Overview
Gastric bypass and other weight-loss surgeries work by making changes to the digestive system in order to help with weight loss. These surgeries are done when diet and exercise have not been effective, or when there are serious health problems because of the weight. Some of the procedures limit how much can be eaten, while others work by reducing the body's ability to absorb nutrients. Some procedures do both.
Weight-loss surgery is a major procedure that can offer many benefits but also poses serious risks and side effects. You must make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of weight-loss surgery.
What are the surgical options?
: There are three main types of surgery that surgeons in the United States perform:
- gastric sleeve
- gastric bypass
- adjustable gastric band
A fourth operation that is less commonly used by surgeons is biliopancreatic diversion with duodenal switch.
Gastric sleeve
In the gastric sleeve surgery, which is also called vertical sleeve gastrectomy, the surgeon removes most of your stomach, leaving only a small, banana-shaped section that is closed with staples. This significantly reduces the amount of food that can fit in your stomach, making you feel full much sooner. Additionally, taking out part of your stomach may also affect hormones or bacteria in the gastrointestinal system that influence appetite and metabolism. Because some of the stomach is permanently removed in this surgery, it is not reversible.
Gastric bypass
Gastric bypass surgery is divided into three steps. The first step is when the surgeon staples your stomach, creating a small pouch in the upper section. This makes your stomach much smaller so you eat less and feel full sooner.
The surgeon will then take your small intestine and divide it into two parts. The lower part of the small intestine will be attached directly to the small stomach pouch. This will cause food to bypass most of the stomach and the upper part of the small intestine. As a result, your body will absorb fewer calories.
The surgeon cuts the upper part of the small intestine and reattaches it to a lower part of the small intestine. This allows digestive juices to flow from the bypassed part of the small intestine to the lower part of the small intestine, so that food can be fully digested.
Adjustable gastric band
In this type of surgery, the surgeon places a ring around the top of your stomach to create a small pouch. The ring has an inner inflatable band that is filled with saline solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing the saline solution through a small device, called a port, that is placed under your skin.
After surgery, you will need to come back several times to get the size of the band opening adjusted. If the band causes problems or is not helping you lose enough weight, the surgeon may decide to take it out.
Today, fewer people in the United States get gastric band surgery than the gastric sleeve or gastric bypass because it is more likely to cause complications, especially the need to remove the band because the person can't tolerate it. Gastric band surgery also typically causes less weight loss and more complications, mostly the need to remove the band because the person can't tolerate it.
Biliopancreatic diversion with duodenal switch
A surgical procedure called biliopancreatic diversion with duodenal switch, or “mixed surgery,” involves two separate procedures. The first procedure is similar to gastric sleeve surgery. A second surgical procedure divides the small intestine into two tracts. Food moves through one tract, bypassing most of the small intestine. This reduces the number of calories and amount of nutrients absorbed. Digestive juices flow from the stomach through the other intestinal tract and mix with food as it enters the colon.
This surgery results in more weight loss than the other three types of surgery, but it also has a higher chance of causing surgery-related problems and vitamin/mineral/protein deficiencies.
Why it's done
Bariatric surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:
- Heart disease and stroke
- High blood pressure
- Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
- Sleep apnea
- Type 2 diabetes
Only after you have tried to lose weight through diet and exercise changes should bariatric surgery be considered.
Who it's for
In general, bariatric surgery could be an option for you if:
- Your body mass index (BMI) is 40 or higher (extreme obesity).
- Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.
You may need to meet certain medical guidelines to qualify for weight-loss surgery, which isn't for everyone who is severely overweight. You likely will have an extensive screening process to see if you qualify. If you do, you must also be willing to make permanent changes to lead a healthier lifestyle.
After surgery, you will likely need to participate in long-term follow-up plans. These plans may include monitoring your nutrition, lifestyle and behavior, and your medical conditions.
Be aware that bariatric surgery can be costly. Find out if your health insurance policy will cover the surgery by contacting your insurance provider or local Medicare or Medicaid office.
Risks
Short-term risks of bariatric surgery may include: Surgical site infections Blood clots Excessive bleeding Bariatric surgery may also lead to long-term health risks, such as: Malnutrition Dumping syndrome Ulcers Low blood sugar Bariatric surgery may involve any of a number of different procedures. The most common type of bariatric surgery is gastric bypass surgery. Bariatric surgery poses potential health risks in both the short term and long term. Surgical site infections, blood clots, and excessive bleeding are some short-term risks that may occur. Long-term risks associated with bariatric surgery include malnutrition, dumping syndrome, ulcers, and low blood sugar. Gastric bypass surgery is the most common type of bariatric surgery.
