Bariatric Surgery
What is Bariatric Surgery?
Bariatric surgery, otherwise known as weight loss surgery or metabolic surgery, is most often used to treat obesity, diabetes, high blood pressure and high cholesterol, among others. Bariatric surgery works to prevent future disease and provide patients a better quality of life and longer lifespan.
Bariatric surgery is among the most studied procedures in medicine. Many of these surgeries are performed non-invasively to reduce recovery time and pain. These procedures are also some of the safest in medicine, with complication rates lower than other common surgeries such as gallbladder removal, joint replacement and hysterectomy.
There are many types of bariatric surgery, but all have the goal to modify the stomach and/or intestines. Following surgery, the way a patient absorbs nutrients is altered, allowing them to eat less to feel full.
Types of Bariatric Surgery
Gastric Bypass
A leading part of medicine for over 50 years, the gastric bypass is one of the most common weight loss procedures. Since 1993, the procedure has seen laparoscopic success in treating obesity and related illnesses.
During the procedure, the stomach is divided, leaving behind a small pouch, roughly the size of an egg. The rest of the stomach is bypassed and no longer works to store or digest food. Then the small intestine is divided as well, and connected to the small stomach pouch to allow food to pass through.
The way this bariatric surgery works is two-fold: it first reduces the size of the stomach to lower food intake. Secondly, the bypassed intestine reduces absorption. This allows for decreased hunger, increased fullness, and a better ability to reach and maintain a healthy weight. It works to treat other symptoms too, like reflux and diabetes.
Adjustable Gastric Band
A gastric band is a silicone device that is placed around the upper part of the stomach to limit food intake. Because results aren’t as pronounced with the gastric band as other procedures listed, the use of this bariatric surgery has declined over the past ten years, but is preferable for patients who may want it removed in the future.
How full a patient feels depends on the size of the opening between the pouch and the rest of the stomach. Advantageously, the opening size can be adjusted with fluid injections through a port underneath the skin. With a gastric band, food travels through the stomach as normal, but is limited by the smaller opening of the band.
Sleeve Gastrectomy
This laparoscopic procedure removes around 80% of the stomach, freeing it from organs nearby. It reduces food intake as the stomach is significantly smaller and holds less. It also reduces the hunger hormone, improving metabolic health in patients. The surgery helps patients maintain a healthy weight and blood sugar level.
Because this bariatric surgery doesn’t touch the small intestine, complications are less likely, making it one of the safest on this list.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
The Biliopancreatic Diversion with Duodenal Switch, or BPD-DS, is a bariatric surgery that starts with creation of a tube-shaped stomach pouch similar to a sleeve gastrectomy. Following creation of the sleeve-like stomach, the first portion of the small intestine is separated then connected to the outlet of the new stomach pouch. When the patient eats, the food moves through the sleeve pouch and into the lower part of the small intestine.
The newly smaller stomach, shaped like a banana, allows patients to eat less food and results in a significant decrease in the absorption of calories and nutrients. With this procedure, patients are required to take vitamins and mineral supplements after surgery. BPD-DS bariatric surgery affects intestinal hormones to reduce hunger, increase fullness and improves blood sugar.
The Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy
Also referred to as SADI-S, this bariatric surgery is the most recent bariatric procedure to be endorsed by the American Society for Metabolic and Bariatric Surgery. Similar to the BPD-DS, the SADI-S is more simple and takes less time since there is only one surgical bowel connection.
The procedure is similar to the gastric sleeve, as it creates a smaller tube-like stomach. Then the first part of the small intestine is divided just below the stomach. Next, a loop of intestine is measured several feet from its end and is then connected to the stomach, the only intestinal connection performed.
This simple bariatric surgery allows food to move through the stomach pouch into the small intestine. The advantage is giving food time to mix with digestive juices, maintaining healthy absorption while still offering weight loss, blood sugar maintenance and diabetes management.
Advantages and Disadvantages of Bariatric Surgery Gastric Bypass
Pros:
- Reliable and long-lasting weight loss
- Effective for remission of obesity-associated conditions
- Refined and standardized technique
Cons:
- Technically more complex when compared to sleeve gastrectomy or gastric band
- More vitamin and mineral deficiencies than sleeve gastrectomy or gastric banding
- There is a risk for small bowel complications and obstruction
- There is a risk of developing ulcers, especially with NSAID or tobacco use
- May cause “dumping syndrome”, a feeling of sickness after eating or drinking, especially sweets
Adjustable Gastric Band
Pros:
- Lowest rate of complications early after surgery
- No division of the stomach or intestines
- Patients can go home on the day of surgery
- The band can be removed if needed
- Has the lowest risk for vitamin and mineral deficiencies
Cons:
- The band may need several adjustments and monthly office visits during the first year
- Slower and less weight loss than with other surgical procedures
- There is a risk of band movement (slippage) or damage to the stomach over time (erosion)
- Requires a foreign implant to remain in the body
- Has a high rate of re-operation
- Can result in swallowing problems and enlargement of the esophagus
Sleeve Gastrectomy
Pros:
- Technically simple and shorter surgery time
- Can be performed in certain patients with high risk medical conditions
- May be performed as the first step for patients with severe obesity
- May be used as a bridge to gastric bypass or SADI-S procedures
- Effective weight loss and improvement of obesity related conditions
Cons:
- Non-reversible procedure
- May worsen or cause new onset reflux and heartburn
- Less impact on metabolism compared to bypass procedure
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Pros:
- Among the best results for improving obesity
- Affects bowel hormones to cause less hunger and more fullness after eating
- It is the most effective procedure for treatment of type 2 diabetes
Cons:
- Has slightly higher complication rates than other procedures
- Highest malabsorption and greater possibility of vitamins and micro-nutrient deficiencies
- Reflux and heart burn can develop or get worse
- Risk of looser and more frequent bowel movements
- More complex surgery requiring more operative time
The Single Anastomosis Duodenal- Ileal Bypass with Sleeve Gastrectomy
Pros:
- Highly effective for long-term weight loss and remission of type 2 diabetes
- Simpler and faster to perform (one intestinal connection) than gastric bypass or BPD-DS
- Excellent option for a patient who already had a sleeve gastrectomy and is seeking further weight loss
Cons:
- Vitamins and minerals are not absorbed as well as in the sleeve gastrectomy or gastric band
- Newer operation with only short- term outcome data
- Potential to worsen or develop new-onset reflux
- Risk of looser and more frequent bowel movements
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Pros:
- Among the best results for improving obesity
- Affects bowel hormones to cause less hunger and more fullness after eating
- It is the most effective procedure for treatment of type 2 diabetes
Cons:
- Has slightly higher complication rates than other procedures
- Highest malabsorption and greater possibility of vitamins and micro-nutrient deficiencies
- Reflux and heart burn can develop or get worse
- Risk of looser and more frequent bowel movements
- More complex surgery requiring more operative time
Bariatric Surgery in Houston – Total Medical Weight Loss
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The Facts of Surgical Weight Loss...
The two most common bariatrics surgeries are Sleeve Gastrectomy and Gastric Bypass. The average weight loss for a Sleeve Gastrectomy is 80 to 100 pounds and for Gastric Bypass it is 100 to 150 pounds. Learn more about creating a better quality of life, fewer medical problems, and less weight.
Bariatrics shouldn't be the last resort. Surgical weight loss procedures are life-changing plans to fight obesity. Learn more here and choose the provider that works best for you.
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