What You Need to Know About Bariatric Surgery

What is weight loss surgery?

Weight loss surgery, also known as bariatric surgery, refers to a variety of procedures that help you lose weight by making changes to your digestive system.

There are various types of bariatric surgery, including gastric bypass, sleeve gastrectomy, biliopancreatic diversion with duodenal switch (BPD/DS). These and more weight loss surgery procedures will be discussed later on in the article.

More and more people are looking to adopt healthy lifestyle habits, which include maintaining a healthy weight.

Being overweight or obese not only makes one uncomfortable, but it can also lead to type 2 diabetes, heart disease, stroke, and other health problems. Fortunately, there are various treatments for overweight and obesity, including:

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• Dietary changes
• Exercise and increased physical activity
• Behavior modification
• Prescription weight-loss medications such as Xenical (orlistat) and Saxenda (liraglutide)
• Weight loss surgery

You can also opt to use a weight loss diet plan to help you shade off some calories.

How effective is bariatric surgery for weight loss?

A study, published in the BMJ, suggested that for those that are obese, weight-loss surgery is more effective at reducing body weight in comparison to non-surgical methods.

Moreover, an article published in the Journal of Diabetes Science and Technology (JDST) stated that people who have bariatric surgery lose about 12% to 39% of their pre surgical body weight.

Is it safe to lose weight through weight loss surgery?

Surgical procedures usually carry risk, and weight loss surgery is no exception as it poses both short-term and long-term health risks and complications.

Risks and side effects may include:

• Bleeding
• Infection
• Leaks in the gastrointestinal system
• Adverse reactions to anesthesia
• Blood clots
• Diarrhea
• Death (rarely)

Depending on the type of weight loss surgery, the long-term risks and complications may include:

• Gallstones
• Bowel obstruction
• Dumping syndrome, a condition whose symptoms include nausea and diarrhea
• Hernias
• Malnutrition
• Low-blood sugar
• Stomach perforation

Is bariatric surgery or weight loss surgery reversible?

Depending on the type, weight loss surgery is either reversible, nonreversible, or difficult to reverse.

For instance, an adjustable gastric band is reversible, whereas sleeve gastrectomy is nonreversible. Be sure to talk to your doctor to know the specifics of each type of weight loss surgery.

Types of bariatric surgery

The most common bariatric surgical procedures are adjustable gastric band, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. Each surgery has its pros and cons.

Gastric bypass

Gastric bypass, also called Roux-en-Y gastric bypass, reduces the size of your stomach so that you eat less and feel full quicker.

It reroutes the food stream by having food bypass most of your stomach and the lower part of your small intestine. The procedure involves two steps:

Making your stomach smaller: your surgeon first staples your stomach to create a small pouch. The pouch is about the size of a walnut and holds about 1 ounce (oz) of food.

Creating a bypass: your surgeon then cuts your small intestine and attaches the bottom end of it to the pouch.

The food you consume will now bypass most of your stomach and the top portion of your small intestine, resulting in your body absorbing fewer calories.

Pros

• Results in significant weight loss, 60% to 80% excess weight loss
• Produces changes in gut hormones that may promote satiety and suppress hunger
• No foreign objects placed in your body
• Maintenance of over 50% excess weight loss

Cons

• Difficult to reverse
• Higher chance of surgery-related complications than gastric band
• Could lead to vitamin/mineral deficiencies especially deficits in vitamin B12, iron, calcium, and folate
• Requires dietary and follow up compliance plus life-long vitamin/mineral supplementation

Sleeve gastrectomy

In sleeve gastrectomy, also known as vertical sleeve gastrectomy, about 80% of your stomach is removed, leaving a tube-shaped section that resembles a banana.

The procedure works by reducing the amount of food that your stomach can hold hence making you feel full with less food.

Additionally, it affects gut hormones and other factors such as gut bacteria that may impact appetite and metabolism.

Pros

• Significantly reduces the amount of food that can fit in your stomach
• Results in rapid and significant weight loss, over 50% in 3-5+ years
• No changes to your intestines and no foreign objects placed in your body
• Requires a short hospital stay of about two days

Cons

• Is non-reversible
• Can cause long-term vitamin deficiencies
• Higher complication rates than those of adjustable gastric band
• Can cause acid reflux

Adjustable Gastric Band

In this weight loss surgery, a surgeon places a ring with an inner inflatable band around the upper section of your stomach, creating a small stomach pouch that limits the amount of food you can eat.

You, therefore, feel full after eating a small amount of food. The size of the opening between the pouch and the rest of your stomach can be adjusted to either restrict more or less food.

A surgeon does this by filling or emptying the band with a salt solution, which is injected or removed through a port placed under your skin.

The Food and Drug Administration (FDA) approved the use of the gastric band for people with a BMI of 30 to 34.9 who have obesity-related medical conditions such as heart disease or diabetes.

Pros

• Is reversible and adjustable
• Causes excess weight loss of about 40% to 50%
• Involves no cutting of the stomach or rerouting of the intestines
• Has the lowest rate of postoperative complications and mortality compared to other weight-loss surgeries
• Has the lowest risk for vitamin/mineral deficiencies
• Short hospital stay, usually less than 24 hours

Cons

• Less weight loss than other bariatric surgical procedures
• Regular follow-up visits to adjust the band
• Requires a foreign object to remain in your body
• Demands strict adherence to the postoperative diet
• Has the highest rate of reoperation due to issues such as band slippage, band erosion, et cetera

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

BPD/DS, otherwise duodenal switch, is a type of gastric bypass involving two separate surgeries.

The first surgery is similar to sleeve gastrectomy while the second procedure reroutes food to bypass most of the small intestine (roughly three-fourths).

