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Bariatric Surgery

Choosing a Bariatric Surgery Procedure

What is bariatric surgery?

Bariatric surgery is a type of surgery to help you lose weight. It is an option for some people who are obese and have not been able to lose weight with other methods. Your doctor might discuss bariatric surgery with you if you are obese, or if you are overweight and have a medical problem such as diabetes. Diabetes and certain other medical problems can get better with weight loss.

Surgeons do bariatric surgery using a number of different methods. The type of bariatric surgery that works best for you will depend on several factors. These include your general health, your medical needs, and your own preference.

What types of bariatric surgeries are available?

The most common types of bariatric surgery are lap banding, gastric bypass, and sleeve gastrectomy.

Lap banding is also known as laparoscopic adjustable gastric banding or LAGB. During lap banding your surgeon places an adjustable band around the top of your stomach. Your surgeon also places a small device called a port under the skin of your abdomen. A thin tube leads from the band to the port. Fluid is injected into the port and flows to the band to make it squeeze tighter around the top of the stomach. Or, fluid can be removed through the port to loosen the band. The band around your stomach reduces the amount of food that you can eat at one time.

Gastric bypass is another common type of bariatric surgery. It's also called a Roux-en-Y gastric bypass. This surgery also reduces the amount of food you can eat at one time. And it reduces the number of calories and nutrients you can absorb from the foods you eat. During gastric bypass, your surgeon separates part of the stomach to create a small pouch. The pouch is then attached to a part of your small intestine. This small pouch holds less food, making you feel full faster. As food bypasses the rest of the stomach and upper part of your small intestine, you absorb fewer calories and nutrients.

A sleeve gastrectomy is a type of surgery that removes up to 85% of the stomach. It's also known as a gastric sleeve. The surgery turns the stomach into a narrow tube that looks like a sleeve. The sleeve holds much less food, and you feel full faster. Your stomach also makes less of the main hormone that causes hunger.

A less common type of weight-loss surgery is called biliopancreatic diversion with duodenal switch (BPD/DS). In this procedure, your surgeon removes part of the stomach to create a gastric sleeve, as with the sleeve gastrectomy. The sleeve is then attached to a part of the lower small intestine. The sleeve holds much less food, and your body absorbs far fewer calories and nutrients from food.

Surgeons can do most of these types of surgeries as minimally invasive procedures. This is also known as laparoscopic surgery. This type of surgery is done with small incisions, a tiny camera, and small tools. Talk with your doctor to see if this type of surgery is best for you.

Surgeons may also do other rare types of weight-loss surgery. Your doctor can tell you more if one of these procedures might be right for you.

What are the advantages and disadvantages of each type of bariatric surgery?

Lap banding is a more simple surgery. After lap band surgery, it is fairly easy to loosen or tighten the band. A tighter band might help you feel fuller sooner. This might help you lose weight more quickly. If you have lap banding, your risk of serious complications right after your surgery is low. But you may be more likely to need a follow-up surgery. This surgery can lead to loss of about half of a person's excess body weight after 2 years.

Lap banding might not be right for you if you think you'll have a hard time following a nutritional program. For example, if you drink a lot of high-calorie liquids, the lap band may not help you lose weight. You might also need to see your surgeon more often after this procedure.

Gastric bypass is a more complex surgery than lap banding. For this reason, it has an increased risk of complications. You are also more likely to have problems with nutritional deficiency. A gastric bypass tends to be a very successful surgery. It can lead to loss of about two-thirds of a person's excess body weight after 2 years.

A gastric sleeve is less complex than a gastric bypass. Because of this, it may lead to fewer complications. It may also be better at controlling hunger than lap banding. The surgery can lead to loss of about two-thirds of a person's excess body weight after 2 years.

A BPD/DS procedure may be most helpful for a person who is extremely obese. It can also be an option for people haven't had much success with other weight loss surgery. It has a higher risk of some complications than other weight-loss surgery. However, it also causes the most weight loss.

What are the risks of bariatric surgery?

All surgery has risks. Your risks may vary according to your general health, your age, the type of surgery you choose, and the amount of weight you need to lose. Talk to your doctor about the risks that most apply to you. Risks of bariatric surgery include:

  • Bleeding

  • Infection

  • Blockage of your bowels (intestinal blockage)

  • Blood clots in your legs

  • Heart attack

  • Need for follow-up surgery

  • Gallstones (a later complication)

  • Nutritional deficiencies (a later complication)

  • Psychological difficulties after the procedure

There is also a risk that your surgery will not help you permanently lose much weight.

How does surgery compare with medical treatment?

People who get surgery tend to lose much more weight than people who get medical therapy for their weight loss. This means that surgery is more likely to help with medical conditions linked to obesity, such as diabetes or sleep apnea. But the results do vary. Some people can have large weight loss with medical therapy alone. And some people do not lose as much weight as they want after surgery.

What should I look for in a bariatric surgery program?

Look for an accredited surgery center with a support staff. Support staff should include a dietician, counselor, and nurses who have had a lot of experience in weight loss surgery. Your doctor should be board certified. The center should also provide you with an education program. The program is to help prepare you for life after surgery. This is very important to help ensure good results after surgery. The program may take weeks or months. And it should provide long-term follow-up.

How will I need to manage my condition after surgery?

For the rest of your life, you need to work with your health care providers to stay healthy. Your medical team will keep track of your health, especially as you lose weight quickly in the first 6 months or so after your surgery. Weight loss tends to be at its peak around a year after surgery.

You will get instructions about how to adapt to your new diet after your surgery. You will likely be on liquid nutrition for a few weeks after surgery. Over time, you'll start to eat soft foods and then solid foods. If you eat too much or too quickly, you may have abdominal pain or vomiting. You'll learn how to know when your new stomach is full.

Your doctor will give you more instructions about your diet. These may vary depending on the type of surgery you had. You'll need to learn good habits like choosing healthy foods and not skipping meals. Your doctor or nutritionist may also need to screen you for low levels of certain nutrients. This is more of a problem with gastric band, gastric bypass, and with BPD/DS surgery.

It's important to have sensible goals about what bariatric surgery might achieve for you. Most people will still be somewhat overweight a year or two after their surgery. Even if you don't lose all of your excess weight, medical issues such as high blood pressure should get better. You may be able to reduce the amount of medications that you need to take. 

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