Weight Loss Surgery Basics

There is a lot of information surrounding weight loss surgery that you need to know before, after and during the procedure. By having all the information you can gather ahead of time, the better prepared you can be and the amount of questions or surprises you come across will be reduced.

In preparation for your bariatric surgery you will need to understand what the pre-op procedures consist of including what tests and consultations you should expect. After your surgery you should be prepared for a new diet, a consistent exercise routine and a drastic change in your body rather quickly.

Types of Bariatric Surgery

There are a number of different bariatric surgery procedures and how they go about helping you achieve weight loss. Each one has its own advantages and disadvantages. Depending on your specific situation and needs your choice in procedure may differ from someone else and what meets their needs. Your doctor can review your situation and the options with you to determine the best route for you to take.

Restrictive Bariatric Surgery Procedures

Restrictive bariatric surgery works by physically reducing the size of the stomach and lowering the amount of food that you are able to take in. Food intake is restricted by creating a small pouch at the top of the stomach where the food enters. This pouch can initially hold about 1 ounce of food but can expand to hold up to 2-3 ounces over time. The pouch’s outlet usually has a total diameter of about 1/4 inch. This small outlet delays the emptying of food from the stomach and causes a feeling of fullness so you eat less.

Weight Loss Surgeries that are restrictive in method are:

  • Gastric Banding
  • Gastric Sleeve
  • Vertical Banded Gastroplasty
  • Gastric Plication

Malabsorptive Bariatric Surgery Procedures

Malabsorptive weight loss surgery works by helping patients lose weight by decreasing the amount of nutrition (calories) the body is able to absorb through the intestinal tract. This is accomplished by bypassing a portion of the small intestine so that it cannot access digested food, decreasing the calories the body can use. This type of surgery does not limit the amount of food that can be taken in.

Weight Loss Surgeries that are malabsorptive in method are:

  • Biliopancreatic Diversion

Hybrid (Combination) Bariatric Surgery Procedures

Hybrid or combination weight loss surgeries combine the techniques of both a restrictive procedure and a malabsorptive procedure in to one. The thought is that both reducing the amount of food intake as well as the ability to absorb that food will help to give a two phased approach to weight loss.

Weight Loss Surgeries that are a combination of restrictive and malabsorptive in method are:

  • Gastric Bypass
  • Duodenal Switch

Gastric Bypass Surgery

Gastric bypass surgery is used to treat morbid obesity which is defined as having a Body Mass Index greater than 40. Gastric bypass is a weight loss surgery that involves both restrictive and malabsorptive technique to achieve weight loss.

At its core a gastric bypass surgery consists of the creation of a smaller thumb-sized pouch derived from the upper stomach, while at the same time bypassing the remaining larger portion of the stomach. This restricts the quantity of food that can be eaten and in turn lowers the possible caloric intake.

The second basic component of gastric bypass surgery is the reconstruction of the GI tract which allows the newly partitioned stomach segments to drain properly. The method used in this reconstruction can differ in the lengths of small bowel used, the degree to which food absorption is affected, and the likelihood of adverse nutritional effects.

Roux-en-Y Gastric Bypass Surgery

Roux-en-Y Gastric Bypass is the most common form of gastric bypass being performed today. This procedure has been shown to be effective and safe over long term duration and thus it is widely accepted by both surgeons and insurance companies as the leading choice for weight loss surgery. The Roux-en-Y gastric bypass involves separating the stomach into a smaller, upper pouch and a larger, lower section, while the small intestine is divided and rerouted. The new small pouch is created at the top of the stomach where the food enters using staples to completely separate it from the lower portion of the stomach. The remaining larger, lower portion of the stomach is bypassed but not removed from the body as it is in something like the gastric sleeve surgery. Since the natural stomach outlet is located in the bypassed portion of the stomach it is also bypassed meaning a new connection is created to the intestines.

