Once you and your doctor decide that you are a good candidate for bariatric surgery, the next step is to discuss the best weight loss surgery for you. Making an informed choice about which bariatric procedure will work for your body starts with understanding more about each weight loss procedure.

What Is Weight Loss Surgery?

Weight loss surgery, or bariatric surgery, changes the stomach's physical makeup and, depending on the type of surgery, the small intestine, as well, to allow for lower-calorie intake and absorption. The effect of weight loss surgery goes beyond just making your stomach smaller so you eat less. Bariatric surgery changes the actions of certain hormones, so you don’t feel hungry.

All bariatric surgeries are effective for weight loss with varying degrees of success: Gastric bypass averages 71 percent of excess weight loss at three years. Sleeve gastrectomy averages 66 percent of excess weight loss at three years. And adjustable gastric banding averages 55 percent of excess weight loss at three years.

What Are The Types Of Weight Loss Surgery?

Gastric Bypass

Gastric bypass is a type of restrictive bariatric surgery where the surgeon uses a stapling device to create a small pouch in the top section of the stomach to reduces the size so it holds less food. Next, the surgeon attaches the lower portion of the small intestine to that small pouch.

Redesigning the digestive system bypasses the lower portion of the stomach and the small intestine's upper section called the duodenum. By closing off the lower section of the stomach, the procedure limits its size to control the amount of food you eat. Attaching the lower section of the small intestine to that pouch also reduces the number of calories the digestive system can absorb. The combination of reduced calorie intake and absorption leads to fast and lasting weight loss.

In addition, the alteration of the stomach changes the effect of the hormone that makes you hungry, so you eat less.

The Pros and Cons of Gastric Bypass Surgery

Pros:

• The combination of restrictive calorie intake and absorption can mean faster weight loss than other bariatric surgery types.
• Should there be severe problems, it is possible to reverse this surgery.
• Gastric bypass is considered the gold standard treatment for morbid obesity.
• Significant weight loss

Cons:

• Because there are two separate steps to this surgery, there is an increased risk of bleeding complications.
• It may require a longer recovery than other weight loss procedures and more time on the operating room table.
• People who have this surgery may experience more instances of dumping syndrome. Dumping syndrome means undigested food enters the small intestine.
• Malabsorption is more likely with gastric bypass.
• People who have this procedure cannot take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve).

Sleeve Gastrectomy

A sleeve gastrectomy changes the stomach's size but doesn’t alter the small intestine, like gastric bypass. The surgeon reshaped the stomach into a small pouch, shaped like a sleeve, and removes the stomach's remaining part. Food goes through the stomach normally into the duodenum since there is no alteration of the small intestine.

By changing the size of the stomach, you get full faster. Also, this surgery has the same hormonal impact as a gastric bypass. You will be less hungry even though you eat fewer calories.

The removal of part of the stomach is permanent, so any complications that occur may be too. There is no way to reverse the procedure and return the stomach to normal size. Also, sleeve gastrectomy can lead to acid reflux that is difficult to control.

The Pros and Cons of Sleeve Gastrectomy

Pros:

• The surgery is not as complex as gastric bypass.
• You are in surgery for half the time as you would be with gastric bypass.
• Fewer malabsorption issues
• Less risk of dumping syndrome
• Effective for weight loss

Cons:

• The surgeon removes that lower portion of the stomach, making the procedure nonreversible.
• Some people experience stomach discomfort with this procedure, such as heartburn or gas. Some also develop difficulty swallowing.

Gastric Banding

Adjustable gastric banding uses a silicon band to separate the stomach into a small and large pouch. A port attached to the abdominal wall allows saline to restrict the size of the food passage to control how much you can eat.

Unlike gastric bypass and sleeve gastrectomy, this procedure does not surgically alter the stomach's anatomy. Instead, a band separates the stomach into an upper and lower section. This restricts the amount of food you can eat at one time.

Of all the available weight-loss surgeries, this one has the lowest average weight loss associated with it. The average weight loss with gastric bypass is 71 percent of excess weight but just 55 percent with adjustable gastric banding. One study published in American Family Physician indicates that 20 percent of adjustable gastric banding procedures fail completely.

However, it is an easily reversed procedure,so if something goes wrong, a surgeon can remove the band, and you can still consider other bariatric surgery types.

The Pros and Cons of Gastric Banding

Pros:

• Adjustable gastric banding does not require any cutting into the stomach or intestine. There are small surgical incisions, though, and a stoma, a small hole in the abdominal wall.
• It is completely reversible.
• Since the goal is only to restrict food intake, it doesn’t have complications associated with bariatric surgery, such as malabsorption and dumping syndrome.

