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What is the Safest Form of Weight Loss Surgery?

For people living with chronic or severe obesity, the decision to finally go through with weight loss surgery can bring about an enormous turning point in their lives. By taking the action necessary to initiate the major weight loss they need in the form of weight loss surgery, patients initiate positive changes to the overall health that will pay dividends for the rest of their lives.

To help you get a better understanding of their risks and benefits, this article will explain the main types and most common procedures in the field of bariatric surgery so that you can have an informed discussion with your doctor about what is the safest form of weight bariatric surgery for you.

The Health Risks of Obesity

Weight loss surgeries are part of bariatric medicine, the branch of medicine that deals with the study and treatment of obesity, which is why they are referred to as bariatric surgeries.

According to the American Society for Metabolic and Bariatric Surgery, bariatric surgery is the most effective and long-lasting treatment for severe obesity. Weight loss surgery helps resolve or prevent a variety of obesity-related conditions, including:

  • Type 2 diabetes

  • Coronary heart disease

  • Stroke

  • Gallbladder disease

  • Osteoarthritis

  • Sleep apnea and breathing problems

  • Many types of cancers

  • Low quality of life

  • Mental illness (clinical depression, anxiety, and other mental disorders)

  • Body pain and difficulty with physical functions

  • Hypertension (high blood pressure)

  • Fatty liver disease

  • Dyslipidemia (High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides)

Understanding Weight Loss Surgery

Overall, bariatric surgery significantly reduces a patient’s risk of premature death while having low rates of complications. Although there is a certain amount of risk inherent in any surgical procedure, bariatric surgeries have been widely performed for many years, and the data clearly shows that they are as safe as other commonly performed surgical procedures, like an appendectomy.

Types of Bariatric Surgery

Although they all have the same end goal - to help bring about major, lasting weight loss - each type of bariatric surgery affects the body differently.

Many different bariatric surgical procedures exist, falling into three broad categories: restrictive, malabsorptive or a combination of the two. In general, current weight loss surgery techniques are based on either a restrictive approach or a combined restrictive/malabsorptive approach.

Restrictive Procedures

These procedures reduce the volume of the stomach to limit the patient’s food intake and bring about weight loss. By reducing caloric intake and slowing digestion, restrictive bariatric procedures are highly effective at reducing body mass, with a very low risk of complications.

Restrictive/Malabsorptive Procedures

Certain bariatric surgical procedures use a restrictive technique while also bypassing part of the digestive system. Surgeries, such as a gastric bypass or duodenal switch, that use this combined approach simultaneously reduce caloric intake and constrain digestion by bringing ingestion further down the intestinal pathway.

Bariatric Surgery Options

The appropriate type of procedure depends on a number of factors, including the patient’s body mass index (BMI), medical history and health conditions, these are the most commonly performed and safest weight loss surgeries.

Laparoscopic Sleeve Gastrectomy

Also known as gastric sleeve surgery, this minimally invasive procedure is often the first step in bariatric surgical treatments. Through the use of a laparoscope (i.e. a small camera) and long surgical instruments inserted through small incisions, this surgery permanently removes part of the stomach to reduce the amount of food required to feel full.

This approach also has the added benefit of affecting the body’s normal satiety mechanism, so patients have a reduced appetite, which is another way it helps them lose weight.

Mini Gastric Bypass

This procedure is based on a combined restrictive/malabsorptive approach. It involves creating a small gastric pouch and re-routing parts of the intestine.

This procedure is an improvement on traditional gastric bypass surgery because it uses only on connection between the stomach and intestines, rather than two. This change results in less operative time and anesthesia, as well as a reduced risk of bowel obstruction.

Laparoscopic Roux-en-Y Gastric Bypass

This gastric bypass surgery also creates a small gastric pouch near the esophageal sphincter, but has some important differences from the mini gastric bypass.

With the Roux-en-Y surgery, the first part of the intestine is cut in two: the lower section (Roux limb) is attached to the newly-formed small pouch, and the upper section (Bilio-Pancreatic limb) is attached further down the Roux limb.

Digestive juices from the excluded stomach and Bilio-Pancreatic limb flow into the Roux limb, thus constraining digestion and ingestion further down the intestinal pathway.

Duodenal Switch

This surgery depends primarily on intestinal malabsorption, but also utilizes gastric reduction to achieve weight loss. Normally reserved for patients with a very high BMI, this procedure is normally performed in two independent stages for patients with a BMI above 60.

The first consists of a sleeve gastrectomy to remove part of the stomach, while the second divides and re-attaches parts of the small intestine. During the second stage, the lowest part of the intestines, the ileum, is divided from the rest. The upper part of the intestines, the duodenum, is also divided, leaving a small segment attached to the stomach and a longer free-hanging segment to which the liver and pancreas are attached.

The ileum is brought up and re-connected to the small segment of duodenum left attached to the stomach. The lower part of the free-hanging intestines is then connected to the ileum. The result is similar to the gastric bypass in that two intestinal limbs persist, one for food and the other for digestive juices.

Single-Anastomosis Duodenal Switch

This simplified version of the duodenal switch uses only one anastomosis between the stomach and the small intestines, rather than two like the traditional procedure. This creates a longer common channel for nutritional absorption and results in less frequent bowel movements, less side effects, and less vitamin deficiencies.

Gastric Balloon

This non-permanent out-patient procedure is the least invasive option, as it does not require incisions of any kind, so patients can leave the clinic on the same day it is performed. It uses an inflatable balloon to reduce the available space in the patient’s stomach.

The gastric balloon is an inflatable balloon that is placed into the stomach temporarily. The balloon is inserted by using a gastroscope (i.e. a thin, tube-like instrument) through the mouth under general anaesthesia. By reducing the volume of the stomach, patients feel full after having eaten a smaller amount of food. The balloon also delays the time it takes to empty the stomach, which allows for longer periods of time between meals. These two dynamics work together to effectively reduce appetite and caloric intake.

A gastric balloon is a great option to compliment a traditional weight loss program of diet and exercise to achieve lasting, long term results Many patients who are not good candidates for weight loss surgery, due to medical history or other health complications, choose this option.

What About Risks and Complications?

Collectively, bariatric surgeries are quite safe. Clinical evidence shows that the health risks of severe obesity greatly outweigh risks of this type of surgery for most patients.

As with any surgical procedure, there is a small risk of complications for weight loss surgeries that varies according to the patient’s profile and the type of procedure performed. Possible weight loss surgery complications include:

  • Abdominal pain, nausea, vomiting (immediately after procedure)

  • Leakage

  • Bleeding

  • Bowel obstruction

  • Ulcers

  • Need for conversion

  • Need for reversal or reoperation

On the whole, the mortality risk associated with bariatric surgery is about 0.1% and the overall likelihood of major complications is about 4%.

For specific information about your risks, consult your doctor for personalized medical advice.

Which Weight Loss Surgery is Right for You?

The type of bariatric surgery that’s right for you depends on several factors, including your current weight, medical history, health conditions, as well as your goals and expectations for the amount of weight you want to lose.

Talk with your doctor about these factors, so you can make a decision together about what is the safest form of weight loss surgery for you.