Advantages of Gastric Bypass

Typically most people will lose about 10 to 20 pounds in the first month after the surgery. Weight loss will continue but decrease over time. The people who see the best results are those who adhere to a strict diet and exercise routine, which is essential to keeping the weight off long term. In addition the following are benefits one can expect from gastric bypass surgery:

  • Increased weight loss due to being a restrictive and malabsorptive surgery
  • Verified long term success
  • Insurance coverage is likely

Gastric bypass surgery not only has the obvious benefit of helping shed weight, but it can help improve a variety of medical conditions that are related to obesity.

  • Type 2 Diabetes
  • High Cholesterol
  • High Blood Pressure
  • Type 2 Diabetes
  • Sleep Apnea
  • Hypertension
  • Joint Pain
  • Asthma

Disadvantages of Gastric Bypass

With any other major medical procedure, there is the potential for gastric bypass complications ranging from minor to major. It is understanding the potential for those risks and managing accordingly that will best help you get through anything that may come arise.

  • Complex operation comes with risks including infection and bleeding
  • “Dumping Syndrome” is associated with this procedure
  • Potential for vitamin and nutrient deficiency due to malabsorptive component of this surgery

The Cost of Gastric Bypass

When considering if gastric bypass surgery is right for you, the cost of the surgery is a major consideration. Read more to learn more about the cost of gastric bypass.

Gastric Bypass Complications

There are complications associated with all weight loss surgeries. It is understanding what to expect and how to manage those complications that will. Read more to learn more about the potential complications of gastric bypass surgery.

How Do I Know if This is the Right Surgery for Me?

There are positives and negatives to gastric bypass surgery and that is why working with your doctor to determine the best option for you is critical. In the meantime you can compare the similarities and differences between some of the major weight loss surgeries with our weight loss surgery comparison infographic.

Finding the Right Doctor

If you are looking for a doctor in your area that can consult with you about gastric bypass surgery you can either browse our directory of bariatric surgeons in your area and contact them directly or contact us for assistance in finding the right weight loss specialist to meet your needs. We recommend reaching out to multiple doctors in order to find one that you are comfortable with before making your decision.

The LAP-Band versus the REALIZE Band

When it comes to gastric banding surgery in the united states, there are two primary choices that you can select from that have been approved and are in use today. These choices are the LAP-band created by Allergan and the REALIZE Band created by Ethicon Endo-surgery (a division of Johnson & Johnson). Both of these options are gastric banding solutions that achieve weight loss by placing a band around a portion of the stomach and neither involves the cutting or restructuring of the stomach. Both make use of a saline filled silicone tube that can be adjusted by your doctor to tighten or loosen the restriction on your stomach.

LAP-Band In Detail

The LAP-Band system was the first FDA approved gastric banding device for use in the United States. More people have chosen the LAP-Band than any other gastric banding option. It has the most long term data in terms of success and know complications.

  • The LAP-Band was the first of the two to be developed and approved for u
    se in the United States.
  • Clinical trials began in 1995 and it was approved by the FDA in 2001.
  • Performed Laparoscopically
  • Average of 5-8 adjustments per year for first 2 years
  • 5 year results: 55% excess weight loss

REALIZE Band in Detail

Physically, the REALIZE Band is the widest of all gastric bands. Ethicon, who is the manufacturer of the REALIZE Band, feels this feature helps improve hunger control when compared to other gastric bands. It is a high volume (9ml total capacity) and low pressure band. This allows for a patient to feel full with less chance of experiencing swallowing difficulties. The REALIZE Band is known to be very safe and durable.

  • The REALIZE band was actually developed first abroad in Sweden in 1985.
  • Clinical trials began in 2003 and it was approved by the FDA in 2007.
  • Performed Laparoscopically
  • Average of 4 adjustments for year 1 and 2 adjustments for years 2 and 3
  • 5 year results still unknown as data is still being collected
  • Short term results on par with LAP-Band data

The REALIZE Band also has some additional benefits that do appeal to many people. Their software program allows you to track your weight and enter daily food diaries to measure the calories, grams of protein, fats, and carbs that you are consuming. Some people have found this to be an attractive feature that leads them to ultimately choose the REALIZE Band.

Which is the right choice for me?

Comparing the two gastric banding options shows us that they are very similar in both method and results. The right choice will ultimately come down to you and your doctor and what the two of you feel most comfortable with and makes the most sense for each patients individual situtation.

