Weight Loss Surgeries
Weight Loss Surgeries
Obesity remains a growing concern globally, affecting millions in America and posing a significant risk for various chronic conditions. While diet and exercise are commendable efforts to lose weight, such changes may seem like an uphill battle for individuals struggling with severe obesity. That’s not to mention the frustration and body image struggles that accompany slow progress and weight plateaus.
At RMC, we acknowledge that some patients require a more permanent solution for sustained weight loss. As part of our bariatric surgery program, we offer a range of interventions specifically designed to promote weight loss and improve overall health outcomes for patients with obesity. Our commitment to patient-centered care means we take the time to understand your specific health profile, lifestyle, and weight loss objectives, guiding you toward the most appropriate surgical option.
Exploring Different Types of Bariatric Surgery
Bariatric Surgery (also known as metabolic surgery) comprises various surgical procedures to address obesity and weight-related health problems. Here are some of the bariatric surgeries available to shed excess weight.
Also known as Roux-en-Y gastric bypass, this is one of the most common bariatric procedures, achieving substantial long-term weight loss and improving obesity-related conditions such as type 2 diabetes, high blood pressure, and obstructive sleep apnea. The surgeon designs a stomach pouch that directs straight to your small intestine, bypassing a large portion of the stomach and the opening section of the small intestine and reducing the volume of food you can consume and retain.
Otherwise called gastric sleeve surgery, this procedure shrinks the stomach by around 75-80%, leaving a tube-like structure. The smaller stomach restricts food intake and suppresses the hunger hormone ghrelin, which helps manage your appetite. The gastric sleeve is less complex than gastric bypass since it doesn’t involve rerouting the digestive system, making it a preferred choice for anyone seeking significant weight loss and improved metabolic health.
The bariatric surgeon places a flexible band around the upper stomach, creating a pouch that restricts how much you can eat. The band can be tautened or slacked by injecting or withdrawing saline via a port below your skin, allowing for personalized weight loss management. Gastric banding is minimally invasive, reversible, and typically results in gradual weight loss. However, frequent follow-up visits may be a requirement for band adjustments.
Revision surgery involves modifying or correcting the original procedure to enhance its effectiveness or to address issues such as staple line leaks, slippage of an adjustable band, severe reflux, and other complications.
On the other hand, conversion surgery changes the original bariatric procedure to a different type of surgery when the initial surgery fails to provide the desired results or the patient experiences severe complications.
The surgeon starts with a sleeve gastrectomy before bypassing a large portion of the small intestine where nutrients are absorbed, restricting food intake and limiting its nutrient absorption. Ultimately, this leads to successful weight loss and potential improvements in blood sugar control.
Comparing the Best Weight Loss Surgeries
All bariatric procedures accelerate your weight loss goals, but the “best” procedure depends on your individual needs and medical profile. Here’s a breakdown of the critical factors to consider for each surgery:
Benefits:
- Most effective for long-term weight loss, often exceeding 60% excess body weight.
- Offers significant improvement in weight-related health conditions (e.g., type 2 diabetes, hypertension, and sleep apnea).
- Reduces hunger hormones, increasing satiety after smaller meals.
Suitability:
- It is ideal for patients who have a very high body mass index (BMI) of 45+ or those with severe sleep apnea and uncontrolled heartburn.
- Suitable for individuals who have struggled with weight regain after trying other treatments like weight loss medications.
Considerations:
- More complex surgery with a longer recovery time compared to other procedures.
- Requires lifelong vitamin and mineral supplementation.
Benefits:
- It’s a less invasive surgery with a shorter hospital stay and faster recovery than gastric bypass.
- Effective weight loss procedure, often achieving 40-50% weight reduction.
- It may improve type 2 diabetes by regulating blood sugar levels and reducing insulin resistance.
- It suppresses appetite by reducing the production of ghrelin, the hunger hormone.
Suitability:
- A good option for patients with lower BMIs (40-45) or those at higher surgical risk.
- It may be preferable for individuals with the motivation to maintain lifestyle changes alongside surgery.
Considerations:
- It may require stricter dietary control to maintain results.
- Increased risk of gastroesophageal reflux disease (GERD) for some patients.
Benefits:
- Minimally invasive surgery with a shorter recovery time.
- Adjustable band allows for customization of weight loss based on individual needs.
- Potentially reversible procedure, offering a psychological advantage for some patients.
Suitability:
- It may be an option for patients with a BMI of 35-40 who have yet to progress with lifestyle changes.
- Ideal for individuals with good eating habits and a strong commitment to long-term follow-up adjustments.
Considerations:
- Post-op requirements include multiple clinic visits for band adjustments.
Benefits:
- Clinical trials prove this procedure yields promising results, often exceeding 70% excess weight loss.
- It may result in remission of type 2 diabetes and improve high cholesterol.
- Reduces hunger hormones and alters nutrient absorption for significant weight loss.
Suitability:
- Only extremely obese patients (BMI over 50) with a record of unsuccessful weight loss attempts are eligible for this procedure.
- We only recommended this procedure for highly motivated individuals committed to lifelong nutritional monitoring.
