Bariatric Surgery Procedures
Bariatric surgery is constantly evolving. Once cutting-edge procedures are now considered routine, and new procedures and techniques are being researched and rolled out every year. From the most minimally invasive surgical procedures to the most complex, there is a surgery to address most needs. Some of the most commonly performed surgeries are as follows:
Gastric Bypass Surgery
Gastric bypass is widely considered the gold standard in bariatric surgery procedures because it offers a patient a high degree of weight loss and disease resolution potential with a long track record.1 Gastric bypass involves both the cutting away of a portion of the stomach, creating a small stomach pouch, and the re-routing of the small intestine. This surgical technique creates weight loss potential by restricting quantity (small pouch) and malabsorption of calories (re-routing of the intestines). While the procedure provides the potential for excellent weight loss, it is also a complex operation. Today, gastric bypass is performed laparoscopically or robotically using tiny incisions rather than the traditional single, large incision in the abdomen. Learn more about gastric bypass by clicking here.
When gastric bypass is performed robotically, this refers to a laparoscopic (small incision) approach with the aid of a surgical robot. With this option, the surgeon controls the robot remotely and their hand movements are translated to the robot with amazing precision. Combined with an incredible field of vision offered by the robot’s high-definition camera, robotic surgery offers many benefits.
Gastric Banding (Lap-Band®)
Gastric banding surgery is otherwise known as the Lap-Band® and restriction is provided by a silicone ring wrapped around the top of the stomach. The band is then tightened, forming two interconnected stomach chambers. The smaller top chamber becomes a primary receptacle for food, and its size forces the patient to eat less food and feel full sooner. Consequently, patients lose weight at a steady pace. The band is both adjustable and removable as needed. Because of longer-term complication rates, the gastric band is rarely performed today. Learn more about the gastric band / Lap-Band® by clicking here.
Gastric Sleeve (Sleeve Gastrectomy)
The gastric sleeve procedure has quickly become the most popular bariatric procedure in the United States. Formerly, the gastric sleeve technique was used as the first part of a two-stage surgery for those who were extremely obese, i.e., with BMIs of over 50. The second stage of the procedure would have been a duodenal switch.
Over the years, however, it became apparent that the gastric sleeve alone was an effective weight loss procedure. As a result, surgeons began to perform the gastric sleeve as a standalone procedure. The gastric sleeve offers weight loss and disease resolution between gastric banding and gastric bypass.1 It is widely used and has become increasingly popular due to its simplicity. During the procedure, the surgeon cuts away a portion of the stomach, leaving a sleeve-shaped pouch in its place. The new stomach, about the size and shape of a banana, holds far less food. The gastric sleeve offers a second benefit in the form of hormonal control. When the fundus of the stomach is removed, the primary hunger hormone (ghrelin) production center goes with it. Learn more about the gastric sleeve by clicking here.
Duodenal Switch
The duodenal switch creates both a restrictive and malabsorptive element for a great degree of weight loss. During the first part of the procedure, about 70-80% of the stomach is removed – a gastric sleeve. During the second part, a significant portion of the small intestine is diverted, leaving two “loops.” The digestive loop transports food from the stomach into the common intestinal tract, while the biliopancreatic loop takes bile from the liver and brings it to the common intestinal tract. The bile and food mix briefly before entering the large intestine. In this procedure, the pyloric valve from the stomach to the small intestine remains intact. This prevents dumping syndrome – an uncomfortable side-effect of gastric bypass. Because of the complexity and potential nutritional effects of the duodenal switch, bariatric surgeons will carefully select patients with higher BMIs and more severe medical problems for this procedure. Learn more about the duodenal switch by clicking here.
Mini Gastric Bypass (MGB)
The mini gastric bypass (MGB) or single anastomosis gastric bypass (SAGB) follows the same principles as a traditional gastric bypass in that it both surgically shrinks the size of the stomach and bypasses part of the small intestine. However, it is a shorter procedure that involves less suturing and intestinal rerouting. That said, the mini gastric bypass has the potential to offer even more significant weight loss potential than its older cousin. Because of its exceptional weight loss results and more straightforward approach versus the traditional gastric bypass, the mini gastric bypass has become a standard procedure in the UK and Europe. It was then approved in the United States in 2022. Learn more about Mini Gastric Bypass by clicking here.
Revisional Surgery
Not every surgical procedure is successful, and as a result, some procedures may need to be revised. Revisional procedures are only performed when there is a medical need because they come with a higher potential for complications than primary bariatric surgical cases. If you have had a weight loss surgical procedure and you believe you are not losing enough weight or you are having complications, contact your surgeon to determine next steps and to learn more about revisional surgery if your surgeon feels this surgery is right for you. Learn more about revisional procedures by clicking here.
References:
1 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292:1724-1737.
