Comparing Bariatric Procedures

According to the National Institutes of Health, bariatric (weight loss) surgery is the most effective method for inducing significant and lasting weight loss in very obese individuals. While today’s weight loss surgery procedures are safer than those used in the 1970s and 1980s, there are still risks and some undesirable side effects that often result. The growing popularity of bariatric surgery as a weight loss therapy and the escalating number of very obese individuals in the US and other industrialized countries has stimulated researchers to develop safer and more effective weight loss surgery procedures. Several new approaches have been developed in the past 15 years. This article will provide a brief comparison of the weight loss surgery procedures commonly used today.

In general, weight loss surgeries can be divided into two broad categories:

• Restrictive: in this type of surgery, the stomach’s capacity is significantly reduced

• Combination Restrictive/Malabsorptive: in this type of surgery the stomach’s capacity is decreased and various portions of the gastro intestinal tract are bypassed to reduce digestion and absorption of calorie-containing nutrients

Restrictive Procedures:

Adjustable gastric banding (AGB) 

Adjustable gastric banding such as the LAP-BAND® and vertical gastric banding are restrictive procedures. In both of these procedures, a band is placed around the upper portion of the stomach to create a new, small stomach pouch and a tiny opening into the remainder of the stomach. The small size of this pouch reduces the amount of food the patient can eat. And because the size of the outlet at the bottom of the pouch is quite small, food moves through the stomach very slowly. This creates an extended feeling of fullness. The adjustable gastric band is connected by thin tubing to a small access port placed directly beneath the skin. The physician uses a needle to inject sterile saline into the port to tighten the band. Saline can be withdrawn in similar fashion to loosen the band, if weight loss occurs too quickly. Both a band and staples are used to create a small pouch during the vertical banding procedure.

The banding procedures are generally safer than other weight loss surgeries, create fewer nutritional deficiencies, and if need be, can be reversed at a later date.

Sleeve gastrectomy

One of the most recent restrictive innovations in bariatric surgery today is the procedure known as sleeve gastrectomy. It involves removing about 60% of the stomach-mainly the large curved portion-by stapling it off. This changes the shape of the stomach into a slender tube or sleeve. The greatly reduced stomach size leads to significant weight loss. Unlike the banding procedures, sleeve gastrectomy is not reversible. This procedure is often performed as a first step to weight loss for extremely obese people. A second weight loss surgery such as a Roux-en-Y or duodenal switch is performed at a later time once the patient has lost some weight.

Combination Procedures:

Roux-en-Y gastric bypass (RGB)

The Roux-en-Y gastric bypass has become the most common and successful combination weight loss surgery in the US. During this procedure, the surgeon creates a small stomach pouch to reduce food intake and splits a section of the small intestine, creating a y-shaped intestine that is attached to the new stomach pouch and bypasses the lower stomach, the jejunum (upper portion of small intestine), and the first part of the duodenum (mid portion of the small intestine).

Biliopancretic diversion (BPD):

Biliopancretic diversion is more aggressive surgery involves removing the lower portion of the stomach and creating a pouch out of the remaining upper portion. The pouch is then attached to the illium, the lower portion of the small intestine, completely bypassing the upper portions where many nutrients are absorbed. This procedure creates significant weight loss, but it also creates significant nutritional deficiencies, so it is less popular than other operations.

Duodenal switch (DW)

The Duodenal switch is a less aggressive form of the Biliopancretic diversion surgery. It retains more of the stomach, including the pyloric valve that regulates the flow of food into the small intestine, and retains the upper portion of the duodenum (the top part of the small intestine that attaches to the stomach).

The greatest amount of weight loss is seen with the Biliopancretic diversion procedure. It also leads to more rapid and complete reversal of weight-related diseases like type 2 diabetes, severe hypertension, and sleep apnea. However, as already noted, it carries more risk of long-term nutritional problems.

Laparoscopic Procedures

Most of these surgeries can be performed laparoscopically. The purely restrictive procedures are almost always performed laparoscopically, but the combination procedures can also usually be performed laparoscopically. However, it is not always possible to do so safely and effectively.

Which Procedure is Best for You?

Your surgeon will help you determine the best type of weight loss procedure for you based on your degree of obesity, health status, lifestyle, and support system. If you will be having a combined procedure, your surgeon will also determine if it is safe to do so laparoscopically.