, can be reversed, is less invasive, has the lowest risk for vitamin and mineral deficiencies, and promotes 40-50% weight loss. Although, this surgery can result in re-operation due to an increase in band size from lack of adherence to a strict diet after surgery or mechanical issues concerning slippage. Patients are recommended to take vitamin/mineral supplements for the rest of their life due to the decreased volume of food being consumed that results in limited nutrients being available to the body. A higher protein consumption is also recommended by ASMBS guidelines. This procedure is suited for someone that is highly motivated regarding diet and lifestyle change postoperative to ensure positive weight loss results.
A sleeve gastrectomy restricts the amount of food that can be eaten, resulting in weight loss similar to that of the adjustable band. About 75% of the stomach is removed leaving a “sleeve” resembling the size and shape of a banana. This new stomach pouch holds a smaller amount of food compared to the normal stomach size. This surgery can also cause changes to gut hormones, similar to gastric bypass surgery, that can help control hunger and fullness. Similar to the outcomes of gastric bypass, there is evidence that the changes to the stomach and gut hormones may help improve or even lead to remission of type 2 diabetes. Dumping syndrome, that may occur after gastric bypass surgery, is less likely to occur after a sleeve gastrectomy.
Is sleeve gastrectomy right for you?
This procedure may become an option if you have a BMI over 40 with multiple health problems that increase your risk of going under anesthesia. This surgery may also be possible as a clinical investigation for someone with a lower BMI battling diabetes. An individual undergoing this surgery must be motivated and willing to make permanent lifestyle changes in regards to diet, exercise, supplemental vitamin/mineral regimen, and high protein intake. This procedure does not include bypass or complex re-routing of the intestinal tract resulting in a shorter hospital stay. It is considered a non-reversible surgery, so it is important to understand the details of the procedure and the options you may have before making a permanent decision.
Biliopancreatic Diversion With Duodenal Switch Gastric Bypass
This procedure is less common than the other surgeries listed above and can be seen abbreviated to BPD/DS. It results in restriction, malabsorption of vitamins/minerals, and changes of hormones in the gastrointestinal tract. First, a sleeve gastrectomy is done where 70-80% of the stomach is removed resulting in a stomach the size and shape of a banana. Next, the intestine is divided further down than in gastric bypass surgery, resulting in a larger amount of the small intestine being bypassed. Unlike gastric bypass, BPD/DS preserves the stomach muscle (pylorus) that controls the emptying of the stomach into the intestine. This means that dumping syndrome (talked about above) is less likely to occur. Due to a larger portion of the small intestine being bypassed and a smaller window for digestive enzymes to mix with food, there is a higher risk of becoming deficient in nutrients that may not be a problem in other surgeries. For example, there is a decrease in the absorption of protein as well as fat which can cause deficiencies in fat-soluble vitamins (A,D,E, K).
Is biliopancreatic diversion with duodenal switch right for you?
BPD/DS has been considered the most effective surgery for treating diabetes and other chronic health problems. With this in mind, BPD/DS is very complicated, has higher risks for malnutrition and vitamin/mineral deficiencies, as well as a longer hospital stay. Adherence to a vitamin regimen, high protein intake, and lifestyle change is important. To be qualified for this surgery, patients usually have a BMI greater than 50. Much like gastric bypass surgery, a specific screening process may be done.