Weight-loss surgery, or bariatric surgery is an alternative for individuals who are chronically obese to lose a significant amount of weight in a short amount of time. People that opt for weight-loss surgery have had difficulty losing massive amounts of weight through traditional diet and exercise. Determining the best option for weight-loss surgery depends on a person's specific weight-loss goals, their doctor's recommendations, their current health, and which procedure is covered by insurance.
The two types of weight-loss surgery are Restrictive and Malabsorptive, and help with weight loss in different ways.
- Restrictive surgery reduces the size of the stomach and slows down digestion. A normal stomach holds approximately three pints of food. Following surgery, the stomach may only hold as little as an ounce of food. Later the stomach may stretch to hold two to three ounces of food. With a smaller stomach, an individual eats less, thus the more weight you lose.
- Malabsorptive surgery is more invasive and changes how the body takes in food. Along with restricting ones stomach size, part of the digest tract is removed or bypassed making it more difficult for the body to absorb calories during food consumption. Malabsorptive surgery is also called intestinal bypass surgery.
Here is a brief overview of four-types of weight-loss surgical procedures, and the pros, cons, and risks associated with each.
Laparoscopic Adjustable Gastric Banding:
This is the least invasive weight loss surgery. An inflatable band squeezes the stomach into a smaller upper pouch and a larger lower section. The channel between the upper and lower sections is smaller thus slowing down the emptying of the smaller upper portion of the stomach. Gastric banding limits the intake of food at mealtime. One can only eat a half to one cup of food at a time before feeling full. Food must be soft and well-chewed.
- Pros: Simpler and safer than gastric bypass surgery. Minimally invasive procedure involving a small incision in the abdomen, special instruments and a laparoscope (tiny camera). Faster recovery time. Procedure can be reversed by removing the band from the stomach. Bands include LAP-BAND and REALIZE. Band can be loosened or tightened in the doctor's office. For tightening, more saline solution is injected into the band, and for loosening, liquid is removed with a needle.
- Cons: People lose less weight than those that opt for more invasive procedures. People also are more likely to regain some of the weight over the years following surgery.
- Risks: Vomiting is the most common side-effect, as a result of eating too much too quickly. This is not uncommon with gastric banding. The band may slip out of place, loosen or leak. Further surgery may be necessary. As with any surgery, infection is a risk, and some complications can be life threatening.
This procedure is a form of restrictive weight-loss surgery removing approximately 75% of the stomach. The remaining portion of the stomach is a narrow tube or sleeve resembling a banana connecting to the intestines. If more weight-loss is needed, the sleeve gastrectomy is the first step in a sequence of surgeries, followed by gastric bypass or biliopancreatic diversion surgery. This procedure is irreversible, but the most effective. It was originally used as a simple modification to the duodenal switch.
- Pros: Simpler operation than the gastric bypass or the biliopancreatic diversion for severely obese or sick individuals. Once weight loss has been achieved and health has improved, individuals can proceed with additional surgery. It usually takes a person 12 to 18 months to lose enough weight before moving on to a second surgery. With the intestines not affected, food absorption and nutritional deficiencies are not a concern with this surgery.
o Cons: This procedure is irreversible. Benefits and risks are still being assessed, as this is relatively new procedure.
- Risks: Typical risks include infection, leaking of the sleeve, and blood clots.
Roux-en-Y Gastric Bypass:
This procedure is the most common weight-loss surgery and is a combination of the restrictive and malabsorptive approaches. The stomach is divided into two sections, sealing the upper portion of the stomach from the lower. The upper stomach is connected to the lower portion of the small intestines. Skipping a part of the digestive tract means fewer calories are absorbed into the body.
- Pros: Weight loss is extremely fast, 50% happens within the first six months and may continue for up to two years. Health conditions often improve, i.e. diabetes, high blood pressure, high cholesterol, arthritis, apnea, and heartburn. Most people keep the weight off for for 10 years or more.
- Cons: Due to the body's inability to absorb food, people are at risk of serious nutritional deficiencies. The loss of calcium and iron lead to osteoporosis and anemia. Dumping may occur, which is food from the stomach goes to small intestines too quickly without proper digestion. Nearly 85% of patients experience dumping. Symptoms of dumping include nausea, bloating, pain, sweating, weakness, and diarrhea. Dumping is usually onset by the intake of sugary or high-carbohydrate foods. One must be very careful with their diet and always take supplements, as there is a permanent change in how the body digests food.
- Risks: The risk of death is about 1%, but is more dangerous than gastric banding. Risk of infection and blood clots, as with most surgeries. Increased risk of hernias. A side effect of rapid weight loss can be gallstones.
Duodenal Switch with Biliopancreatic Diversion:
This procedure removes a portion of the stomach along the edge of the greater curvature and re-routes a large portion of the small intestine to create two pathways with a single common channel. The shorter path carries food from the stomach to the common channel. The longer path carries bile from the liver to the common channel. The common channel allows bile and food to mix before pushing it through to the large intestine. This procedure reduces the body's absorption of fat and reduces the amount of time it has to absorb calories, resulting in extreme weight loss.
- Pros: Studies indicate a long-term loss of 70% to 80% of excess weight. One may be able to eat larger meals with this surgery than others.
- Cons: Less common surgery than gastric bypass. Risk of nutritional deficiencies is more serious. Poses the risk of dumping, but with the duodenal switch there may be lower risk.
- Risks: This is the most complicated and high-risk weight-loss procedure. The risk of death from the duodenal switch ranges between 2.5% to 5%. Surgery poses a high risk for hernias.
Choosing the best option of weight-loss surgery depends on your current health. Consult with a physician to discuss all possible options available and which is the best recommendation. If possible, go to a medical center that specializes in weight-loss surgery. Make sure that your surgeon has had plenty of experience in the procedure that you need and make sure that you fully understand the risks. Other than weight loss surgery that could prove expensive, you can also find some useful weight loss programs which will save your money.
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