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According to the National Institutes of Health (NIH), there are three types of bariatric surgeries commonly done in the United States. They are called gastric sleeve, gastric bypass, and adjustable gastric band. Before you consider any type of bariatric surgery, you should try diet and exercise to lose weight. If diet and exercise don’t help you lose enough weight, you may be a candidate for bariatric surgery if you are extremely obese or if you are very obese and you have a condition that makes obesity more dangerous for you, such as high blood pressure, sleep apnea, or type 2 diabetes.
All bariatric surgeries have pros and cons you need to consider with your surgeon. In most cases, before surgery you will also meet with a psychologist and a dietician to talk about life after bariatric surgery. Benefits of bariatric surgery include weight loss between 40 and 90 pounds, and a decreased risk of obesity-related diseases like heart disease, stroke, high blood pressure, fatty liver disease, sleep apnea, and type 2 diabetes.
Risks of bariatric surgery include surgery risks like bleeding, infection, blood clots, and the risk of general anesthesia. Long-term risks include heartburn, vomiting, diarrhea, ulcer, and malnutrition. In most cases, bariatric surgery is done using an operating scope and long, thin surgical instruments inserted through small incisions in your belly, called laparoscopic surgery.
Gastric Sleeve Surgery
This surgery removes about 80 percent of your stomach. You are left with a small, tubular stomach, like a sleeve. Part of the stomach that is removed is responsible for the chemical messenger (hormone) that controls your appetite. After this procedure, you will be less hungry and you will feel full much sooner due to your small stomach size.
The advantages of this procedure are that your small intestine is left intact, that means there is less chance of not absorbing enough vitamins or minerals and developing malabsorption. The disadvantage is that this procedure is not reversible since most of your stomach is removed. There is also a higher risk of heartburn and gastric reflux, so if you need to take medications that increase the risk of heartburn and ulcers, your surgeon may choose another option.
Gastric Bypass Surgery
The most common gastric bypass procedure is called the Roux-en-Y gastric bypass. During this surgery, your stomach is divided into an upper and lower pouch. The upper pouch is only about the size of a walnut. This has the effect of making you feel full quickly and decreasing your appetite. A second part of the procedure divides your small intestine. The lower part of the intestine is attached to the upper pouch. The upper part of the intestine that is still attached to your lower stomach is attached to a lower part of your small intestine. This allows the digestive juices from your stomach to start digestion lower down in your digestive system, so you absorb less calories.
The main advantage of this procedure is that it causes reliable weight loss that is more likely to prevent or reverse obesity-related conditions like diabetes. This procedure also has less risk of heartburn or reflux. The disadvantages are a higher risk of surgical complications because the procedure is longer and more complex, and a greater risk of vitamin or mineral deficiency because this procedure bypasses a portion of the small intestine.
Another type of bypass procedure is called the biliopancreatic diversion with a duodenal switch. This is done as two separate procedures. First comes a sleeve gastrectomy. This is followed by a bypass procedure. Although this surgery causes significant weight loss, it also causes more long-term complications related to loss of minerals and vitamins and proteins, so it is rarely recommended.
Gastric Band Procedure
The gastric band is called a procedure rather than a surgery because nothing is removed or bypassed. This procedure places an inflatable silicone band around the top of the stomach to limit the amount of food that passes into the stomach and create a feeling of fullness. The opening can be adjusted by injecting a salt water solution into the band through a port placed under the skin.
The advantage of this procedure is that it has very few complications due to the procedure, however it has several long-term disadvantages. It does not cause as much weight loss as the bypass or gastric sleeve and it does not reduce obesity-related disorders as reliably. It requires frequent follow-up visits and adjustments and it often needs to be removed, because the band is a foreign body that may fail or be rejected. For these reasons, the gastric band is used less frequently than the sleeve or bypass.
What Is the Safest Form of Weight Loss Surgery?
The gastric sleeve, bypass, and gastric band are all considered safe surgeries. The gastric band has the least surgical complications but gives less weight loss and may have more long-term problems. The best long-term results come from bypass surgeries, but they may cause vitamin or mineral deficiencies. The gastric sleeve also has good results but may cause heartburn or reflux. There are many factors that determine which procedure is best for you. Talking to your bariatric team is the best way to weigh the risks and benefits.
Recovery From Weight Loss Surgery
After all these surgeries, you will start resuming your normal diet slowly. You may start with clear liquids before moving to a soft diet. When you eventually resume your normal diet, you will need to eat smaller meals and chew your food well. Your bariatric dietician will guide you through these steps. In some cases, your dietician may add vitamin and mineral supplements. Maintaining physical activity and following a diet designed to provide nutrition without excess calories is the key to success of weight loss surgery. You can gain lost weight back if you do not follow your diet and exercise plan.