7 Types of Weight Loss Surgery and Procedures

types of weight loss surgerytypes of weight loss surgery

The Different Types of Weight Loss Surgery

Obesity is a huge problem plaguing the world, with a three-fold increase in obesity rates between the years 1975 and 2016. According to the World Health Organization, approximately 1.9 billion adults worldwide were overweight and obese in 2016. The prevalence of obesity in adults has significantly increased recently, however, it is the increase of obesity rates in children and adolescents that is even more concerning. In 2016, more than 340 million children and adolescents were obese or overweight, which accounts for 18 percent of the total population between the ages of 5 years and 19 years. In 1975, the prevalence was a mere 4 percent.

The rapid increase in obesity is alarming because obesity is the main risk factor for the development of several pathologies. Obesity can increase your risk of developing cardiovascular disease, diabetes, stroke, gastroesophageal reflux disease or GERD, and even some cancers. These potential complications of obesity are the main reason why we should be looking into finding ways to treat and manage obesity, immediately.

Losing weight, after you cross the threshold of obesity, can be very difficult. Physical exercise and caloric deficit alone may not be enough to make a significant change in your weight. This is why weight-loss surgeries or bariatric surgeries have become more common as they can help you lose weight when all other methods have failed.

What is a weight loss surgery?

Weight loss surgery, also known as bariatric surgery or metabolic surgery, is a complex, medically necessary procedure performed with the purpose of treating obesity and reducing the risk of becoming obese, again. This type of surgery falls under “based on purpose surgery type“. These surgeries specifically target your stomach and the first part of your small intestines, modifying them such that the overall space in them decreases. This results in early satiety or fullness and helps you reduce weight, significantly.

In the beginning, weight loss surgeries were performed in an invasive manner, with the surgeon making a huge incision in your abdominal region, to gain access to your stomach and intestines. However, with the recent technological advancements and improvements in surgical techniques, these procedures are performed laparoscopically or in a minimally invasive manner. It is worth noting that although the procedure is now performed with smaller incisions, it is still an extensive surgical procedure and you should consider all the risks and benefits before making an informed decision about undergoing the procedure.

Types of weight loss surgery

Obesity is a common problem in the world, however, not everyone has the same clinical presentation and not everyone will undergo the same type of weight loss surgery. Depending on your specific case, and the extent of your obesity and related medical conditions, you may choose to undergo any of the following six weight loss surgery procedures.

1. Sleeve Gastrectomy Procedure

A sleeve gastrectomy procedure, also known as a vertical sleeve gastrectomy, is a surgical procedure that includes the removal of a portion of your stomach. The aim of the procedure is to reduce the overall size of your stomach, resulting in decreased food intake, and eventually, management of obesity.

The procedure is performed laparoscopically and leaves behind a banana-shaped stomach. Approximately, 60 percent to 80 percent of your stomach will be removed in this procedure. This procedure helps with weight loss in two specific ways; it reduces the overall space of the stomach and it also removes the part of the stomach responsible for inducing hunger in your body, hence reducing the production of hunger hormone in the body.

This procedure is commonly performed to help people lose overall weight and is even endorsed by the American Society for Metabolic and Bariatric Surgery. Moreover, this procedure is also recommended for those who are undergoing revisional bariatric surgery, which basically means that you had a weight loss surgery that either didn’t work or resulted in complications, requiring re-surgery.

2. Gastric Band Procedure

The gastric band procedure is a surgical, open weight loss procedure, performed with the purpose of reducing the stomach size without surgical removing portions of the stomach. The procedure includes the placement of a gastric band around the stomach, which limits the size of the abdomen and eventually affects the amount of food you consume. However, this is an old procedure, and several advancements have been made in the techniques of the procedure, resulting in a new procedure called an adjustable gastric band procedure.

The gastric band procedure placed a single gastric band, whose size could not be altered or fixed after the procedure. Moreover, the procedure was open and invasive. But the adjustable gastric band procedure is performed laparoscopically, in a minimally invasive manner, and as the name aptly describes, a silicone band is placed around the stomach that is adjustable in size.

It is important to note that this procedure only has minimal effect on obesity and the management of obesity-associated medical conditions, especially diabetes mellitus type 2. However, it is believed to be moderately effective against metabolic conditions arising as a complication of obesity. You should take this into consideration before opting to go for this procedure.

