About Bariatric Surgery
Deciding which procedure is best for you requires information and insight. All three types of procedures can help with weight loss and may help with Type 2 diabetes. Remember, it is normal to be concerned about any surgery, but a little information can go a long way towards helping you feel more at ease.
Bariatric procedures: Three common types
Weight-loss surgeries generally fall into 2 categories: restrictive procedures, which make the stomach’s capacity smaller, and malabsorptive procedures, which reduce the calories and nutrients your body absorbs. The most commonly performed types of weight-loss surgery are gastric bypass (combination of restrictive and malabsorptive), gastric sleeve (restrictive), and gastric band (restrictive). Most procedures can be performed using minimally invasive techniques with small incisions in the abdomen (See “About Minimally Invasive Surgery” below).
Gastric bypass (Roux-en-Y)
This procedure works in 2 ways.
(1) After surgery, most of the stomach is closed off, leaving a small “pouch” about the size of an egg (15-30 cc) that limits your food intake. The remnant stomach stays in place and produces acids that meet up with food further downstream in the small intestine. The closing off of a majority of the stomach also changes the amount of “hunger hormone” produced, causing most patients to eat smaller amounts of food and not experience extreme hunger.
(2) The small intestine is rerouted slightly so that fewer calories and nutrients are absorbed by the body. This malabsorption effect requires you to take vitamins and supplements after gastric bypass surgery and be checked postoperatively to prevent nutritional deficiencies. Note that for gastric bypass surgery, greater weight loss and type 2 diabetes resolution are more typical than with gastric band procedures.
Gastric sleeve (sleeve gastrectomy)
As its name indicates, part of the stomach is removed, leaving a small sleeve-shaped stomach tube that limits food intake. Also, because the now-smaller stomach produces less of a certain “hunger hormone,” appetite may be reduced.
In patients with a very high BMI or those with a history of high surgical risk, the gastric sleeve procedure is sometimes done as the first stage of a 2-surgery treatment plan, with a malabsorptive procedure (biliopancreatic diversion with duodenal switch) performed a year or more later.
Gastric band (laparoscopic adjustable gastric band/LAGB)
A band is placed around the top of the stomach, creating a small pouch that limits food intake. Additionally, a small port is affixed inside the body that allows the band to be adjusted later to make the pouch smaller or larger.
Weight-Loss Procedures: Overview Chart
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The chart below compares each procedure in several categories to help you decide what is best for you. This may be a good tool to take with you when you discuss surgery with your doctor.
About minimally invasive surgery
Most weight-loss surgeries today use laparoscopy, in which a small incision is made in the abdomen and a small camera, or scope, is inserted, enabling the surgeon to view the internal organs on a video monitor. Other small incisions are usually made to insert the surgical instruments. Laparoscopic surgery is less invasive than “open” abdominal procedures, resulting in less postoperative pain, fewer wound complications, shorter hospital stays, and earlier returns to work. Note that through recently technological advances, some minimally invasive procedures are now being performed through Single Incision Laparoscopic Surgery (SILS™), an advanced technique that requires only one small incision, rather than multiple small incisions. The single incision is typically done through the belly button.
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