What are my Weight-Loss Surgery Options?

Are you ready to consider weight-loss surgery? There is plenty of research to comb through, so we’ve created a quick guide to help you understand your options before making your choice.

Gastric Bypass

The Roux-en-Y Gastric Bypass (gastric bypass) procedure consists of two components, requiring cutting and rerouting of the organs and hundreds of staples. First, the top of the stomach is divided from the rest of the stomach, which creates a small stomach pouch. Then, the first portion of the small intestine is divided. The stomach pouch created in the first step is attached to the bottom end of the small intestine that was just divided. Finally, the remaining portion of the divided intestine is attached to a different portion of the small intestine. This means that stomach acids and digestive enzymes will eventually mix with ingested food.

After surgery, the stomach pouch is smaller, which means that smaller meals (and fewer calories) are consumed. Because one segment of the small intestine doesn’t have food going through it, it is presumed that overall, there is less calorie and nutrient absorption, requiring expensive supplements. Gut hormones change in response to the new food stream, which can promote the feeling of fullness and suppress appetite. These changes provide advantages such as long-term, significant weight loss, increased energy, and maintenance of weight loss.

Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy, or “the sleeve,” removes 80% of the stomach. The remainder of the stomach is approximately the size of a banana. The procedure is irreversible and involves cutting and stapling the stomach. The smaller size of the stomach means it can hold much less, so food consumption is significantly limited. Gut hormones are also changed, which can induce feelings of fullness, curb appetite, and control blood sugar.

In the sleeve gastrectomy procedure, the intestines do not need to be rerouted, unlike with gastric bypass surgery. However, patients will experience a similar change to gut hormones, which can increase feelings of fullness and suppress appetite. The sleeve results in fairly quick and significant weight-loss. Patients must stay in the hospital to recover for approximately two days. Patients who undergo this surgery are at risk for malnutrition and require long-term supplements and vitamins to avoid possible deficiencies.

Lap-Band® (Gastric Banding)

The Lap-Band Procedure the safest of all bariatric procedures with the lowest complication and mortality rates. It is a much simpler procedure when compared to gastric bypass and the gastric sleeve. An inflatable band is placed around the upper portion of the stomach. The band creates another, smaller stomach above the band, while the stomach below remains intact. The smaller stomach allows the patient to feel fuller faster and to stay full longer. The band is easily adjusted by filling the band with sterile saline (injected through a port under the skin). This in turn adjusts the size of the stomach opening. This leads to weight-loss that is gradual and lasting. Unlike gastric bypass, food is digested and absorbed normally, so typically only a multivitamin is required. The band is both reversible and non-anatomy altering.  

Pros and Cons

There are pros and cons to each bariatric procedure. Gastric bypass surgery and the gastric sleeve are much more complicated than the Lap-Band Procedure. A more complicated procedure requires a longer hospital stay, whereas the Lap-Band Procedure is performed in about one hour and patients can go home soon after. The Lap-Band is also the only procedure that is non-anatomy altering and can be reversed.

With gastric bypass surgery and the gastric sleeve, there is the risk for vitamin and mineral deficiencies, typically in vitamin B12, iron, calcium, and folate. Because the procedures aren’t reversible, patients may need to take supplements for the remainder of their lives.

To learn more about your options, talk to a Lap-Band Surgeon.

Sources:

• ASMBS Informed Consent for Laparoscopic Adjustable Gastric Band
• ASMBS Informed Consent for Informed Consent for Laparoscopic Roux-en-Y Gastric Bypass
• ASMBS Informed Consent for Laparoscopic Vertical Sleeve Gastrectomy