BARIATRIC SURGERY – ESSENTIAL QUESTIONS & ANSWERS
What Is Bariatric Surgery?
Bariatric surgery includes a variety of procedures performed on people who have obesity. Significant and rapid weight loss and the resulting health improvements are achieved by one or more of the following, depending on the procedure:
• Restriction
• Feel full sooner while eating and feel less hungry by reducing the number of contents that the stomach can hold
• Malabsorption
• Absorb fewer calories and/or minerals
Are There Different Bariatric Surgeries to Choose From?
There are 5 common types of bariatric surgery to choose from, including:
Weight Loss Balloon (endoscopic intragastric balloon): A weight loss balloon is a non-surgical option.
Lap Band (laparoscopic adjustable gastric band): The Lap-Band is a minimally invasive surgery where a flexible ring is put around the stomach's upper part.
Gastric Sleeve (vertical sleeve gastrectomy): Gastric sleeve surgery, or sleeve gastrectomy, is a minimally invasive surgery where our surgeon removes about 80-90% of your stomach.
Gastric Bypass (Roux-en-Y gastric bypass): The Roux-en-Y gastric bypass is a bariatric surgery involving a smaller stomach and rerouting of the intestines.
Duodenal switch (biliopancreatic diversion with duodenal switch): This makes the stomach smaller, reroutes the intestines, and removes the gallbladder.
Which Bariatric Surgery Procedure Is Best?
There is no "one size fits all" bariatric surgery procedure. Each has its pros and cons to consider before making a decision. For example:
• Gastric sleeve, gastric bypass, and duodenal switch result in the most weight loss and greatest health improvement but also have longer hospital stays and recovery times and more dietary restrictions.
• LAP-BAND weight loss is almost as good as sleeve, bypass, and duodenal switch, but it has a lower long-term success rate and requires more follow up visits with the doctor
• A gastric balloon is the least expensive, is non-surgical, and has the quickest recovery, but it must be removed in 6 months.
Is Bariatric Surgery Safe?
While bariatric surgery carries the same general risks associated with any type of surgery, its safety profile is impressive, and its upsides tend to outweigh its risks.
Points to consider include:
• Bariatric surgery has a 99.9% survival rate.
• Complications ranging from minor (more common) to severe (less common) are experienced by about 1 in 10 patients.
• The long-term risks of remaining obese are much greater than the risks of bariatric surgery. For example, individuals suffering from obesity are 50% more likely to die over any period of time than weight loss surgery patients.
How Much Weight Will Lose After Bariatric Surgery?
You will start losing weight fast after any bariatric surgery procedure, but the total amount lost varies based on:
• The procedure you choose
• How closely you follow your doctor’s instructions
For example, depending on your height and weight and chosen procedure, you could lose as little as 25 pounds (#11.3kg) or as much as 125 pounds (#56.7kg) in 1 to 2 years.
Bariatric Surgery Weight Loss Estimation.
How Will Your Health Change After Bariatric Surgery?
Bariatric surgery “cures” or significantly improves many obesity-related health conditions, including:
• Diabetes
• Sleep apnea
• Hypertension (high blood pressure)
• Joint issues
• Asthma
• High cholesterol
• Migraines
• Infertility
• Depression
• Gastroesophageal Reflux Disease (GERD)
• Venous Stasis Disease
• Stress Urinary Incontinence
• Metabolic Syndrome
Do You Qualify for Bariatric Surgery?
Patients who qualify for bariatric surgery usually:
• Are at least 80 lbs (36 kg) overweight
• Are between 18 and 75 years old
• Have a history of failed weight loss attempts (e.g., failed diets)
• Thoroughly understand that the procedure is just a tool; long-term success requires significant diet and lifestyle changes.
The minimum bariatric surgery qualifications include:
• A body mass index (BMI) of 40 or more
• OR a BMI between 35 and 39.9 with an obesity-related severe health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, or others.
• OR a BMI of 30 to 40 with or without health issues for the gastric balloon procedure.
What Are the Downsides of Bariatric Surgery?
While most patients call bariatric surgery the best decision of their life, it comes at the cost of:
• Big lifestyle changes (see the overview of diet and lifestyle)
• A recovery period after surgery
• Risk of complications
• Possible side effects
Bariatric Surgery Recovery Period
Bariatric surgery recovery varies by procedure. Here are the ranges:
1. Timeline Range: from 3 days to 6 weeks to full recovery
• Hospital Stay: from outpatient (return home same-day) to 3 days
• Back to Work: from 3 days to 3 weeks
2. Pain Range: from mild discomfort to manageable with medication
3. Diet Range: from no restrictions to slow transition from clear liquids to solid foods
4. Activity Range: from no restrictions to slowly transition back to regular activity and exercise
Bariatric Surgery Complications
While the survival rate for bariatric surgery is extremely high at 99.9%, as many as 1 in 10 patients do experience complications.
As with most other aspects of surgery, this varies widely by procedure type. For example:
• Procedures that result in greater weight loss tend to carry greater risk because they alter your anatomy. Anatomy-altering procedures include gastric sleeve, gastric bypass, and duodenal switch.
• Procedures that do not alter your anatomy usually result in less weight loss and have less risk. Non-anatomy altering procedures include gastric balloon and AspireAssist.
• LAP-BAND is in a category of its own. It has weight loss just under more invasive procedures like gastric sleeve but does not alter the anatomy. However, the implanted band can lead to unique band-related complications that occur in a relatively high percentage of patients, especially those who do not follow post-surgical guidelines closely.
Bariatric Surgery Side Effects
Bariatric surgery side effects range from minimal to extensive, depending on the procedure.
The most common side effects include:
• Digestion issues such as difficulty swallowing, constipation, diarrhea, nausea, or intolerance to certain foods
• Sagging skin from rapid weight loss (correctable through plastic surgery, depending on the severity)
• Vitamin or mineral deficiency, especially after gastric bypass and duodenal switch
• Gallstone formation (as a result of rapid weight loss – usually temporary)
• Hair loss (as a result of rapid weight loss – usually temporary)
Jan 30, 2021
HUNG M. DO, MD, PhD