Bariatric Surgery Risks and Benefits

Dr. Christopher McGowan
October 9, 2023

The prevalence of severe obesity has essentially doubled over the past 20 years, and that has also meant an increase in a number of serious, obesity-related medical conditions. In light of this, more and more people are turning to health interventions like bariatric surgery. In fact, according to the American Society for Metabolic and Bariatric Surgery (ASMBS), the number of people opting for a bariatric procedure of any kind has increased more than 60% since 2011. Yet as potentially beneficial as such procedures are, there remain significant risks that must be weighed with the benefits.

What Is Bariatric Surgery?     

Also known simply as weight loss surgery, bariatric surgery is the general term for any medical procedure designed to help individuals with severe obesity lose weight and improve their overall health. A commonality in all types of bariatric surgery is the modification of the digestive system in a way that either reduces the capacity of the stomach or changes the way the body absorbs nutrients. Given that most procedures are permanent, bariatric surgery is typically only considered when traditional weight loss methods have been unsuccessful.

Not everyone is a good candidate for these weight loss procedures, however; to qualify for bariatric surgery, the patient has to first be healthy enough to go through surgery. Also, a determination must be made about the severity of obesity, and that is typically done by evaluating body mass index (BMI), which is essentially the ratio between a person’s height and weight. Generally speaking, a patient should have a BMI of 35 or higher or a BMI of 30-35 and an obesity-related condition like heart disease or type 2 diabetes.

Types of Bariatric Surgery

In the last few decades, various types of bariatric surgery have been developed that each have their own particular aim and mechanism for promoting weight loss. The method selected will depend on the patient’s current weight, health status, preferences, and ability to tolerate surgery. Below are the main types of bariatric surgery available:

  • Gastric bypass: Gastric bypass surgery is the most common surgical procedure for weight loss. Technically known as Roux-en-Y gastric bypass, the surgery first involves dividing the stomach into a small upper pouch that is approximately 20% of the original stomach volume. The procedure gets the “Y” part of its name from the fact that two sections of small intestine are used to bypass a substantial portion of the small intestine’s absorptive capacity. This method limits both the amount of food that can be ingested in one sitting and the amount of nutrients that can be absorbed by the body.
  • Sleeve gastrectomy: Also known simply as gastric sleeve, the sleeve gastrectomy procedure also involves removing a portion of the stomach in order to reduce its overall volume. In this case, the stomach is divided along the greater curvature into two parts; the larger part is removed, and the smaller part is formed into a banana-shaped “sleeve” that has about 25% of the original capacity. As with gastric bypass, the goal is to limit the amount of food that can be eaten in one sitting. Over time, this is meant to promote new eating habits and a caloric deficit.
  • BPD/DS: Biliopancreatic diversion with duodenal switch (BPD/DS) is a complex procedure that involves a sleeve gastrectomy and an intestinal bypass. The gastric sleeve component works just like in the regular gastric sleeve surgery, but then the duodenum is detached from the lower part of the stomach and is reconnected to the lower section of the small intestine. This connection point is much further down the small intestine than in gastric bypass, though, and that means that roughly 2/3 of its absorptive capacity is bypassed.
  • Adjustable gastric banding: Gastric banding is one of the few reversible types of bariatric surgery, which makes it appealing for patients who are uncomfortable with a permanent procedure like gastric bypass or gastric sleeve. During the procedure, the doctor will place an inflatable silicone band around the upper part of the stomach that restricts the amount of food that can pass through. The fact that the band has an adjustable opening allows flexibility in how significant the food restriction will be and thus the potential rate of weight loss.
  • Intragastric balloon: Like gastric banding, a gastric balloon is a reversible procedure that is actually intended to only be used temporarily. In this procedure, a deflated silicone balloon is placed in the stomach via endoscope. The balloon is then filled with a harmless saline solution until it is roughly the size of a grapefruit. With this device taking up so much space in the stomach, the amount of food that can be eaten is limited. The balloon is only meant to be in the stomach for around 6 months, and during that time it can help promote a calorie deficit and better long-term eating habits.

Benefits of Bariatric Surgery

After decades of experience and research, it’s clear that overall bariatric surgery is an effective method for achieving long-term weight loss. While the figures vary depending on the study, patients often lose 30-50% of excess weight in the first six months after the procedure and then a steady amount as time goes on. One study showed that patients were able to maintain such a loss for more than 10 years after the surgery. Yet beyond offering significant weight loss, bariatric can also lead to improvements in some areas of health and reduced risk for certain obesity-related conditions:

Risks of Bariatric Surgery

Even though there are clear benefits to bariatric surgery, there are a number of risks and potential side effects that can’t be ignored. Many of these risks and side effects are associated with surgery in general. Most bariatric procedures are laparoscopic, and this means the surgeon makes small incisions in the abdomen that allow a special surgical scope to be inserted. While this is technically considered “minimally invasive,” that really only means less invasive than full open surgery. Below are some of the risks associated with these procedures:

  • infection
  • bleeding internally and at the incisions
  • blood clots
  • leakage at the site of the sutures
  • hernia where the incisions weaken the abdominal wall
  • complications from anesthesia 

In addition to the side effects directly related to the surgery, there are also a variety of gastrointestinal issues that may arise. For instance, gallstones may develop as a result of rapid weight loss. Malnutrition is also possible in cases where part of the small intestine was bypassed. There are also potential functional problems like a bowel obstruction or dumping syndrome, a condition involving food moving from the stomach to intestines too quickly. However, some of these problems will resolve on their own given enough time.

Endoscopic Sleeve Gastroplasty: A Non-surgical Alternative

Weighing the risks and the benefits of bariatric surgery could leave anyone wondering if it’s really worth it. Fortunately, though, a state-of-the-art alternative has emerged in recent years that changes the whole calculation: endoscopic sleeve gastroplasty (ESG). The primary difference is that ESG is performed with an endoscope, a long flexible tube that is fed down the esophagus. This means that no incisions are necessary; the entire procedure is performed with the endoscope from inside the stomach.

As the name implies, ESG involves reshaping the stomach into a banana-shaped sleeve just like with a sleeve gastrectomy procedure. In this case, though, the tools on the end of the endoscope can close off 80% of stomach volume with sutures; and rather than removing this section of the stomach, it can safely remain unused in the body. Once the procedure is completed, the stomach has only about 20-30% of its original capacity and can similarly promote new eating habits and a calorie deficit.

Because an endoscope is used to perform ESG, it can be completed quickly and usually in only 30-45 minutes. Moreover, the lack of incisions means that the procedure is safer in general and requires a much shorter recovery time; whereas gastric bypass can take up to a month, most people can return to regular activities after only 2-3 days. The best part, of course, is that ESG also leads to similar weight loss. On average, patients can lose 23.1% of their total body weight and 70% of excess weight within a year. And 97% of patients will lose at least 10% of body weight within a year.

Contact True You Weight Loss Today    

At True You Weight Loss, we are passionate about helping patients find the freedom they’ve been looking for, and we specialize in using ESG to make that a reality. While bariatric surgery may be the right choice for some people, the fact remains that there are risks associated with surgery. ESG is an alternative that our team is highly experienced at performing, and our patients have a proven track record of weight loss success. If you’d like to learn more about ESG or any of our other non-surgical weight loss procedures, please contact us today to request a consultation.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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