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 Currently the most effective treatment for considerable weight loss is surgery called bariatric surgery. The procedure-along with appropriate long-term nutrition and exercise plans following the surgery-result in significant weight loss and improvements in health and related co-morbid conditions. In addition, many patients see improvement in mobility, stamina, self-image, and general quality of life following the surgery. Like any surgery, however, bariatric procedures are not completely risk-free. Consult your physician about risks associated with bariatric surgery.
Bariatric Surgery Options
Generally speaking, bariatric surgery involves restrictive and/or malabsorptive techniques.
- Restrictive techniques reduce your stomach size, limiting your food intake. You'll feel full after eating just a small amount of food. Therefore, you eat less.
- Malabsorptive techniques focus on your intestine and limit your ability to absorb nutrients. With these techniques, food bypasses part of your digestive system so you absorb fewer calories.
Today there are four primary types of bariatric surgery.
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Roux-en-Y Gastric Bypass
- Most common
- 30-year history in U.S.
- Most insurance companies cover
- Mostly restrictive but somewhat malabsorptive
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PROCEDURE
A small pouch is created at the top of the stomach, reducing the stomach by 95%
Approximately 48 inches (the first and second segments) of the small intestine) are bypassed to reduce absorption of calories
Generally takes 1 hour and requires an inpatient stay of 1-2 days
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RESULTS
50-100 pounds of weight loss in the first six months
70% of long-term excess weight loss
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Duodenal Switch
- Appears to offer the most weight loss success
- Only 40 surgeons perform
- More malabsorptive = more medically controversial, more complications (metabolic problems including anemia, protein malnutrition, and osteoporosis), and limited insurance coverage
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PROCEDURE
The stomach is divided vertically and a portion is removed, making it 85% smaller
A longer length of the intestines is removed, connecting the stomach to the last segment of the small intestine
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RESULTS
Weight loss is quick
Weight loss continues for 18 to 24 months following the surgery
75-80% of long-term excess weight loss
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Laparoscopic Adjustable Gastric Banding (Lap-Band)
- Approved by the FDA in 2001 but has an investigational code
- Outpatient setting, with only an overnight stay in the hospital; considered safe and effective
- Restrictive: does not permanently change the gastrointestical tract
- Newer procedure = less insurance coverage
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PROCEDURE
A smaller pouch-like stomach is created by wrapping a hollow plastic band around the top of the stomach
The Lap-Band is then inflated with saline, tightening it around the stomach
An access port allows the band to be adjusted over time
Procedure takes 45-60 minutes, and patients generally return home the same day
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RESULTS
Slower weight loss but generally similar to gastric bypass in 2-3 years
Success depends on quality aftercare and change in eating habits and exercise
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Restrictive Vertical Gastroplasty/Gastectomy
- New procedure that minimizes complications and risks
- Ideal for patients over 50 years old or those with a 50+ BMI
- Also used for lower-BMI patients who are concerned about the long-term risks associated with intestinal bypass procedures
- No malabsorption = no vitamin deficiencies and nutritional problems
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PROCEDURE
90-95% of the stomach is removed
The tube-like stomach remains directly connected to the intestine
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RESULTS
Weight loss similar to gastric bypass and duodenal switch
No long-term weight loss data yet available
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There are two other bariatric surgery procedures, but they are not common in the United States. The bibiopancreatic diversion (also called the Scopinaro procedure) is rarely performed today due to complications. The sixth technique involves using a device, similar to a pacemaker. This procedure is available in Europe and Canada, but is still undergoing clinical trials in the U.S.
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