3. Gastric Bypass Procedure

A gastric bypass procedure is like a sleeve gastrectomy procedure, but with an extra step. It includes the removal of most of the stomach content and attaching the remaining stomach pouch directly to the second part of the intestines. In this procedure, the food with bypass, as the name suggests, most of the stomach and first part of intestines.

Also known as Roux-en-Y gastric bypass, which is just French for ‘in the shape of Y’. the procedure alters the anatomy of your gastrointestinal system. This helps you lose weight directly by reducing the amount of food your stomach can hold, and by decreasing the absorption of food in the small intestines. Moreover, the procedure has a significant effect on lowering the levels of hormones responsible for the complications of obesity such as diabetes mellitus type 2.

4. Duodenal Switch with Biliopancreatic Diversion

Biliopancreatic Diversion with Duodenal Switch or BPD/DS is a complex procedure, much like its name. This procedure is much like a combination of a sleeve gastrectomy procedure and a gastric bypass but includes a greater portion of the stomach and intestines not being used. This procedure is performed such that almost 75 percent of both the digestive organs are not being used, hence also reducing your food consumption significantly.

The BPD/DS weight-loss procedure, due to its intensive nature, has a greater effect on reducing hunger, increasing satiety or fullness, and decreasing the level of hormones responsible for stimulation of hunger, obesity, and obesity-associated complications.

This surgical procedure is not performed as commonly as other procedures mentioned above as it is quite complex, but it is one of the most effective surgical procedures for the management of obesity and diabetes mellitus type 2. It is usually recommended to those with severe obesity and uncontrolled diabetes mellitus.

5. Gastric Ballooning

Gastric Ballooning is a minimally invasive, outpatient procedure that includes the placement of a ballon in the stomach. The balloon place is filled with saline and is inserted into your stomach, endoscopically, with the whole procedure taking approximately 20 minutes to 30 minutes in total.

The balloon inserted is adjustable like the adjustable gastric band and has a retractable inflation tube attached to it which helps your doctor adjust the balloon and remove the balloon, down the road. The placement of a gastric balloon helps you lose weight by increasing the feeling of fullness, as most of the stomach space is occupied by it. Moreover, the presence of the balloon tricks your stomach into feeling full for longer periods of time by reducing stomach movements and potentially, delaying the emptying of the stomach.

6. Single Anastomosis Duodenal-Ileal bypass with Sleeve Gastrectomy

This weight loss procedure is a relatively new addition to the list of bariatric procedures by the American Society for Biliary and Metabolic Surgery. This procedure includes a sleeve gastrectomy which is also the first step of the procedure. Once that step is completed, the newly formed pouch of the stomach or sleeve of the stomach is then attached to the distal part of your small intestines. This may sound like the gastric bypass procedure but it is quite different as a portion of the intestine is not being removed but rather actually bypassed as the surgeon forms one single connection between the stomach and small intestine.

This surgical weight loss procedure is preferred over a gastric bypass or BPD/DS mainly due to the simple nature of the procedure. Moreover, the procedure is a great fit for revisional bariatric surgery following a sleeve gastrectomy that did not reach its full potential for weight loss.

However, it is worth noting that this procedure is quite new and there may be certain long-term side effects and complications that doctors are still unaware of.

You can discuss the details of each type with your surgeon and based on your healthcare team’s suggestion and your own research, you can choose the best type of weight loss surgery for you.

Ideal Candidate for Weight Loss Surgery

Weight-loss surgery should not be seen as a simple way of losing weight because it is not. These procedures are long, complex procedures that require appropriate preparation and follow-up. These procedures are only recommended when other methods of losing weight have been exhausted and they yielded no results.

To be eligible for a weight loss procedure, in general, you must meet one of the following criteria:

You must have a BMI of more than 40, with is classified as morbidly obese and suffering from complications of obesity.
Your BMI lies between 35-39.9, which is moderately obese, and you suffer from diabetes mellitus type 2, GERD, or cardiovascular health problems as a result of your obesity.
Your BMI is between 30-34, or you are obese with either comorbidities or the potential to develop severe health complications.
Your BMI puts you in the overweight category but you are already suffering from metabolic, cardiac, and neurological complications of obesity.

