Weight loss procedures such as gastric bypass are collectively referred to as bariatric surgery. These weight loss surgery options all involve making changes to the patient’s digestive system to help them lose excess weight. Undergoing bariatric interventions is often only advised when other methods, like exercise and diet, haven’t worked or when the patient has developed severe health problems due to obesity. Essentially, some of these weight loss surgery options limit the body’s nutrient-absorbing abilities, while others limit the amount of food one can consume. While these interventions may be highly beneficial, they are all major procedures that carry a certain percentage of risk. All weight loss surgery options will require permanent dietary and lifestyle changes to ensure long-term success.

Weight loss procedures are undertaken with the aim of mitigating the patient’s susceptibility to weight-related health issues, which can pose significant risks to life. These medical conditions include:

  • Hypertension
  • Nonalcoholic fatty liver disease
  • Nonalcoholic steatohepatitis
  • Type 2 diabetes
  • Stroke and heart disease
  • Sleep apnea

Bariatric surgery is typically performed on patients who:

  • Have a BMI (body mass index) of 40 or higher (extreme obesity).
  • Have a BMI between 35 and 39.9m but have a serious obesity-related health condition.
  • In some cases, people with a BMI between 30 and 34 may qualify if they have a serious obesity-related health problem.

This approach isn’t universally suitable, as specific medical criteria must be met for eligibility. Potential candidates will undergo a thorough screening process to assess their suitability and are required to exhibit a dedication to adopting enduring lifestyle changes for enhanced health. Moreover, individuals contemplating weight-loss surgery may be expected to participate in extended post-operative follow-up programs. Qualified candidates for bariatric surgery will receive comprehensive instructions from their healthcare team to adequately prepare for the procedure. These programs involve continuous assessment of nutritional habits, lifestyle choices, behavioral patterns, and medical conditions.

Preparing for Bariatric Surgery

Those who qualify for bariatric surgery will receive detailed instructions from their healthcare team to properly prepare for the procedure. Some patients may need to undergo several exams before their procedure. In most cases, patients will also need to start an exercise program and stop smoking as well as switch medications and make dietary changes. The procedure is typically performed in a hospital setting with the administration of general anesthesia, ensuring that the patient remains asleep throughout the procedure. The specific details of the surgical approach employed are contingent upon the patient’s unique circumstances, the type of weight-loss surgery chosen, and the established practices of the hospital or attending physician. Some weight-loss surgeries involve the utilization of traditional large incisions in the abdominal region; however, the majority of bariatric surgeries are conducted laparoscopically. This minimally invasive approach involves the use of a laparoscope, a small tube-like instrument equipped with a camera. The laparoscope is inserted through small incisions in the abdomen, allowing the surgeon to visualize and perform the necessary procedures within the abdominal cavity without resorting to traditional large incisions. While laparoscopic surgery often leads to quicker and shorter recovery times, it may not be suitable for all patients.

The surgery typically spans several hours in duration. Following the procedure, patients regain consciousness in a designated recovery area, where medical professionals closely monitor them for any potential complications. Depending on the specific surgical intervention, patients may be required to remain in the hospital for a few days post-surgery.

Surgical Weight Loss Options

If you are contemplating bariatric surgery, it is advisable to have a thorough discussion with your doctor before making any final decisions. Your doctor can provide valuable insights into the various surgical options available, taking into account your specific health needs and circumstances. Surgical options may include:

Sleeve Gastrectomy: In the case of sleeve gastrectomy, approximately 80% of the stomach is surgically removed, resulting in the creation of an elongated, tube-shaped pouch. This reduced stomach capacity means it cannot accommodate large food quantities and also leads to a decrease in the production of the appetite-regulating hormone ghrelin, potentially reducing the urge to eat. The benefits associated with this surgical approach encompass substantial weight loss and the absence of intestinal rerouting, distinguishing it from many other weight-loss procedures. Additionally, sleeve gastrectomy generally necessitates a shorter hospital stay compared to most alternative surgical methods.

Roux-en-Y Gastric Bypass: This is the most common method regarding gastric bypass, and it’s usually not reversible. It decreases the amount one can consume and reduces the body’s capacity to absorb nutrients. During the procedure, the surgeon makes a horizontal incision at the upper part of the stomach, effectively isolating it from the remainder of the stomach. The resultant pouch is roughly equivalent in size to a walnut, with a capacity to accommodate only about one ounce of food. In contrast, a normally functioning stomach can hold approximately three pints of food. After this, the doctor will cut the small intestine as well, sewing a part of it onto the pouch directly. The food will then go to the small pouch first and immediately into the small intestine. This way, the food will bypass most of the stomach.

Biliopancreatic Diversion with Duodenal Switch: This surgical process consists of two distinct phases. Initially, a procedure resembling a sleeve gastrectomy is performed. Subsequently, in the second surgery, the end portion of the intestine is connected to the duodenum in close proximity to the stomach, a process known as duodenal switch and biliopancreatic diversion. This rerouting effectively bypasses a significant portion of the intestine. This dual-stage surgery serves a dual purpose: It restricts the quantity of food that can be consumed and diminishes the absorption of nutrients. While it yields remarkable effectiveness in achieving weight loss, it also carries heightened risks, including the potential for malnutrition and vitamin deficiencies.

Weight Loss Surgery Risks

As with any major intervention, weight loss procedures also have potential health risks, which may include:

  • Infection
  • Blood clots
  • Excessive bleeding
  • Lung problems
  • Adverse anesthesia reactions
  • Malnutrition
  • Bowel obstruction
  • Acid reflux
  • Vomiting
  • Need for additional surgery
  • Ulcers
  • Gallstones
  • Hernias
  • Dumping syndrome

Following the procedure, the digestive system requires a healing period, during which patients are typically not permitted to eat for one or two days. Subsequently, they are advised to adhere to a specific diet and attend regular medical appointments for recovery monitoring. The extent of weight loss is influenced not only by the type of surgery but also by the patient’s commitment to their prescribed diet and exercise regimen. It’s noteworthy that some patients may shed half or even more of the excess weight within the initial two years. Beyond weight loss, many patients also witness improvements in conditions associated with obesity.

Bariatric surgery has its own risks and benefits, and the intervention isn’t for everyone, even if they are obese. To learn more about the requirements of the procedure and to learn more about the potential side effects, speak to a TopLine MD Alliance affiliated physician.