Bariatric surgery is a treatment option available for patients diagnosed with severe obesity. Bariatric surgery is undertaken not only for weight reduction but also to treat complications such as type 2 diabetes. Here are a few of the most common bariatric surgery procedures explained:
1. Gastric Bypass
The gastric bypass, more formally known as The Roux-en-Y Gastric Bypass, is the most commonly performed bariatric procedure for last 30 years. It can be done laparoscopically which means it can be performed through a small incision on the abdomen. A gastric bypass is essentially dividing the stomach into a smaller pouch which is then attached to one part of the Y limb of the small intestine known as the Rouxlimb thus creating a “Gastric Bypass” so that the amount of food consumed is significantly less. The food by-passes the large portion of the stomach and duodenum straight into the Jejunum resulting in a malabsorption of Calories and nutrients. This procedure is recommended to treat severe Obesity and Diabetes as it results in 100 lbs or more of weight-loss due to restriction and malabsorption of food.
Advantages
Average weight loss is 60-70% of patient’s excess weight.
Can cause reversal of type 2 diabetes, treat heartburn, sleep apnea and heart problems.
Physically restricts the amount of food one can hold
Can lead to greater energy expenditure
Allows for changes in gut hormones which reduce appetite and boost satiety
Disadvantages
Is a more complicated surgery than some other options, and can thus possibly have higher complication rates
Can cause dumping syndrome, leaks, hernia’s etc
Leads to Protein, Vitamin and mineral deficiencies due to malabsorption.
Usually requires a longer hospital stay post op
Requires one to stick to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up consultations
2. Sleeve Gastrectomy
A laparoscopic sleeve gastrectomy involves a large portion of the stomach, approximately 80%, being removed. The stomach left is significantly smaller, and resembles a tube or banana.
Advantages
Physically restricts the amount of food one can hold
Average weight loss is 60-70% of patients excess weight after 1 year.
Allows for rapid and significant weight loss, compared to that of the gastric bypass.
Requires no foreign objects, and no re-routing of the digestive system
Involves a relatively shorter hospital stay
Allows for changes in gut hormones that reduce appetite and boost satiety
Disadvantages
Is a non-reversible procedure
Can possibly lead to long-term vitamin/mineral deficiencies
Has a higher early complication rate than some other procedures
3. Adjustable Gastric Band
In a gastric band procedure, an inflatable band is wrapped around the upper stomach. This creates a smaller section of the stomach above the band, sort of similar to the stomach made in a gastric bypass procedure.
Advantages
Physically restricts the amount of food one can hold
Person should lose 1-2 lbs/week if the band is properly adjusted
Average weight loss is 50% of patients excess weight.
Involves no cutting of the stomach or rerouting of the intestines
Involves a shorter hospital stay, with some patients being discharged the day of the procedure
Is reversible and adjustable
Has the lowest rate of early complications and mortality among other bariatric procedures
Has the lowest risk for vitamin/mineral deficiencies
Disadvantages
Slower and less early weight loss than other bariatric procedures
The procedure has a greater percentage of patients that fail to lose at least 50 percent of excess body weight compared to the other bariatric surgeries
Requires a foreign device to remain in the body
Complications such as band slippage, band erosion, or other mechanical problems with the band, tube or port can possibly occur
Can result in dilation of the esophagus if the patient overeats
Requires one to stick to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up consultations
Highest rate of re-operation
4. Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
The Biliopancreatic Diversion with Duodenal Switch, abbreviated as BPD/DS, is a two step procedure. First, a large portion of the stomach is removed, very similar to how a gastric sleeve procedure would go. Then, the small intestine is bypassed. This is done by taking the lower portion of the small intestine and attaching it to the new, smaller stomach.
Advantages
Average weight loss is greater than most other procedures (up to 70% of patients excess weight.)
Allows patients to eventually eat near “normal” meals after surgery
Reduces the fat absorption by 70 percent or more
Allows for changes in gut hormones that reduce appetite and boost satiety
Is the most effective procedure against diabetes compared to others
Disadvantages
Has higher complication rates and risk for mortality than some other procedures
Requires a longer hospital stay than some other procedures
Has a greater potential to cause protein deficiencies and long-term vitamin/mineral deficiencies
Requires one to stick to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up consultations; They are critical to avoiding serious complications from protein and certain vitamin deficiencies
Sources:
Anon., n.d. The American Society for Metabolic and Bariatric Surgery (ASMBS). [Online]
Available at: https://asmbs.org/patients/bariatric-surgery-procedures#
[Accessed 6 August 2019].