Here is a BMI calculator

Furthermore, you should be willing to make a significant change in your lifestyle to help maintain the results of the procedure and prevent weight gain again. You will also need to do frequent follow-ups and continuously take certain medications and supplements to prevent any deficiencies.

Benefits of Weight Loss Surgery

Weight loss procedures are frequently performed due to their increased medical, physical, mental, and aesthetic benefits.

Weight loss surgery helps you lose approximately 50 percent, or more depending on your procedure, of your weight within the first three months to six months of the procedure. This reduction of body fat has positive effects on obesity-associated medical conditions such as diabetes mellitus type 2, GERD, high blood pressure, and high cholesterol levels, to name a few. This can result in significant improvement in your overall health and a decrease in the overall risk of mortality and morbidity due to obesity.

Apart from being good for your health, weight loss via these procedures can work wonders for your confidence and self-worth as well. They can give your confidence levels a boost and result in increased self-worth, hence improving your mental health. Moreover, the new figure allows you to feel good in your skin and flaunt it, improving your aesthetics and social perception.

These are the general benefits of these procedures, and each procedure has a list of pros and cons of its own, as mentioned below:

The Procedures of Weight Loss Surgery

Sleeve Gastrectomy Procedure

This procedure has several benefits over the other weight loss procedures, however, it is important to note that this procedure has minimal to no effect on your metabolism, when compared to other procedures, like gastric bypass.

Sleeve gastrectomy is a commonly performed procedure that is preferred because of its simplicity and shorter surgery time. Moreover, it is often the first procedure performed on patients with obesity, and it is either performed as a stand-alone procedure or it can be used as a bridge to a gastric bypass or other invasive procedures.

Furthermore, this procedure is well tolerated by obese patients with obesity-associated medical conditions.

Gastric Band Procedure

The advantages mentioned here are more specifically related to the adjustable gastric band procedure. This procedure is found to result in the least amount of complications after the surgery. This advantage can be contributed to the fact that it does not involve removing or cutting of stomach and intestines.

Most weight loss procedures result in vitamin deficiencies down the line as most of the stomach and intestine are removed from them. However, that is not the case with an adjustable gastric band procedure. And due to the lack of complexity of the procedure, it is performed as an outpatient procedure and you can go home the same day.

The most important benefit of this procedure is that it is a reversible weight loss procedure.

Gastric Bypass Procedure

The gastric bypass procedure is one of the most reliable weight loss procedures, with results that will last for a long time, without the need for revisional weight loss surgery. It is one of the most studied procedures that is improved, with the involvement of new technology, and a better understanding of the human anatomy.

Gastric Bypass is mostly recommended for severely obese people with several obesity-associated medical conditions as it is the most effective against all of them. It can help you manage these side effects quite efficiently.

Duodenal Switch with Biliopancreatic Diversion

The BPD/DS procedure is an intensive procedure that removes most of your intestines and stomach. This removal is what is responsible for most of the procedure’s benefits as it reduces stimulation of hunger and promotes early satiety or fullness.

Moreover, this procedure is highly recommended in those suffering from Diabetes Mellitus type 2 as a result of obesity. If these patients cannot lose weight and their diabetes is uncontrolled, they may be the ideal candidate for BPD/DS weight-loss surgery.
Gastric Ballooning

Gastric ballooning is a non-surgical, outpatient procedure with most of its benefits revolving around these features of the procedure. The lack of a surgical procedure means that you do not need to take any medications or be put under general anesthesia. Similarly, you are at a lower risk of surgery-associated complications.

The gastric ballooning procedure is an affordable, temporary procedure that is available to you even if you do not meet the eligibility criteria to undergo a weight loss procedure. This procedure is suitable even for patients who are not obese or suffering from an obesity-associated medical condition but are overweight and can not seem to lose weight the traditional way.

Single Anastomosis Duodenal-Ileal bypass with Sleeve Gastrectomy

This is a relatively new procedure so all the long-term effects of the procedure, both good and bad are not yet known completely. However, this procedure is associated with significant weight loss in the first 6 months. Most patients lose approximately 90 percent of the excess weight by the end of 9 months post-op.

The exact mechanism for this benefit is not known but it has been found that this procedure is associated with relatively less post-operative pain.

