What is the Safest Weight Loss Surgery?

Is There The Safest Weight Loss Surgery?

Weight loss surgery, or bariatric surgery, 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 discussing the safest weight loss surgery, we must realize that this may vary depending on the person and their factors, the surgeons’ experience, the procedure’s implication, and the goal we want to achieve. This is why certain techniques can be better for some people and other procedures for others.

This article will discuss some of the safest weight loss surgery options, their complications, and their benefits, as well as other noninvasive weight loss options.

Most Common Weight Loss Surgery Options

Sleeve Gastrectomy

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; no anastomosis (a connection between organs) is required.

Results: Patients may lose up to 70% of their excess body weight, typically within two years after the surgery. Individual results can vary based on factors such as adherence to dietary guidelines and post-operative care

Complications:

• Bleeding
• Obstruction of gastric emptying
• Gastric dilatation
• Separation of the surgical suture and bleeding

Benefits:

• 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

Adjustable Gastric Banding: Once considered a less invasive option, this procedure involves placing an adjustable band around the upper portion of the stomach to create a small pouch and narrow passage into the rest of the stomach. However, due to concerns over long-term effectiveness and potential complications, it has become less commonly recommended compared to other weight loss surgeries.

Results: You can lose between 40-60% of weight.

Benefits:

• Minimally invasive procedure
• Individualized adjustments
• Reversible procedure
• Normal digestion and absorption

Biliopancreatic Diversion with Duodenal Switch

Biliopancreatic Diversion with Duodenal Switch: This procedure combines restrictive and malabsorptive approaches. It begins with a sleeve gastrectomy to reduce stomach size. It continues with rearranging the small intestine to separate the flow of food from the flow of bile and pancreatic juices, significantly reducing calorie and nutrient absorption.

Results: Loss of 60-80% of weight

Complications

• 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

Benefits:

• 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 with a capacity of one ounce (30 ml). A roux-en-Y gastrojejunostomy is attached to this new stomach, and a jejunal loop joined to the duodenum is 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

Complications:

• Separation of the surgical suture and bleeding
• Fistulae
• Gastric ulcers
• Bleeding
• Stenosis (occlusion) of the anastomosis
• Internal hernias

Benefits:

• 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

Other Procedures

Intragastric balloon

This procedure involves placing a silicone balloon filled with saline solution inside the stomach via an endoscopic procedure. It aids in weight loss by reducing the stomach’s capacity, thus limiting food intake and promoting an earlier sensation of fullness. The treatment is temporary, usually 6 to 12 months, after which the balloon is endoscopically removed, not disintegrated or eliminated through the stool.

Indicated:

• 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.

Endobarrier

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, such as adjustable gastric banding and intermittent vagal blockade, and endoscopic procedures, like end barrier and balloon placement, accomplish a minor percentage of weight loss 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 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. Each individual should be evaluated on a case-by-case basis to find the best and safest weight loss surgery, considering 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 managing 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.

A very low-calorie diet: 800 Kcal/day, only when we need to lose weight quickly for health reasons.

Pharmacological Treatment

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.

Conclusions

Weight loss surgery can be a valuable tool in managing obesity when other measures have been unsuccessful.

The safety and efficacy of different weight loss surgeries can vary. To identify the best and safest surgery more accurately, we should determine the specific clinical outcome we want, the expected weight loss, and the patients’ risk profiles.

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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