Gastric Sleeve Surgery Cost

The cost of gastric sleeve surgery can be quite expensive especially since not all insurance companies will cover this procedure just yet due to how new the practice is. Gastric sleeve surgery cost on average is close to $10,000 and can easily total up to over $20,000 when you factor in all the additional related expenses that go along with having this surgery. This cost is typically a bit less than you would expect to pay for traditional gastric bypass surgery.

Due to the relative newness of gastric sleeve surgery, insurance is less likely to cover this procedure than a more “routine” gastric bypass surgery. This means that the patient must come up with the costs out of pocket or work out a financing plan with the surgeon who will be performing the procedure.

Gastric Sleeve surgery costs include hospital fees, surgeon fees, anesthesia, pre and post-op car, hopsital bed time, x-rays and scans. In addition there are costs that are not included in your bill but can add up over time. These costs include vitamins and supplements, behavior modification therapy, exercise, and diet counseling. In addition there is often costs for body contouring surgery (cosmetic surgery) for the removal of excess skin.

Additional Factors that Impact Cost

The following factors can also play a part in determining what your cost will be for gastric sleeve surgery

  • Location – Where you have the surgery performed affects the price. Areas without many doctors who can perform this procedure may see higher surgeons fees.
  • Travel – Will you need to travel to your surgeron? If so, where will you stay? These costs can add up quickly if you have to pay for airfare and hotel to have the surgery performed with a surgeon that you feel comfortable with.
  • What type of patient are you – Are you having the surgery performed as an in-patient in the hospital or as an outpatient. This can affect the costs of gastric sleeve surgery greatly.

Gastric Sleeve Cost Compared to Other Weight Loss Surgeries

Read more about how the cost of gastric sleeve surgery compares to other weight loss surgery options and additional factors that can have an impact on the total price.

Gastric Sleeve Surgery

Gastric sleeve surgery (sleeve gastrectomy) is one of the newer forms of bariatric surgery but has quickly been gaining popularity over the recent years. Also known as vertical sleeve gastrectomy, vertical gastroplasty or sleeve gastroplasty, this procedure is another option for those looking to help with their morbid obesity through gastric bypass surgery. The gastric sleeve is a restrictive procedure meaning that it achieves weight loss results by restricting the amount of food that your body is physically able to take in. There is no malabsorption involved with this procedure but can be followed up with a malabsorptive procedure afterwards if the patient wishes.

How Does Gastric Sleeve Surgery Work?

Gastric sleeve surgery involves permanently removing a large portion of the stomach, anywhere from 60% to 85% of the total stomach. The portion left behind is a slim tube or “sleeve” that will serve as your new stomach. This stomach is already connected naturally to the stomach inlet and outlet which means that no rerouting of the intestines is needed.

What differentiates a gastric sleeve procedure from other weight loss surgeries is the nerves to the stomach and the outlet valve (pylorus) of the stomach remain intact to preserve the functions of the stomach while at the same time, reducing the volume it is able to hold. There is no bypass of the intestines with the gastric sleeve, only stomach capacity reduction. A sleeve gastrectomy also works because it removes the part of the stomach that produces Ghrelin, which is a hormone that stimulates appetite. This helps to noticeably reduce without completely eliminating a person appetite.

Advantages of the Gastric Sleeve

The primary features of gastric sleeve surgery are reducing the size of the stomach up to 85%, to restrict food intake while also reducing the hormones that create the craving for food due to the removal of the excess stomach portion. This reduces the production of the Ghrelin hormone which in turn reduces the hunger sensation.

The advantage of gastric sleeve surgery include:

  • 30 to 60% extra weight loss within the first 12 months of the procedure
  • Less invasive than gastric bypass
  • No cutting or, disconnection or alteration of the intestines
  • No risk of “dumping syndrome” typically associated with gastric bypass
  • No need for implementation of foreign devices in to the body such as a gastric band
  • Less restrictive post-surgery diet
  • Procedure may be followed by gastric bypass or duodenal switch for even better results for super obese patients (those with a BMI > 70)
  • Can be performed laparoscopically on extremely obese patients

Disadvantages of the Gastric Sleeve

As with any medical procedure of this nature, there is always the potential for adverse affects. The biggest potential drawback for some people with this procedure is that is irreversible and thus you must really understand all of the implications before proceeding with gastric sleeve surgery.

