Best Weight Loss Surgery: What Is the Best Weight Loss Surgery?
Weight loss surgery, also known as bariatric surgery or metabolic surgery, involves procedures that modify the digestive system and/or appetite to promote weight loss.
Obesity, a chronic medical condition that poses significant health risks, necessitates long-term management.
Various medications, devices, and surgeries are available to assist in achieving weight loss.
You might be eligible for weight loss surgery if:
- You are obese, with a body mass index (BMI) of 30 or higher, and have a weight-related health condition such as uncontrolled type 2 diabetes despite optimal treatments.
- Your BMI exceeds 35, even in the absence of other weight-related conditions.
- You are aware of the risks and benefits involved.
- You are willing to adapt your eating habits following the surgery.
- You are committed to making lifestyle changes to sustain weight loss.
Weight loss surgery involves more than just weight loss.
It can contribute to a longer, higher quality of life by addressing and preventing obesity-related conditions such as:
- Heart disease
- High blood pressure
- Diabetes
- Arthritis
- Certain cancers
Before undergoing weight loss surgery, you will undergo a screening process.
Your doctor will assess your physical and emotional well-being and decide on your readiness to embrace permanent lifestyle changes.
Screening for eating disorders, depression, and substance use disorder may also be part of the evaluation.
If you are contemplating metabolic/bariatric weight loss surgery, consult your doctor to determine if it is a suitable option for you.
Without further ado, let’s take a look at the pros and cons of the six best weight loss surgeries.
1. Adjustable Gastric Banding for Weight Loss
Definition
Adjustable gastric banding is a form of weight loss surgery that operates on the principle of restriction.
Mechanism
During the procedure, an inflatable band is utilised by the surgeon to divide the stomach into two parts: a smaller upper pouch and a larger lower section.
These sections remain connected through a narrow channel, slowing down the emptying process of the upper pouch.
Most individuals experience a feeling of fullness or discomfort after consuming only half a cup to one cup of food.
Additionally, the food needs to be soft or well-chewed.
Advantages
This surgery is comparatively simpler and safer than gastric bypass and other procedures.
It results in a smaller incision, typically leads to faster recovery, and offers the option to remove the band surgically if necessary.
By injecting more saline solution into the band, the doctor can tighten it and further restrict the size of the stomach.
Conversely, to loosen the band, the doctor uses a needle to remove liquid from it.
Disadvantages
Individuals who undergo gastric banding often experience less dramatic and slower weight loss compared to those who opt for other surgical procedures.
Over time, they may have a higher likelihood of regaining some weight.
Risks
Vomiting after consuming excessive amounts of food too quickly is one of the most common side effects of gastric banding.
The band can potentially slip out of place, become too loose, or develop leaks.
Like any surgical intervention, there is a risk of infection, albeit low.
Although rare, certain complications can be life-threatening.
2. Sleeve Gastrectomy for Weight Loss
Definition
Sleeve gastrectomy, also known as vertical gastric sleeve surgery (VSG surgery), is a type of weight loss surgery that primarily operates through restriction.
Procedure
During the surgery, approximately 80% of the stomach is surgically removed, leaving behind a narrow tube or sleeve that connects to the intestines.
This removal of a section of the stomach responsible for producing hunger-inducing hormones also helps to reduce appetite.
Advantages
Sleeve gastrectomy is a straightforward and safe procedure that offers a lower-risk approach to weight loss.
After losing weight and experiencing improved health, typically within 12-18 months, a second surgery, such as gastric bypass, can be considered if necessary.
Since the procedure does not affect the intestines, it does not significantly alter the body’s ability to absorb nutrients, reducing the risk of nutritional deficiencies.
Disadvantages
Unlike gastric banding, sleeve gastrectomy is an irreversible procedure.
Risks
Common risks associated with sleeve gastrectomy include infection, sleeve leakage, and heartburn or reflux.
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3. Gastric Bypass Surgery for Weight Loss
Definition
Gastric bypass surgery employs a combination of restrictive and malabsorptive techniques.
Procedure
During the operation, the surgeon divides the stomach into two sections, effectively sealing off the upper portion from the lower.
Subsequently, the upper stomach is directly connected to the lower section of the small intestine.
Essentially, this creates a shortcut for food, bypassing a segment of the stomach and small intestine, resulting in reduced calorie absorption by the body.
Advantages
Gastric bypass surgery often leads to rapid and significant weight loss, with approximately 50% occurring within the initial 6 months, and the weight loss continuing for up to 2 years following the procedure.
Additionally, many obesity-related conditions, such as diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, and heartburn, tend to improve quickly due to swift weight loss.
Long-term studies have shown that a substantial number of individuals successfully maintain most of the weight loss for 10 years or longer.
Disadvantages
The altered digestive process following gastric bypass surgery may result in a reduced ability to absorb food, which puts individuals at risk of inadequate nutrient intake and potential vitamin and mineral deficiencies.
Calcium and iron loss could lead to conditions like osteoporosis and anaemia.
It becomes crucial to closely monitor the diet and take supplements for the rest of one’s life.
Related Concerns
Dumping syndrome is another risk associated with gastric bypass, where food moves too quickly from the stomach to the intestines without proper digestion.
Around 85% of individuals who undergo gastric bypass experience some degree of dumping.
Symptoms may include nausea, bloating, pain, sweating, weakness, and diarrhoea.