Considerations:
- Long-term post-op requirements include long-term management of electrolyte imbalances and vitamin deficiencies.
Discuss these options with your doctor to find the best fit for your situation, medical history, and weight loss goals.
New and Innovative Weight Loss Procedures
Advancements in bariatric surgery continue to evolve, allowing our multidisciplinary team to offer new and innovative options for weight loss. Some of these include:
Endoscopic Sleeve Gastroplasty (ESG)
This minimally invasive procedure uses an endoscope and suturing device to shrink the stomach, creating a sleeve-like shape without external incisions. ESG is an outpatient procedure with a shorter recovery than traditional bariatric surgery. It’s ideal for patients with moderate obesity who want less invasive weight loss approaches.
Gastric Balloon Procedures
It involves placing two connected, saline-filled balloons into your stomach to limit its capacity and induce satiety. The balloons remain in the stomach for six months, during which patients adopt healthier eating habits and lifestyle changes. This procedure is ideal for individuals with a BMI of 30-40 who need assistance jump-starting their weight loss journey.
Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S)
The SADI-S procedure combines sleeve gastrectomy with a single-loop duodenal switch, simplifying the traditional duodenal switch surgery by reducing the number of anastomoses (surgical connections). It’s suitable for patients with a high BMI and those needing significant weight loss, particularly individuals with metabolic disorders.
AspireAssist
This reversible, non-surgical weight loss procedure involves placing a small tube in the stomach to drain a portion of stomach contents after meals. It reduces calorie absorption and promotes weight loss without altering the stomach’s anatomy. The device is implanted through a minimally invasive endoscopic procedure and is removable if necessary. AspireAssist is suitable for individuals with a BMI of 35-55 who have yet to achieve significant weight loss through diet and physical activity.
Robotic Bariatric Surgery
We can use robotic-assisted surgery technology for many bariatric procedures (e.g., sleeve gastrectomy and gastric bypass). Watching through a tiny camera, our surgeons operate through small incisions using robotic arms, which provide enhanced dexterity and visualization. This technology allows for more accurate tissue manipulation, lower risk of complications, and swifter recovery.
Determining the Right Surgical Option for You
Choosing the right bariatric surgery involves a thorough evaluation by a medical professional. Here are several factors to guide your doctor’s decision.
Medical History and Current Health Status
Certain medical conditions can create more risk factors for some procedures. For example, if you have a history of severe gastroesophageal reflux disease (GERD), a sleeve gastrectomy may not be the best option, as it can worsen reflux symptoms.
Additionally, past abdominal surgeries might influence the choice of bariatric surgery due to potential complications and scar tissue that make it more challenging for surgeons to navigate the surgical site.
Your BMI is also a factor—higher BMIs might necessitate more extensive procedures like gastric bypass or BPD/DS for significant weight loss.
Weight Loss Goals and Expectations
Bariatric procedures offer varying degrees of weight loss. For instance, gastric bypass and BPD/DS generally result in more substantial weight loss than sleeve gastrectomy or adjustable gastric banding.
Additionally, consider how quickly you aim to achieve your weight loss goals. For example, gastric bypass offers more rapid results than the adjustable gastric band, which leads to more gradual weight loss.
Lifestyle and Commitment
Evaluate your readiness to commit to a structured eating plan. This plan involves transitioning from a liquid diet to pureed foods and eventually to solid foods, with lifelong portion control and healthy eating habits.
Additionally, consider your willingness and ability to engage in a regular exercise program post-surgery. You must adhere to follow-up care to monitor your progress, nutritional status, and potential complications. Some surgeries require more frequent follow-ups than others.
Insurance and Financial Considerations
Contact your insurance provider to understand what bariatric surgeries your plan covers. Coverage often depends on meeting specific criteria; for example, you should prove that you have failed weight loss efforts after diet and exercise.
But even with insurance, there may be out-of-pocket costs, including co-pays, deductibles, and expenses for pre-surgery evaluations and post-surgery follow-ups.
FAQs on Weight Loss Surgery Types
The effectiveness of weight loss surgery varies by individual. Gastric bypass and BPD/DS generally offer the most significant weight loss, but sleeve gastrectomy and adjustable gastric band are likewise effective with fewer complications.
Although recovery times vary, patients can expect a hospital stay of 1-3 days for most surgeries and a return to normal activities within 4-6 weeks.
Are weight loss surgeries covered by insurance?
Bariatric surgery may qualify for insurance, but coverage details vary. It’s essential to check with your insurance provider to understand your benefits.
As part of a patient’s treatment plan following any weight loss procedure, their doctor or registered dietitian will provide specific post-surgery dietary instructions. Generally, post-surgery patients should follow a specific diet that progresses from liquids to pureed foods and finally to solid foods. Lifelong dietary changes and vitamin supplementation are also necessary to ensure proper nutrition, avoid deficiencies, and prevent excess weight gain.
Some procedures, like the adjustable gastric band, are reversible. However, most surgeries, such as gastric bypass and sleeve gastrectomy, are permanent and cannot be undone.