Common Types of Weight Loss Surgery Procedures
There are a few different types of weight loss surgery procedures that are common today. Some are only restrictive in nature, which means that a new, smaller stomach “pouch” is created and the exit of food from the stomach is limited (slowed gastric emptying), whereas others are also malabsorptive, which means that the surgery changes the way food is absorbed as it leaves the stomach and enters the small intestine, typically because part of the small intestine is re-routed or removed. Restrictive and malabsorptive procedures are both used to treat obesity and Some surgical procedures result in a more rapid loss of weight but may lead to more problems. Some operations are “open,” which means that they require a larger incision to be made in the abdomen; others can be performed laparoscopically, which involves the surgeon (who may be assisted by a robot in some facilities) operating with the assistance of a camera that is inserted through a much smaller incision; and still others can be performed either way. The laparoscopic adjustable-silicone gastric banding (lap-band) and the roux-en-Y gastric bypass are the operations that have been studied the most, are generally acknowledged by the medical community, and are performed the most frequently (RYGB).
Although many consider biliopancreatic diversion to be a procedure that is on the decrease due to the increased risks of complications and the more difficulty in performing the procedure technically, some surgeons still undertake the procedure.
Benefits and Risks
Each weight loss surgery comes with its own set of advantages and disadvantages. In the next section of this article, we will discuss the typical complications and nutritional deficits that are associated with each procedure. Even though it has significantly improved over the past several years, the quality of the research that has been done on surgical weight loss has, unfortunately, been subpar.
The Cochrane group released an updated review and analysis of all the literature to date on weight reduction surgery in 2005. The purpose of the study was to determine the effects of surgery for morbid obesity on medical disease, weight, and quality of life. The review and analysis were updated in 2005. This research found that just 26 studies out of 3,223 published references were of high enough quality to be utilized in their report, and according to the reviewers, the majority of these 26 studies still had a significant amount of bias. This does not imply that the publications are invalid; rather, it simply means that they are preliminary and frequently do not compare different surgical approaches to each other or to other weight loss methods. In addition, the researchers who wrote them did not use appropriate research procedures to “randomize” patients (which is necessary for comparing different approaches), and/or they did not follow patients for a long enough period of time (at least 12 months) to be able to detect long-term effects.
It does imply, however, that despite the significant amount of study that has been done on obesity surgery, there are many things that surgeons still do not know and need to learn, and you should take this reality into consideration. As with any other serious medical operation, there are dangers associated with this practice. However, given the nature of the area, it is possible that there are other hazards associated with this practice that are not yet acknowledged by the medical community. Be careful to give this issue a lot of thought before making a choice, and talk about it with the people who are treating you.
Part 1 Surgical Procedures (Restrictive Procedures)
Vertical Banded Gastroplasty (VBG)
A line of staples is used in this technique to split the stomach, which results in the creation of a considerably smaller gastric pouch that is only capable of holding around an ounce of food. The diameter of the opening at the bottom of the new pouch is approximately 1012 millimeters. This opening drains into a portion of the stomach, which subsequently, as was said before, discharges its contents into the small intestine. In most cases, the surgeon will fortify the outlet by stitching mesh or Gore-Tex into it. The VBG operation can either be carried out using an open incision or through laparoscopic techniques.
Siliastic-Ring Vertical Gastroplasty
A modification of the gastroplasty that was discussed before. This time, a series of staples are used to create a tiny gastric pouch by dividing the stomach into two halves. As was described above, this treatment involves reinforcing the new, narrower outlet of the new gastric pouch with a silicone band in order to establish a narrow exit into the stomach. This surgery is described in more depth above.
Laparoscopic Adjustable Silicone Gastric Banding (LASGB or lap-band)
In 2001, the Food and Drug Administration of the United States gave its blessing to the weight loss surgery that is often referred to as the lapband. As the name suggests, it can only be carried out using a laparoscopic technique. In this procedure, similar to the gastroplasty, staples are used to form a new gastric pouch; however, unlike the gastroplasty, the band that surrounds the outlet from the new pouch into the stomach is adjustable. This is possible because the band is connected to a reservoir that is implanted under the skin. The surgeon can alter the tightness of the band and the size of the gastric outlet in an outpatient environment by injecting saline into the reservoir or withdrawing it from the reservoir and replacing it with a different amount of saline.