Unlike adjustable gastric banding, gastric bypass surgery is typically considered irreversible, although rare cases of reversals have been reported.
Risks
Gastric bypass surgery is a more complex procedure, making it inherently riskier.
Infection and blood clots are potential risks, similar to most surgeries.
Rapid weight loss may also increase the likelihood of developing gallstones.
4. Biliopancreatic Diversion for Weight Loss
Definition
Biliopancreatic diversion is a more extreme variant of gastric bypass surgery.
The procedure involves removing up to 70% of the stomach and bypassing approximately 75% of the small intestine.
A Less Extreme Version
Biliopancreatic diversion with a duodenal switch, also known as “the duodenal switch,” offers a somewhat less invasive approach compared to biliopancreatic diversion without the switch.
This procedure involves removing a smaller portion of the stomach and bypassing a smaller segment of the small intestine.
As a result, it reduces the occurrence of dumping syndrome, malnutrition, and ulcers compared to standard biliopancreatic diversion.
Advantages
Biliopancreatic diversion can lead to even greater and faster weight loss compared to gastric bypass surgery.
Although a significant portion of the stomach is removed, the remaining portion is larger than the pouches formed in gastric bypass or banding procedures.
This allows for the potential to consume larger meals.
Additionally, the procedure influences intestinal hormones in a way that reduces hunger, promotes satiety, and improves blood sugar control.
Disadvantages
Biliopancreatic diversion is less commonly performed than gastric bypass because of the increased risk of inadequate nutrient intake, which is a more serious concern with this procedure.
It shares many of the risks associated with gastric bypass, including the potential for vitamin and mineral deficiencies and dumping syndrome.
However, the duodenal switch may mitigate some of these risks.
Risks
Biliopancreatic diversion is one of the most complex and high-risk weight loss surgeries.
Similar to gastric bypass, there is a considerable risk of hernias, which may require additional corrective surgery.
5. Single Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy for Weight Loss
Definition
SADI-S is a simplified version of the duodenal switch procedure.
It combines aspects of restrictive and malabsorptive techniques, involving a sleeve gastrectomy followed by a bypass of the small intestine.
Procedure
The surgeon initiates the process by creating a narrow gastric sleeve, removing approximately 80% of the stomach.
Subsequently, a portion of the small intestine is rerouted, establishing two pathways.
One pathway transports food from the stomach to the bowel, while the other allows bile to flow from the liver into the small intestine.
Benefits
SADI-S offers a simpler and safer alternative to the traditional duodenal switch procedure.
It presents fewer complications compared to conventional bypass surgeries while resulting in greater weight loss and improved diabetes management.
Since it involves removing less of the intestine than other bariatric surgeries, the body retains more nutrients.
Drawbacks
Lifelong monitoring of diet and nutritional supplementation becomes necessary.
Increased frequency of bowel movements and heightened flatulence may be experienced.
Risks
The risks associated with SADI-S, such as bleeding, nausea, and leaks at the surgical connection sites, are similar to those of other weight loss procedures.
Reversing the sleeve gastrectomy is not possible, in addition to the fact that this is a newer procedure, which means long-term outcomes are not extensively documented.
6. Weight Loss Devices: Alternative Approaches to Weight Loss
Gastric Balloon and Vagal Blockade are non-surgical methods utilised to aid weight loss.
Although they are not classified as weight loss surgeries, these devices are implanted or placed in the body under medical supervision to facilitate weight reduction.
Gastric Balloon for Weight Loss
The intragastric balloon involves a restrictive procedure where a deflated balloon is inserted into the stomach through the mouth.
It is then filled with saline solution, creating a feeling of fullness and reducing hunger.
Benefits
No surgical intervention is required, eliminating the need for a hospital stay.
The balloon is temporary, remaining in place for six months, during which approximately 10% of excess body weight can be lost.
Drawbacks
Potential stomach-ache, nausea, and vomiting a few days after balloon placement.
Risks
The FDA has reported rare cases of complications associated with intragastric balloons, including potential perforation of the stomach or oesophagus, intestinal blockage, spontaneous over inflation of the balloon, and pancreatitis caused by pressure on surrounding organs.
Vagal Blockade (or vBloc) for Weight Loss
Vagal Blockade (or vBloc) involves the implantation of a pacemaker-like device that emits regular electrical impulses to the valgus nerve, signalling the brain that the stomach is full.
The device is positioned beneath the rib cage and can be adjusted externally using a remote control.
Benefits
The device implantation procedure is non-invasive, typically performed on an outpatient basis under general anaesthesia.
Drawbacks
In the event of complete battery drainage, reprogramming by a doctor is necessary.
Side effects may include nausea, vomiting, heartburn, swallowing difficulties, belching, mild nausea, and chest pain.
Risks
Possible infection or pain at the site of implantation. However, serious complications associated with the device are rare.
Note: The American Society of Metabolic and Bariatric Surgery (ASMBS) does not endorse vagal blockade.
Therefore, medical centres accredited by the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) must obtain institutional review board (IRB) approval prior to device implantation.
Choosing the Best Weight Loss Surgery
The most suitable weight loss surgery depends on individual health and body type. Complex surgeries may not be viable options for individuals with severe obesity or prior abdominal surgeries.
Consultation with a doctor is vitally important to weigh up both the pros and cons of each procedure.
Prioritise doctors and surgeons with ample experience in the specific procedure you require.
Thanks for checking out this article on the best weight loss surgery.
That’s all for today.
Speak soon.
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