The bypassed section of the small intestine is reconnected to the last portion of the small intestine, allowing bile and pancreatic enzymes to mix with the food stream.

BPD/DS significantly reduces the absorption of calories, vitamins, and nutrients (particularly protein and fat).

It is the most effective surgery for weight loss compared to those discussed in this article. However, it is also the riskiest. As a result, surgeons do not often perform it.

Pros

• Causes more weight loss than roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric band, 60% to 70% (or more) excess weight loss
• Is the most effective surgery for the treatment of diabetes among the procedures we’ve discussed
• Patients are eventually able to eat near-normal food amounts
• Improves satiety and reduces appetite by causing favorable changes in gut hormones
• Reduces the absorption of fat by 70% or more

Cons

• Has a higher risk of surgery-related problems and mortality than the others
• Requires a longer hospital stay than sleeve gastrectomy and adjustable gastric band
• Is highly likely to cause protein, vitamin, and mineral deficiencies
• Requires strict adherence to dietary and vitamin supplementation guidelines and follow-up compliance

Note, the term “laparoscopic” in laparoscopic sleeve gastrectomy, laparoscopic gastric bypass, and the like usually means that the weight loss surgery is performed using a laparoscope.

An intragastric balloon, though less common, is another weight-loss procedure worth mentioning.

It involves placing a silicone balloon in your stomach through a catheter and filling it with saline. It works by limiting how much you eat and making you feel full sooner.

The procedure takes about 30 minutes. Patients can expect about a 10% to 15% of body weight loss in the first six months. Health insurance usually doesn’t cover the cost for placing and removing an intragastric balloon.

Benefits of having bariatric surgery

You may consider bariatric surgery as an option if:

• You’re severely obese, meaning your body mass index (BMI) is 40 and above. One is said to have a healthy weight if their BMI is between 18.5 and 24.9.
• You have a BMI of 35 to 39.9 and a serious health problem linked to obesity, such as type 2 diabetes or heart disease.
• You have a serious weight-related health problem and a BMI of between 30 to 34.9, for the gastric band only.

However, not everyone that falls in these categories qualifies for weight loss surgery. You may require to meet several medical guidelines to qualify and must be willing to make healthy lifestyle changes.

You may also be required to participate in long-term follow-up plans that include monitoring your nutrition and medical conditions if any.

Besides helping you lose weight, bariatric surgery may also improve or resolve many health problems related to being overweight or obese, such as:

• Type 2 diabetes
• Heart disease
• High blood pressure
• Heart attack
• Sleep apnea
• Stroke
• Osteoarthritis
• Kidney disease
• Fatty liver disease

How much does bariatric surgery cost?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the average cost of weight loss surgery is $15,000 to $25,000. How much you pay for weight loss surgery will depend on various factors, including:

• The type of surgery you have
• Your location
• Your surgeon’s expertise
• The hospital you choose, costs may include personnel, operating room, medical device, and overhead costs

Under the Affordable Care Act, some states require health insurers to cover bariatric surgery.

The insurance company may require proof that the surgery is medically necessary, a recognized surgeon perform it a recognized medical facility, or other requirements.

For more information about bariatric surgery coverage, check with your health insurance company or your regional Medicare or Medicaid office.

What to expect before weight loss surgery

You will meet with various health care providers before surgery. These will include:

• A doctor: asks you about your medical history, performs a thorough physical exam, orders blood tests, and other tests to ensure you are healthy enough for surgery. If you smoke, you will likely be asked to stop at least six weeks before the surgery.
• A surgeon: tells you how to prepare for surgery, what happens during, the risks involved, and the follow-up needed.
• A dietitian: explains what and how much you will be able to eat and drink after surgery and helps you prepare for these dietary changes.
• A psychiatrist/psychologist: assesses whether you’re mentally and emotionally prepared to undergo bariatric surgery.

What to expect during weight loss surgery

On the day of the surgery, make sure to arrive on time and follow the eating and drinking before surgery instructions.

Weight loss surgery usually takes place in a hospital. And you’re normally under general anesthesia during the procedure, which means you don’t feel pain because you’re completely unconscious.

The specifics of your weight loss surgery will depend on the type, your surgeon’s practices, and individual factors.

Bariatric surgery is done in two ways:

• Open surgery: where your surgeon makes a large surgical cut in your abdomen.
• Laparoscopically: your surgeon uses a laparoscope, a long, thin, tubular instrument with a high-resolution camera at the front. The surgeon inserts the laparoscope through small incisions in the belly. The camera is connected to a video monitor, allowing your surgeon to view inside your belly while operating.

Laparoscopy has various advantages over open surgery, including a shorter hospital stay, quicker recovery, less pain, smaller scars, and lower risk of infection.

It is, however, not suitable for everyone. Following surgery, which usually takes several hours, you’re immediately moved from the operating room to a recovery room for monitoring.

What to expect after weight loss surgery

Patients spend an average of 2 to 5 days in the hospital following weight loss surgery, or longer if complications develop.

During your hospital stay:

• You will be asked to sit up, stand at your bedside, and walk a little on the same day you have surgery.
• Your doctors and nurses will help manage your pain through pain medication, administered intravenously or orally, once you’re able to tolerate fluids.
• Your nurses will teach you how to cough and take deep breaths. Coughing and deep breathing helps prevent pneumonia.
• You may be asked to wear compression stockings on your legs to help prevent blood clots from forming.

Your doctor will discharge you based on your progress, which includes eating liquid or pureed food without vomiting and moving around without a lot of pain. Recovery at home will involve following the dietary and physical activity instructions given by your medical team.

Follow-up appointments are also essential as they ensure that you are recovering well and that there are no potential complications. To ensure the weight loss surgery is successful, follow the recommended lifestyle changes.