Is There The Safest Weight Loss Surgery?
Weight loss surgery, also known as bariatric surgery, is a medical procedure that can be life-changing for individuals with obesity (a body mass index (BMI) of 40 or higher or a BMI of 35 with at least one weight-related medical problem).
These procedures involve altering the digestive system to some extent to promote weight loss and improve overall health. While bariatric surgery can be an effective tool, it is essential to understand the different options available and their safety profiles.
When we talk about the safest weight loss surgery, we have to realize that this may vary depending on the person and their individual factors, the experience of the surgeons, the implication of the procedure, and the goal that we want to achieve. This is why certain techniques can be better for some people and other procedures for others.
In this article, we will discuss some of the safest weight loss surgery options, their complications, their benefits, and other opportunities to lose weight that don’t involve an invasive procedure.
Most Common Weight Loss Surgery Options
Sleeve gastrectomy has gained popularity as a safe and effective weight-loss surgery. It is a restrictive and resective technique. Almost 80% of the stomach is resected, including a part that produces ghrelin hormone, which regulates appetite and nutrition homeostasis. This creates a tubular stomach, and no anastomosis (a connection between organs) is required.
Results: 70% of weight loss.
- Obstruction of gastric emptying
- Gastric dilatation
- Separation of the surgical suture and bleeding
- It is considered less invasive than other weight loss surgeries
- Lower risk of nutritional deficiencies compared to gastric bypass surgery
- There is no rerouting of the intestines.
Adjustable Gastric Banding
This is the least invasive of all the procedures; it consists of applying an adjustable gastric band about the proximal stomach with the access port being subcutaneous, which allows the gastric emptying rate to be adjusted.
Results: You can lose between 40-60% of weight.
- Minimally invasive procedure
- Individualized adjustments
- Reversible procedure
- Normal digestion and absorption
Biliopancreatic Diversion with Duodenal Switch
This is a purely malabsorptive (in which there is less room for the intestine to absorb nutrients) and a more complex procedure, where a sleeve gastrectomy is done with an anastomosis between the proximal duodenum and the terminal ileum. A portion of the small intestine is excluded from the gastrointestinal tract creating a degree of malabsorption of nutrients.
Results: Loss of 60-80% of weight
- Higher incidence of short and long-term malnutrition with the need for vitamin supplementation
- Lower quality of life
- These are the reasons it is infrequently performed
- It helps to lose a large amount of weight
- Can result in the resolution of obesity-related health conditions
- Retains the potential for long-term weight loss maintenance
Gastric Bypass with a Roux-en-Y Gastrojejunostomy
This technique is the gold standard of bariatric surgeries. In this procedure, the stomach is transected, creating a gastric pouch of one ounce of capacity (30 ml). To this new stomach, a roux-en-Y gastrojejunostomy is attached, which is a jejunal loop that later is joined with the duodenum still joined to the remains of the stomach that were not used to create the pouch.
This ensures that the absorption of nutrients will not be produced until later in the digestive tract preserving all the gastric, biliary, and pancreatic secretions.
Results: 50-80% of loss weight
- Separation of the surgical suture and bleeding
- Gastric ulcers
- Stenosis (occlusion) of the anastomosis
- Internal hernias
- 80% of patients have an improvement of their comorbidities, type 2 diabetes above all.
- Good quality of life
- Early satiety
- Long-term success rates are relatively high
This is a procedure where a silicon balloon full of saline solution is placed inside the stomach. This helps to lose weight by limiting the amount of food that you can eat before feeling full. It’s used as a temporary treatment (in 6-12 months, it disintegrates and is eliminated with stool.
- As a preoperative measure for patients who are morbidly obese to reduce surgical risk
- Patient with a BMI between 30-35 that does not have a surgical indication
- Result: Loss of 10-15% of weight.
It’s an endoscopic procedure where a prosthesis is placed in the first segment of the small intestine. This allows the food to arrive in the other segment faster and without being digested. This procedure helps to improve the production of insulin.
Intermittent Vagal Blockade
Leads are placed in the vagal trunk near the diaphragm to produce intermittent vagal blockade. This produces a loss in appetite and establishes early satiety.
Weight Loss After Surgery
In general, less invasive procedures, like adjustable gastric banding and intermittent vagal blockade, and endoscopic procedures, like end barrier and balloon placement, accomplish a minor weight loss percentage but have fewer complications in the short and long term.
It is important to remember that weight loss surgery is not a quick fix and that it requires a lifelong commitment to lifestyle changes, including a balanced diet, regular physical activity, and medical follow-up.
The goal should always be to improve the different pathologies that affect the patient, and each individual should be evaluated on a case-by-case basis to find the best and safest weight loss surgery, considering the overall health, medical history, and willingness to comply with post-surgery guidelines.
Other Non-Surgical Weight Loss Treatment
Diet and Exercise
Lifestyle changes are key to the management of weight being irreplaceable, even when opting for surgery. Physical exercise is fundamental for the maintenance of weight loss in the long term, and also it may be beneficial for your mental health. There are two types of diets:
Hypocaloric diet: 800-1500 Kcal/day with an even mixture of proteins, fats, and carbohydrates.
Very low-calorie diet: 800 Kcal/day, only when we need a fast weight loss for health reasons.
This kind of treatment is indicated in patients with a BMI > 30 or >27 with type 2 diabetes or hypertension. It should be used as a treatment in addition to diet and exercise management.
Orlistat: Lowers the absorption of ingested fats. Its main adverse effect is gastrointestinal discomfort.
Liraglutide: It is used in the treatment of type 2 diabetes and has proven its effectiveness for the management of obesity when used in higher doses.
Naltrexone-bupropion: It reduces appetite by acting on the brain. The side effects are nausea, hypertension, and trouble sleeping.
Weight loss surgery can be a valuable tool in the management of obesity when other measures have been unsuccessful.
The safety and efficacy of the different weight loss surgeries can vary, and to more accurately identify the best and safest weight loss surgery, we should determine the specific clinical outcome that we want, the expected weight loss, and the risk profile of the patients.
With proper evaluation and commitment to long-term lifestyle changes, weight loss surgery can help achieve lasting weight loss and improve their health and quality of life.
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Virginia Rodriguez is a last-year medical student at the Catholic University of Cordoba, Argentina. Her undergraduate studies are complemented by a diploma in eating disorders and experience as a teaching assistant in a normal anatomy chair for 6 years at the same university. She is interested in developing her research skills and producing educational content.