Today, there are three common surgical weight loss procedures: gastric bypass, sleeve gastrectomy and adjustable gastric banding. To be successful, these operations must be performed by an experienced bariatric surgeon in a facility with multidisciplinary bariatric team and extensive before/after surgery program.
Choosing the best procedure for each patient involves consideration of multiple factors such as existing medical conditions, medications needed, past surgical procedures, expected amount of weight loss, rate of weight loss desired, activity level or limitations, food preferences, eating behaviors, fear of foreign body or needles and previous dietary successes.
All three weight loss procedures are performed laparoscopically with six small incisions, require about 60 minutes to perform and have average 1-2 weeks return to work.
The most common procedure, gastric bypass, involves making a small stomach pouch, and a part of the small bowel is bypassed. Rapid weight loss occurs by limiting the amount of food intake and the patient does not absorb all calories taken in. Gastric bypass has the most solid data for diabetes resolution. More than 90 percent of type 2 diabetics are cured within a month of surgery.
This operation is the most effective for patients with severe reflux and heartburn and works well for patients with a slow metabolism or limited mobility. Gastric bypass also has the most effective weight loss. Patients lose at least 75 percent excess body weight and typically reach goal weight at approximately one year.
The sleeve gastrectomy involves decreasing the stomach size approximately 80 percent. This creates a stomach tube the size of a banana. Due to its lower risk, it is becoming the most popular procedure. It is also optimal for patients who have had extensive previous surgery and preferred for patients that must have predictable medication absorption (such as for seizure disorder or mental health stability). With compliance, patients' weight loss expectation is similar to a patient who undergoes gastric bypass.
The adjustable gastric band is wrapped around the upper stomach, and is becoming a less popular option. Multiple postoperative adjustments of the amount of liquid in the band is required. Optimally the band is tight enough to restrict food intake, but not too tight to cause reflux or vomiting. To achieve the "right" fit can be challenging. This procedure also requires the most work for the patient in terms of food choices and exercise to reach weight loss goals. Following the band procedure, it can take two or more years to lose 50 percent excess body weight.
Deciding which procedure is best should involve discussion with an experienced bariatric provider. Choosing the "right" procedure is imperative for excellent outcomes. No matter which operation a patient chooses, the operation is a tool to help control appetite and portion size, but the rest is up to the patient. Success is dependent on the patient's willingness to make lifestyle changes such as food selection, exercise, vitamin intake and follow-up.
Indications for weight loss surgery are defined by the National Institute of Health, which states that surgery is safer for an individual than the long-term health risks of morbid obesity. These criteria are for a BMI of 35 with co-morbidities such as hypertension, sleep apnea and diabetes, or a BMI of 40 without such co-morbidities.