Bariatric Surgery
Bariatric surgery refers to a group of surgical procedures designed to help people with obesity lose weight. Bariatric surgeries are sometimes also called weight loss surgeries. Healthcare professionals tend only to suggest bariatric surgery as an option if other methods of weight loss have been unsuccessful.
Candidates for bariatric surgery generally either have a BMI of 40 or over, or 35 to 39.9 plus an obesity-related condition like diabetes or heart disease. Most types of bariatric surgery can be performed laparoscopically, which is a minimally invasive technique using smaller incisions and smaller tools than traditional open surgery. This may cut down on the rate of post-op complications and shorten recovery time.
Weight loss surgery isn’t for everyone, and it’s important to discuss the possible risks with your doctor. Your insurance company may have specific requirements, such as proof of trying other methods first. Continued weight loss — and eventually maintenance — may be achieved when surgery is combined with diet and lifestyle changes.
Here are some of your surgical obesity treatment options.
Sleeve Gastrectomy
According to the American Society for Metabolic and Bariatric Surgery (ASMBS), sleeve gastrectomy is the most popular type of bariatric surgery by far, with more than 160,000 procedures performed in 2022.
WIth a sleeve gastrectomy, a surgeon will remove approximately 80 percent of your stomach. What’s left over is roughly the size and shape of a banana. Not only can your stomach now hold less food, which makes you less likely to overeat, the portion removed also makes the majority of ghrelin. Ghrelin is a hormone that signals to your brain that your body needs food.
After five years, you can expect to have lost up to 60 percent of your excess weight (approximately 20 percent of your starting body weight). Complications rates are generally low but can include surgical site infection, leakage, and internal bleeding.
Some centers are now performing sleeve gastrectomy endoscopically (through a scope, rather than with incisions). This procedure leads to weight loss that is somewhat less than with surgical sleeve gastrectomy (approximately 15 percent of starting body weight after five years). But most insurance plans do not cover endoscopic sleeve gastrectomy.
Roux-en-Y Gastric Bypass
Gastric bypass (also known by the French phrase Roux-en-Y) is the second most popular form of bariatric surgery.
This operation reduces the size of your stomach (even smaller than a sleeve gastrectomy) and reroutes your gastrointestinal tract to skip most of the stomach and the first half of the small intestine. This means that fewer calories are both consumed and absorbed.
You can lose 70 percent or more of your excess weight within two years of gastric bypass (approximately 25 percent of starting body weight). Complications mirror that of sleeve gastrectomy, with the addition of possible long-term risk of bowel obstruction and dumping syndrome (when food moves too quickly through your GI tract).
Biliopancreatic Diversion With Duodenal Shift (BPD-DS)
BPD-DS is a more aggressive procedure in which a sleeve gastrectomy is combined with a more extensive bypass of the small intestine. It is sometimes done in one operation and sometimes done in two separate operations. It carries a higher risk of nutrient malabsorption because of the longer bypass in the small intestine. It produces the largest weight loss on average but also comes with the highest risk of nutrient deficiency.
Because of its technical difficulty, BPD-DS is performed in fewer centers than sleeve gastrectomy or gastric bypass. It’s usually reserved for people with very high BMI. Surgical complications are similar in rate and nature to gastric bypass.
Gastric Balloon
The gastric balloon is one option for people needing to lose weight before they can safely undergo a permanent bariatric procedure (sleeve, bypass, or BPD-DS). A surgeon uses a long, flexible tool called an endoscope to place a balloon into your stomach, which is then filled with saline or air. It takes up room in your stomach, which keeps you from eating too much. After you’ve lost the weight you want to lose, you have the balloon removed. The balloon is not a long-term solution for obesity treatment because it has to be removed. It should be viewed as a step toward another treatment modality (medication or surgery).
Complications are generally mild, and may include nausea, stomach pain, constipation, and acid reflux. A gastric balloon is generally not covered by insurance.