In addition the following potential drawbacks should be taken in to consideration:

  • Since the gastric sleeve is a restrictive weight loss procedure and not malabsorptive, inadequate weight loss or weight regain is more likely to occur than would in a procedure involving intestinal bypass
  • The newly created pouch has the potential to stretch over time
    Weight Loss only really noticeable with total change in diet combined with exercise
  • Additional surgery may be required for follow-up procedures to combine methods
  • Leakage may occur at the site of stapling
  • Still no knowledge of long term results due to short history of procedure
    Insurance may not cover due to the short history of the procedure making the cost potentially prohibitive for many people.

Cost

The cost for gastric sleeve surgery is similar to other major weight loss surgery options. It can be an expensive procedure that you would need to talk to your insurance company about whether or not it would be covered.
Read more about the factors that influence the cost of gastric sleeve surgery.

Success Rates & Results

While this procedure is still in the early stages compared with other weight loss surgery procedures, some of the initial findings are pointing to this procedure showing some very good success rates in both weight loss and the alleviation of comorbidities related to that excess weight.
Read more here about the success of gastric sleeve and the results seen so far.

Complications

There are potential complications related to gastric sleeve surgery just as there are with all form of bariatric surgery. Understanding what those potential risks are and being prepared will help you should any of these complications arise after your surgery.
Read more about gastric sleeve complications and risks.

What Can I Eat After My Surgery?

There will be a drastic change in your diet after your surgery and the amount of food you can physically eat. You will need to ease in to your new diet and retrain your body to the new, smaller amount of food you will be eating from that day on.
Read more about what makes up a gastric sleeve diet and how what you choose to eat will decide the eventual outcome of your sleeve gastrectomy.

How Do I Know if This is the Right Surgery for Me?

There are positives and negatives to the gastric sleeve and that is why working with your doctor to determine the best option for you is critical. In the meantime you can compare the similarities and differences between some of the major weight loss surgeries with our weight loss surgery comparison infographic.

Finding the Right Doctor

If you are looking for a doctor in your area that can consult with you about gastric sleeve surgery you can either browse our directory of bariatric surgeons in your area and contact them directly or contact us for assistance in finding the right weight loss specialist to meet your needs. We recommend reaching out to multiple doctors in order to find one that you are comfortable with before making your decision.

Gastric Plication Complications

While gastric plication has shown some very promising early results, most notably in a Brazilian study conducted between 2007 and 2010 published in the Bariatric Times (http://bariatrictimes.com/2010/05/19/..), there are some drawbacks you should be aware of with this procedure.

In the study referenced above, there were no complications reported during the procedure itself, however due to the nature of the surgery, which is similar in nature to other stomach capacity reduction surgeries such as vertical sleeve surgery, there is the potential for the following complications during or shortly after gastric plication surgery.

  • Esophagitis
  • Stenosis
  • Fistulas
  • Gastric Leaks

Both leaks and fistulas are reported in nearly one percent of cases and can be very difficult to treat and are the biggest threat to the patients health during surgery

Non-Medical Related Drawbacks

Aside from medical complications there are other potential drawbacks which can be even bigger obstacles for many people. Due to the young age of this procedure, gastric plication is not yet fully supported in the United States. This means that the FDA hasn’t fully approved it’s use and insurance companies are unlikely to cover the costs of this procedure. Until more studies are done and more data is available covering the long term complications and success rates, it will continue to be a surgery that is more common to be performed abroad than it is within the U.S. This can be a major hurdle for many people.

Additional Weight Loss Surgery Options

While there are more commonly selected choices such as gastric bypass, gastric banding or the increasingly popular gastric sleeve surgery. There are other weight loss surgery options that may be more appropriate for many people. Every patient is unique and the surgery that is the best choice for one person may not be the best choice for another.

Alternative surgery options can be geared towards patients who are “super-obese” as these patients are more prone to complications. Alternative choices can include the following: