Why and When Bariatric Surgery is Performed

There are different types of weight-loss surgeries, which are collectively known as bariatric surgery. Bariatric surgery involves making changes to your digestive system to enable major long-term weight loss. Although the main goal of bariatric surgery is to help you lose excess weight, it also reduces the risk of weight-related potentially life-threatening health problems. 

Bariatric surgery is usually performed only after you’ve tried losing weight with conservative methods of eating a healthy diet and exercising; or, if you are facing a life-threatening medical condition due to your excess weight.

Types of Bariatric Surgery

Some procedures limit the amount of food you can eat and drink. Other surgeries reduce the body’s ability to absorb nutrients. Some bariatric surgeries perform both. Each type of bariatric surgery has its advantages and disadvantages and must be carefully evaluated by you and your doctor for your individual situation.

Gastric Bypass

Gastric bypass, or Roux-en-Y (roo-en-wy) gastric bypass, is the most common method of gastric bypass and remains the gold standard for bariatric surgeries. This surgery is not reversible as the top of the stomach is sealed off from the rest of the stomach, leaving a pouch that can only hold about one ounce of food (about the size of a walnut). 

The small intestine is then redirected and part of it sewn directly onto the new pouch. When you eat, food goes into the pouch then directly into the middle part of your small intestine, bypassing the rest of your stomach and the first section of your small intestine.

This surgery decreases the amount of food you can eat at one time as well as the absorption of nutrients.

Gastric Sleeve

The gastric sleeve, or sleeve gastrectomy, removes about 80% of the stomach, leaving a long, skinny pouch. The surgery also removes cells that produce ghrelin, a hormone that produces the feeling of hunger and is used by the body for appetite regulation. The surgery works by the patient having a lessened feeling of hunger and eating less. 

This procedure produces significant weight loss and no rerouting of the intestines is required. A shorter hospital stay than other procedures is another benefit.

Duodenal Switch/SIPS

SIPS stands for stomach intestinal pylorus-sparing. This bariatric surgery is a modified and better-tolerated version of a procedure called biliopancreatic diversion with duodenal switch. That surgery is a kind of combination of a gastric sleeve and gastric bypass. The majority of the intestine is bypassed. 

This surgery reduces the amount you can eat and reduces nutrient absorption. Though extremely effective for weight loss, this procedure is more high risk than the others, including the risks of malnutrition and vitamin deficiencies.

Adjustable Gastric Band

The adjustable gastric band, also known by its brand name LAP-BAND, is a nonpermanent weight loss option. A band with a balloon attached to the inside is placed around the top of the stomach to close off a portion, creating a small pouch. The balloon portion is filled with saline, which can make the band tighter or looser. The pouch initially can hold one to three ounces of food or liquid. Frequent adjustments are made in the doctor’s office using a saline pump.

Intragastric Balloon

The intragastric balloon is also a nonpermanent weight loss option and is nonsurgical. The patient swallows capsules containing balloons that are then inflated. The balloons take up space in the stomach, creating a feeling of fullness before overeating occurs. 

The balloons are usually removed after a few months or however long your doctor determines, and then the procedure is combined with a long support program. This procedure requires great diligence and commitment to significant lifestyle changes.

The best type of weight-loss surgery for you depends on your specific situation. Your surgeon and weight loss team will evaluate many factors, such as body mass index, your eating habits, any other health issues, previous surgeries and the risks involved with each type of procedure. 

In some cases, revisional surgery may be required (a second surgery) to correct any complications from an original surgery.

Benefits of Bariatric Surgery

The main benefit of bariatric surgeries is that they can provide long-term weight loss, which often has a cascade effect in improving other health conditions. The amount of weight lost varies on the type of surgery and the commitment level in changing lifestyle habits. 

In addition to long-term weight loss, bariatric surgery may improve or resolve other health conditions related to being overweight, including:

  • Gastroesophageal reflux disease (GERD)
  • Type 2 diabetes
  • Heart disease
  • High blood pressure
  • Obstructive sleep apnea
  • Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
  • Joint pain (osteoarthritis)

Bariatric surgery can also improve your quality of life, allowing you to perform routine daily activities that you previously could not.

Who Is a Candidate?

Bariatric surgery is not a cure for obesity and is not an appropriate treatment option for every person who is severely overweight. Certain medical guidelines must be met in order to qualify for weight-loss surgery. There is often an extensive screening process and most importantly, you must be willing to make permanent lifestyle changes in order for the surgery to be successful and for you to maintain weight loss. 

Candidates for bariatric surgery have indications including:

  • Extreme obesity, also called morbid obesity, which is defined as having a body mass index (BMI) of 40 or higher
  • Obesity, which is defined as having a BMI of 35 to 39.9, as well as having a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea
  • A BMI of 30 to 34 in certain cases where serious weight-related health problems also exist

At Advanced Laparoscopic Associates, you will have a team approach to your care with long-term follow-up including monitoring your nutrition, exercise, lifestyle and other medical conditions.

Risks of Bariatric Surgery

Bariatric surgery offers many benefits, but all forms of weight-loss surgery are major procedures that can pose serious risks and side effects. Also, you must make permanent healthy changes to your diet and get regular exercise to ensure the long-term success of bariatric surgery.

Short-term postoperative risks include:

  • Adverse reactions to anesthesia
  • Blood clots
  • Excessive bleeding
  • Infection
  • Leaks in your gastrointestinal system
  • Lung or breathing problems
  • Death (rare)

Long-term risks and possible complications vary based on the type of procedure and include:

  • Malnutrition (nutritional deficiencies)
  • Acid reflux
  • Bowel obstruction
  • Dumping syndrome, which leads to diarrhea, flushing, lightheadedness, nausea or vomiting
  • Ulcers
  • Gallstones
  • Hernias
  • Hypoglycemia (low blood sugar)
  • Vomiting
  • Revision surgery (a second procedure)
  • Death (rare)

For additional information, you’re invited to attend a free educational seminar at Advanced Laparoscopic Associates. This seminar is a great source of information about the procedure you may be considering. You also can meet the surgeons, ask questions, and meet some post-operative patients. We offer free seminars at three locations or via webinar:

  • Hackensack University Medical Center
  • Hackensack UMC at Pascack Valley
  • Palisades Medical Center

Sign up today! Or, give us a call to schedule an appointment with one of our weight loss specialists. Telemedicine appointments are available. ALA is here to help you through all the stages of your weight loss journey on your way to a healthy lifestyle.

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