Cons:

• Has a lower success rate than both gastric bypass and sleeve gastrectomy.
• The band can cause complications, such as slippage or erosion.
• To access the port attached to the band, the surgeon creates a stoma or opening in the abdominal wall. There can be complications with the stoma, as well, such as irritation, infection, or blockage.
• Since the band is a foreign object, it’s possible your body may not respond well to it, too. Scar tissue can develop. Band intolerance can cause nausea and vomiting.
• Lower weight loss than other bariatric surgeries
• The band may need adjustments or saline refills.

Revisional Surgery

Revisional bariatric surgery is a procedure to reverse or modify an earlier weight loss surgery. It is typically done because the earlier procedure failed in some way. It may have produced disappointing outcomes or an undesirable effect. Studies indicate that between 5 to 8 percent of weight loss surgeries fail and require revisional procedures to correct or reverse them.

Some common reasons to have revisional surgery include:

• Inadequate weight loss
• Weight gain
• Anastomotic stricture
• Stomal stricture
• Difficulty swallowing
• Frequent vomiting
• Ulcers
• Reflux
• Gastric dilation or enlargement
• Esophageal dilation
• Band erosion or slippage
• Gastro-gastric fistula
• Hernia
• Bowel obstruction

How the revisional procedure works will depend on the original bariatric surgery. In some cases, reversible surgery means converting one procedure to another. For instance, someone having problems with an adjustable band might have revisional surgery that includes gastric bypass. The goal of revisional surgery might be to modify the original procedure. For example, making the “sleeve” in a sleeve gastrectomy smaller.

Revisional surgery might completely reverse either a gastric bypass or an adjustable gastric band. Simply reversing the original surgery would likely lead to significant weight gain, though, so converting to a different type of bariatric procedure is often the goal.

The Pros and Cons of Revisional Bariatric Surgery

Pros:

• Revisional surgery, when the procedure converts one form of bariatric to another, can help you avoid the significant weight gain that could reverse the original procedure.
• Getting revisional surgery might offer more weight loss potential if the first bariatric procedure failed. For some, though, the revisional surgery is necessary because they have problems with the original procedure.

Cons:

• Revisional surgery is another procedure that could come with complications such as bleeding or infection.
• You also are paying for a second surgery, so cost is a significant factor.

How To Select A Weight Loss Surgery

When wondering how to select a weight loss surgery, the short answer is to talk with your doctor. That is a decision you and your doctor will make together. Each type of weight loss surgery has pros and cons worth considering, but, ultimately, it will come down to a variety of factors such as medical history, lifestyle, and risk aversion.

There is no better or worse weight loss surgery, only the surgery that will work best for your body type and weight loss goals. What can help the decision-making process, however, is to do your research on the surgeries available to you so you can fully discuss the impact they’ll have on your life with your weight loss surgery team.

The surgical center you choose may impact your options. While AnMed offers a range of weight loss surgeries, not all weight centers do. Some may specialize in gastric bypass, so that is what they recommend most of the time.

Is Weight Loss Surgery Right For Me?

Again, that is a decision you will make with your doctor. There are qualifications you must meet before you can be a candidate for any bariatric surgery, including:

• A BMI of 40 or more
• A BMI of 35 to 39.9 with existing weight-related health problems, including hypertension, type 2 diabetes, or severe sleep apnea.

The surgeon may disqualify you based on other factors, too, like health conditions that make this kind of surgery unsafe for you.

The choice to have this surgery is not something you shouldn’t make lightly. There are potential risks that come with any surgical procedure, such as infection or blood clots. You must also be willing to make the long-term commitment necessary for bariatric surgery. There are significant dietary restrictions that you will have to follow for the rest of your life. You must also be willing to adhere to an exercise program, take dietary supplements, and keep follow up appointments.

However, bariatric surgery is a tool to help you be healthier if you are willing to stick with the program and follow the rules that come with it. Many benefits can come from bariatric surgery; people who undergo bariatric surgery tend to have lower blood pressures, healthier joints, and even reverse type two diabetes.

If you are looking for a surgical weight loss solution, AnMed's weight loss program can help. We offer the latest and least invasive surgeries available. Our registered dietician is available to help you understand the commitment you will be making, and we offer financial counseling if you are looking for ways to fund the procedure. If you still have questions, our certified bariatric nurses and surgeons can guide you through the process so you can make an informed decision about your health including which weight loss surgery is right for you.