Risks and Complications of Weight Loss Procedure

Weight loss procedures are surgical procedures and there are quite a few risks and complications associated with all surgical procedures. However, these are not very common and with appropriate care and frequent follow-ups, you can avoid these complications or catch them early on, giving you the chance to treat them as needed.

Some of the common risks and complications associated with weight loss procedures include:

  • Acid reflux
  • Anesthesia-related risks
  • Persistent nausea and vomiting
  • Widening of the esophagus
  • Inability to eat certain foods
  • Infection
  • Stomach obstruction
  • Weight gain
  • Failure to lose weight, requiring revisional surgery

There are some long-term associated with weight loss procedures that you should be on the lookout for, as they can be quite serious and result in even worse complications:

  • Dumping syndrome, the symptoms of which include nausea, dizziness, weakness
  • Hypoglycemia or low blood sugar
  • Frequent vomiting
  • Stomach ulcers
  • Obstruction of the bowel
  • Hernia
  • Malnutrition

These are the common complications, however, there are specific complications associated with each procedure mentioned above. The risks specific to each procedure include:

Sleeve Gastrectomy Procedure

  • Blood clots
  • Gallstones
  • Hernia at the site of incision
  • Internal bleeding
  • Bleeding through the incisions
  • Leakage of stomach contents through staples
  • Perforation of stomach/ intestiens
  • Separation of mucosa
  • Stricture or constriction
  • Vitamin or iron deficiency

Sleeve gastrectomy also has the ability to worsen certain medical conditions such as heartburn and reflux.

Gastric Band Procedure

The adjustable gastric band procedure and gastric band procedure include several follow-up visits as the band is not a one-size-fits-all. Moreover, it takes several tries to adjust the band appropriately where you don’t experience constant discomfort and nausea.

The placement of the band may change over time, as it can slip over the stomach which can result in several complications down the road. The band, when in its spot for a long time, can erode through the stomach causing severe damage to the stomach and its lining.

As the procedure isn’t that intensive, and non-surgical, the results of the procedure aren’t that extensive either. When compared to other weight-loss procedures, the weight loss associated with this procedure is slow and relatively less.

Gastric Bypass Procedure

The main complication that you should be wary of is dumping syndrome, which will present as dizziness and nausea, in most cases.

  • Dumping syndrome
  • Gallstones
  • Perforation of stomach or intestines
  • Pouch/anastomotic obstruction or bowel obstruction
  • Protein or calorie malnutrition
  • Pulmonary and/or cardiac problems
  • Spleen or other organ injuries during the procedure
  • Gastric and intestinal (duodenal) ulceration, especially if you smoke or take NSAIDs.

Duodenal Switch with Biliopancreatic Diversion

BPD/DS has advantages and disadvantages arising from the same principle that it is an intensive procedure. Due to the invasive nature of the procedure, patients who undergo this procedure are more susceptible to complications than other patients. The longer you stay under anesthesia, the higher your chance of anesthesia-associated complications.
Moreover, they are more likely to suffer from malabsorption and vitamin deficiencies, since most of the stomach and intestine are removed in this procedure. Same as the gastric sleeve procedure, BPD/DS can also worsen pre-existing reflux and heartburn.
Gastric Ballooning

  • Bloating and Diarrhea
  • Peptic ulcer
  • Allergic reaction to sedatives
  • Aspiration pneumonia
  • Esophageal/gastric perforation
  • Deflation of the gastric balloon and intestinal obstruction

The placement of gastric ballooning also puts you at risk of persistent nausea and vomiting fro which you will be prescribed medication by your doctor. However, it is important you take it as prescribed, and before the onset of nausea as they aren’t effective in stopping nausea that has already developed.

Single Anastomosis Duodenal-Ileal bypass with Sleeve Gastrectomy

SADI Bypass with Sleeve Gastrectomy makes you susceptible to the risks of sleeve gastrectomy and can worsen your reflux and heartburn. Not much is known about the risks of the procedure since it is a relatively new procedure. However, it is known that it can have an effect on your bowel movements, making them looser and more frequent than before.

Based on your health, your doctor will suggest the best option for you and explain these benefits in detail to you. You should discuss any concerns you may have with your doctor to ensure that you are both agree on the same results and options.

How is weight loss surgery performed?