Risks associated with the surgical procedure can include:
- Excessive bleeding
- Infection
- Adverse reactions to anesthesia
- Blood clots
- Lung or breathing problems
- Leaks in your gastrointestinal system
- Death (rare)
Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:
- Bowel obstruction
- Dumping syndrome, which leads to diarrhea, flushing, lightheadedness, nausea or vomiting
- Gallstones
- Hernias
- Low blood sugar (hypoglycemia)
- Malnutrition
- Ulcers
- Vomiting
- Acid reflux
- The need for a second, or revision, surgery or procedure
- Death (rare)
How you prepare
You will need to follow specific instructions from your health care team before your bariatric surgery, which may include having various lab tests and exams, restrictions on your diet and medications, and starting a physical activity program. You will also need to stop using tobacco.
If you think you'll need help at home after your surgery, plan ahead and arrange for it.
What you can expect
The bariatric surgery is done by putting the patient under general anesthesia in the hospital, meaning they will be unconscious during the entire procedure.
Others are done laparoscopically, which uses a number of smaller incisions and a special surgical camera called a laparoscope. The details of your surgery will depend on your individual circumstances, the type of weight-loss surgery you have, and the hospital's or doctor's practices. Some weight-loss surgeries are done with traditional large incisions in your abdomen, while others are done laparoscopically, which uses a number of smaller incisions and a special surgical camera called a laparoscope.
Bariatric surgery that is performed laparoscopically is done so by using a small tubular instrument called a laparoscope. This instrument has a camera attached to the end of it, which allows the surgeon to see inside the abdomen without having to make large incisions. Laparoscopic surgery is often quicker to recover from, but it is not an option for everyone.
The typical surgery lasts for a few hours. Once you are done, you will be in a recovery room where medical staff will watch over you for any potential complications. Depending on the procedure, you might have to stay in the hospital for a few days.
Types of bariatric surgery
Each type of bariatric surgery has pros and cons. Here's a look at common types of bariatric surgery:
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The most common type of gastric bypass surgery is called Roux-en-Y. This surgery is usually not reversible, and it works by making the stomach smaller so you can't eat as much at one time, and by bypassing part of the small intestine so that you absorb fewer nutrients.
The surgeon makes a cut at the top of your stomach, which will seal off the stomach from the rest of the body. The new, smaller stomach can only hold about an ounce of food, as opposed to the three pints that a regular stomach can hold.
The surgeon creates a small pouch out of the stomach and sews a portion of the small intestine to it. Food enters the pouch and bypasses the stomach and the first section of the small intestine, going directly into the middle section of the small intestine.
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The sleeve gastrectomy is a weight loss surgery that removes 80% of the stomach, leaving a smaller stomach that can't hold as much food. This surgery also decreases production of the hormone ghrelin, which makes you feel hungry.
The benefits of this surgery are that you lose a lot of weight and don't have to change the way your intestines are positioned. It also doesn't take as long to recover in the hospital.
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Biliopancreatic diversion with duodenal switch is a two-part surgery in which the first step involves sleeve gastrectomy and the second surgery involves connecting the end portion of the intestine to the duodenum near the stomach.
This surgery both decreases the amount of food you can consume and lowers the ability to absorb nutrients. Although it is highly successful, it has more dangers, such as malnutrition and vitamin deficiencies.
Your surgeon will take many factors into account to decide which weight-loss surgery is best for you, including body mass index, eating habits, other health issues, previous surgeries and the risks involved with each procedure.
After bariatric surgery
After weight-loss surgery, you will usually not be allowed to eat for one to two days, in order to allow your stomach and digestive system to heal. After that, you will need to follow a specific diet for a few weeks. This diet begins with only liquids, then progresses to pureed, very soft foods, and eventually to regular foods. However, there may be many restrictions or limits on how much and what kinds of food and drink you are allowed to consume.
After weight-loss surgery, you will need to have frequent medical checkups. This may include laboratory testing, blood work, and various exams.
Results
These types of surgeries can help people lose a lot of weight in a relatively short period of time.
In addition to weight loss, gastric bypass surgery may improve or resolve conditions often related to being overweight, including:
- Heart disease
- High blood pressure
- Obstructive sleep apnea
- Type 2 diabetes
- Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
- Gastroesophageal reflux disease (GERD)
- Osteoarthritis (joint pain)
The surgery can help you with things you do every day, making your life better in general.
When weight-loss surgery doesn't work
If a weight-loss surgery does not go as planned, you may not lose any weight and could even develop further health complications.
Make sure to keep all your follow-up appointments after weight loss surgery. If you're not losing weight or having complications, go see your doctor right away. They can keep track of your weight loss and find out what's causing the issues.
If you don't make recommended lifestyle changes after weight-loss surgery, it's possible to either not lose enough weight or regain weight.