Surgical Procedures (Restrictive Malabsorptive)
Roux-en-Y Gastric Bypass (RYGB)
The RYGB is the operation that is performed the most frequently. It includes either stapling or dividing the stomach in order to create a tiny gastric pouch that is between V3 and 1 ounce in capacity. This pouch drains via a tiny opening into the jejunum, which is located in the middle of the small intestine. By doing so, it avoids the duodenum, which is the section of the small intestine that food typically travels through on its route to the jejunum. The more mature section of the stomach is no longer used, although it continues to have its typical connection to the duodenum and the first half of the jejunum. After this, the terminal end of the jejunum is connected to the “new small intestine” that was generated by the method described in the previous paragraph. This results in the formation of the letter “Y,” which is referenced in the name of the weight loss surgery. This rerouting of the small intestine into a different pathway is a malabsorptive characteristic that works in conjunction with the restrictive feature of the smaller gastric pouch. The RYGB procedure can either be done using an open incision or through a laparoscopic incision.
Biliopancreatic Diversion (BPD)
Because of its higher perceived technical difficulty, this operation is performed on a much more seldom basis. In this weight loss surgery, the stomach is removed in what is known as a “subtotal” gastrectomy, which means that the patient is left with a significantly bigger gastric pouch than in the other choices. At the level of the ileum, which is the third and last segment of the small intestine, the small intestine is separated, and then the ileum is attached directly to this midsize gastric pouch. When this is complete, the remaining portion of the small intestine is linked to the ileum as well. Due to the fact that this treatment circumvents a portion of the stomach as well as the entirety of the duodenum and jejunum, there is only a little portion of the small intestine that is utilized for absorption.
Biliopancreatic Diversion with Duodenal Switch (BPDDS)
BPDDS is a variation of BPD. The initial piece of the duodenum, which is the first section of the small intestine, is preserved as a result of this weight loss surgery.
Large sections of the small intestine are bypassed during this operation; however, because to the high risk of complications and death associated with the weight loss surgery, it is no longer advised in the United States or Europe.
In a similar vein, you should think twice before putting your faith in a doctor who makes the concept of obesity surgery sound like it is either nothing to worry about or your sole choice, as this is not a fair conclusion to take from the information that we have. If you have suffered for years from poor health, poor quality of life, low self-esteem, and social stigmatization due to extreme obesity and have made multiple unsuccessful attempts to lose weight using other methods, surgery may be an option for you. This is especially true if you have tried multiple times to lose weight using other methods. When weighing the potential advantages of bariatric surgery against the potential hazards, a skilled and experienced surgeon will be the first to recognize that there are risks associated with the procedure. These concerns should be taken into consideration along with the potential benefits.
To begin, it is essential not to forget that this is a surgical treatment that will be performed while the patient is under the influence of general anesthesia. As such, it unquestionably poses the possibility of a number of problems, one of which is even death. The patient’s age, overall health, and weight, as well as the weight loss surgery that is being performed, all have a role in the likelihood of each risk. Patients who are morbidly obese are considered to be “high-risk” patients when it comes to undergoing surgery. This is due to the fact that a higher dose of anesthesia is required, the procedure itself is more difficult to carry out, and the patients’ overall health is frequently poor, which increases the likelihood of potential complications.
On the other hand, information obtained from the International Bariatric Surgery Registry, which is a registry that has information on more than 10,000 patients, showed a 30-day death rate of 0.3%. According to the findings of other published research, the death rate thirty days after treatment ranges anywhere from 0.2 percent to 1.9 percent. A one-year death rate of 4.6 percent was found in a study of Medicare recipients, who are regarded to have possibly worse overall health than the general population. The 30-day mortality rate was found to be 2.0 percent. Mortality rates are greater in elderly patients, particularly in those who are older than 65 when they undergo surgery.
The level of experience that your surgeon possesses has a significant bearing on both the mortality rate and the rate of subsequent hospitalization in the years that follow an operation. Studies have shown that there is a clear connection between the surgeon’s workload (the number of bariatric procedures that he or she conducts on a regular basis, which often also reflects their degree of expertise) and reduced rates of death and readmission after surgery. You need to choose a surgeon who is not just board qualified in surgery but also a member of the American Society for Bariatric Surgery (ASBS).