6 Types of Weight Loss Surgery and Procedures

The Different Types of Weight Loss Surgery

Obesity is a significant global health issue, with a more than three-fold increase in global obesity rates between 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 in 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 to treat obesity and reduce the risk of becoming obese again.

This type of surgery falls under general surgery. It specifically targets your stomach and the first part of your small intestines, modifying them so 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, due to recent technological advancements and improvements in surgical techniques, these procedures are now performed laparoscopically or minimally invasively.

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 it.

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, also known as a vertical sleeve gastrectomy, is a surgical procedure that involves removing a portion of the stomach.

The procedure aims 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 ways: it reduces the overall space of the stomach. It removes the part of the stomach responsible for inducing hunger in your body, hence reducing the production of hunger hormones.

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 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 minimally invasive, not open, weight loss procedure performed to reduce the stomach size without surgically removing portions of the stomach.

The procedure includes placing a gastric band around the upper portion of the stomach, creating a small pouch above the band and limiting food intake.

However, this is an old procedure, and several advancements have been made in its techniques, 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.

However, the adjustable gastric band procedure is performed laparoscopically, in a minimally invasive manner. As the name aptly describes, a silicone band that is adjustable in size is placed around the stomach.

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 consider this before opting to go for this procedure.

3. Gastric Bypass Procedure

A gastric bypass procedure is like a sleeve gastrectomy but with an extra step. It includes removing 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 the intestines.

Also known as Roux-en-Y gastric bypass, which is French for ‘in the shape of Y’, the procedure alters the anatomy of the 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 so that almost 75 percent of both digestive organs are not being used, reducing your food consumption significantly.

Due to its intensive nature, the BPD/DS weight-loss procedure significantly reduces hunger, increases satiety or fullness, and decreases the level of hormones responsible for stimulating hunger, obesity, and obesity-associated complications.

This surgical procedure is not performed as commonly as other procedures mentioned above as it is quite complex. Still, it is one of the most effective surgical procedures for the management of obesity and diabetes mellitus type 2.

It is usually recommended for 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 balloon in the stomach. The balloon is filled with saline and 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 gastric band. It has a retractable inflation tube attached to it, which helps your doctor adjust the balloon and remove it later.

Placing a gastric balloon helps you lose weight by increasing the feeling of fullness, as it occupies most of the stomach space.

Moreover, the balloon’s presence tricks your stomach into feeling full for longer periods by reducing stomach movements and potentially delaying stomach emptying.

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.

Once that step is completed, the newly formed pouch or sleeve of the stomach is attached to the distal part of your small intestines.

This may sound like a gastric bypass procedure. Still, it is quite different. In this procedure, a portion of the intestine is not removed but bypassed, as the surgeon forms one single connection between the stomach and the small intestine.

This surgical weight loss procedure, Single Anastomosis Duodenal-Ileal bypass with Sleeve Gastrectomy, is considered due to its potentially lower complexity than traditional gastric bypass or BPD/DS. 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 doctors may still be unaware of certain long-term side effects and complications.

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

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 lengthy, complex procedures that require appropriate preparation and follow-up. These procedures are only recommended when other methods of losing weight have been exhausted and yielded no results.

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

It would be best if you had a BMI of more than 40, which 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. Furthermore, it would help if you were willing to change your lifestyle significantly to help maintain the procedure results and prevent weight gain.

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 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 significantly improve your overall health and decrease the overall risk of mortality and morbidity due to obesity.

Besides being good for your health, weight loss through these procedures can also boost your confidence and self-worth.

They can boost your confidence levels and increase your self-worth, 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 other weight loss procedures. However, it is important to note that this procedure has minimal to no effect on your metabolism 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 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 has been found to result in the least number of complications after the surgery. This advantage can be attributed to the fact that it does not involve removing or cutting off the stomach and intestines.

Most weight loss procedures result in vitamin deficiencies as most of the stomach and intestine are removed from them.

However, that is not the case with an adjustable gastric band procedure. Due to the lack of complexity, it is an outpatient procedure and you can go home the same day.

The most crucial 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 a long time without revisional weight loss surgery.

It is one of the most studied procedures that has improved with 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 responsible for most of the procedure’s benefits as it reduces the stimulation of hunger and promotes early satiety or fullness.

Moreover, this procedure is highly recommended for 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. Most of its benefits revolve around these features.

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 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 completely known.

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 many risks and complications are 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, allowing you 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 can worsen certain medical conditions, such as heartburn and reflux.

Gastric Band Procedure

The adjustable and gastric band procedures 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 so that you don’t experience constant discomfort and nausea.

The band’s placement may change over time, as it can slip over the stomach, resulting in several complications.

When in its spot for a long time, the band 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 aren’t that extensive either.

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 the 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 from the same principle: 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.

Similar to 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, for which you will be prescribed medication by your doctor.

However, you must 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 procedure’s risks since it is relatively new.

However, it is known that it can affect your bowel movements, making them looser and more frequent than before.

Your doctor will suggest the best option for you based on your health and explain the benefits in detail.

It would be best to discuss any concerns you may have with your doctor to ensure you agree on the same results and options.

How is weight loss surgery performed?

Weight loss or bariatric procedures require a skilled surgeon specializing in this department, as they 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 surgeon will staple the rest back.

At this point, the stomach 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 your surgeon making small incisions in the abdominal region.

After the probes are in place, a specific 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 marks the end of the procedure.

Gastric Bypass Procedure

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

For this procedure, your surgeon will first separate the stomach from the other organs, which are all closely located in your abdominal region.

Once separated, a small stomach pouch will be created, becoming 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 are attached further down your small intestine. This connection looks like the letter Y, hence the procedure’s name.

Duodenal Switch with Biliopancreatic Diversion

For this procedure, a huge part of your stomach is removed, creating a sleeve. This sleeve is 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 similarly to the 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.

Depending on your comfort level, the size will be adjusted over the first week.

Single Anastomosis Duodenal-Ileal bypass with Sleeve Gastrectomy

This procedure is similar to gastric bypass and BPD/DS. However, it includes just one instead of two anastomoses or connections.

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 the small intestines and the stomach. The rest are left as free-ended.

Life after Weight Loss Surgery

After undergoing weight loss surgery, you must maintain your health and live a healthy life to avoid complications or weight gain.

It would help if you were willing to make this lifestyle change before the procedure is even considered.

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 that there are no complications from the procedure.

After the weight loss procedure, your life 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 because you are making a huge lifestyle change and it is normal to feel anxious about it.

As you understand more about the procedure and see its benefits, anxiety is likely to reduce.

Advances in Weight Loss Surgeries

Weight loss surgeries are relatively standard 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 to find better, non-surgical, and less-invasive ways of performing bariatric procedures.

These research 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 in the stomach.

These signals stop the vagal nerve’s effect. The vagal nerve stimulates the movement of stomach muscles, resulting in gastric emptying. Blockage of the nerve suppresses appetite and is quite beneficial in treating obesity.

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

Weight Loss Surgery by State

Further Medical Reading

What is the Safest Weight Loss Surgery?

What is the Least Invasive Weight Loss Surgery?

What are the Most Popular FDA Approved Weight Loss Medications

What to Expect from a Weight Loss Surgery

Weight Loss Surgery Cost With Insurance

Weight Loss Clinical Trials in the US

Grants for Plastic Surgery After Weight Loss

Clinical Trials for Weight Loss Surgery in the USA

See Also

Weight Loss Surgery for Low Income

Biomedical Science Research

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