Weight loss procedures or bariatric procedures require a skilled surgeon specializing in this department as the procedures can be quite tricky. Mentioned below are the basic steps of how different procedures are performed. This is to help you understand the physical extent of the procedure and make an informed decision about the procedure.

Sleeve Gastrectomy Procedure

A sleeve gastrectomy is performed under general anesthesia, laparoscopically. The first step of the procedure is to insert probes for the surgery. After that, the stomach needs to be separated from other organs to allow easier removal of a portion of the organ. Once around 80 percent of the stomach has been removed, the rest of the stomach will be stapled back by the surgeon.

The stomach at this point looks like a banana or a sleeve, hence the name. The incisions will be sutured at the end of the procedure after the probes have been removed completely.

Gastric Band Procedure

This procedure is performed laparoscopically, with small incisions made in the abdominal region by your surgeon. After the probes are in place, a specific piece of instrument is used to place the gastric band around your stomach, creating a small pouch. This is the only step performed during this procedure, and completion of it marks the end of the procedure.

Gastric Bypass Procedure

A gastric bypass procedure is a slightly complicated procedure, also done laparoscopically.

For the purpose of this procedure, your surgeon will first separate the stomach from other organs as they are all closely located in your abdominal region. Once separated, a small pouch of the stomach will be created which will then become your newly-sized stomach. This pouch is completely separated from the rest of the stomach and is attached to the second part of your small intestines.

The remaining part of the stomach and the first part of the intestines is then attached further down your small intestine. This whole connection looks like the letter, Y, hence the name of the procedure.

Duodenal Switch with Biliopancreatic Diversion
For the purpose of this procedure, a huge part of your stomach is removed creating a sleeve. This sleeve is then attached directly to the lower parts of your small intestine, so the food bypasses most of the stomach and intestines. The first parts of the intestine are attached further below. This procedure is performed similar to gastric bypass procedure, however, even less of the small intestines are used overall.

Gastric Ballooning

This procedure is performed endoscopically, under sedation. Your surgeon will use an endoscope to place the balloon in your stomach. The size is then adjusted over the course of the first week, depending on your comfort.

Single Anastomosis Duodenal-Ileal bypass with Sleeve Gastrectomy

This procedure is similar to the gastric bypass and BPD/DS, however, instead of including two anastomosis or connections, it includes just one. First, a sleeve gastrectomy is performed, following which the newly-formed gastric pouch is attached directly to the intestines, a few feet ahead of the stomach. This is the only connection made between small intestines and stomach, the rest are left as free ended.

Life after weight loss surgery

After undergoing weight loss surgery, you need to maintain your health and live a healthy life, to avoid any complications or weight gain. In fact, you should be willing to make this lifestyle change before the procedure to even be considered for the procedures.

Moreover, you will be required to go for frequent health checkups to ensure everything is going over smoothly, that you are living a healthy life and there are no complications from the procedure.

Overall, your life after the weight loss procedure will be full of energy and increased mobility. It will also include an elevated mood, however, this is after the initial bouts of anxiety that many patients go through after a weight loss procedure. This anxiety is mostly due to the fact that you are making a huge lifestyle change and it is normal to feel anxious about it. As you understand more of the procedure and see the benefits of the procedure, the anxiety is likely to reduce.

Advances in Weight Loss Surgeries

Weight loss surgeries are relatively common procedures and their demand is bound to increase due to the huge increase in rates of childhood, adolescent, and adult obesity. This is why further research is being done in the field to find better, non-surgical, and less-invasive ways of performing bariatric procedures.

These researches and studies have resulted in the development of the new procedure, mentioned below:

Vagal Blockade (vBloc)

The vagal blockade involves the placement of a device that sends inhibitory signals to your vagal nerve, on the stomach. These signals stop the effect of the vagal nerve, which stimulates the movement of stomach muscles, resulting in gastric emptying. Blockage of the nerve suppresses appetite and is quite beneficial in the treatment of obesity.

Further research is required to stop the obesity pandemic at its root cause and find non-invasive methods of treating obesity.

Further Medical Reading

https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

https://asmbs.org/patients/bariatric-surgery-procedures

https://www.ifso.com/single-anastomosis-duodenal-Ileal-bypass-with-sleeve/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859128/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836195/

See Also

Weight Loss Surgery for Low Income

Biomedical Science Research

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