An Overview of Bariatric Surgery Options

By: 
Dr. Christopher McGowan
agosto 15, 2023

With estimates that it affects nearly 42% of the population, it has become well known that the United States has an obesity problem. The traditional and popular methods of losing weight—mainly adopting a restrictive diet and/or a punishing exercise regimen—have unfortunately not made a difference in this area over time. One approach that consistently does make a difference is weight loss surgery, also referred to as bariatric surgery. Yet even though bariatricians are passionate about the potential benefits of these procedures, there are still only a fraction of eligible patients who actually opt in.     

What is a Bariatric Doctor?   

Bariatric medicine is a branch of the medical field that involves the causes of and treatment for obesity and obesity-related conditions. Bariatrics is a relatively new branch of medicine that has only really existed since the 1960s, and that may be part of why people who might benefit from it are hesitant to get help. While bariatric surgery is a significant component of many obesity interventions, bariatric doctors typically use it in combination with recommended changes in eating habits and physical activity levels. 

Over the years, the relative ineffectiveness of various popular weight loss programs has sparked greater interest in the possibility of weight loss surgery. At the same time, advances in surgical technology have made the procedures safer than ever. All of this has led to an increase in the number of patients who actually opt in for surgery. In fact, according to the American Society for Metabolic and Bariatric Surgery, the incidence of bariatric surgery has nearly doubled since 2011 and is expected to continue rising. 

Types of Weight Loss Surgery

In the decades since bariatric surgery first emerged as a reliable approach to treating obesity, a number of different procedures have been developed. Most of these procedures attempt to promote weight loss by one or both of two main modalities: reducing absorption of nutrients and limiting the amount of food that can be ingested in one sitting. Below is a list of the most common weight loss procedures and what is involved: 

  • Gastric bypass: Though there are a few subtypes of this kind of bariatric surgery, by far the most common is known as Roux-en-Y gastric bypass surgery. This surgery involves altering the anatomy of the stomach and small intestine to both reduce nutrient absorption and limit food intake. First, a smaller stomach pouch is fashioned with the use of surgical staples in order to physically constrain the amount of food the stomach can hold. Then the small intestine is divided into upper and lower sections; the upper part of the small intestine is connected to the new stomach pouch while the lower part is reconnected further down the line, forming a Y-shaped configuration. The procedure is conducted laparoscopically through small incisions, with patients under general anesthesia.   
  • Sleeve gastrectomy: A sleeve gastrectomy (also known simply as gastric sleeve) similarly involves removing a significant portion of the stomach in order to limit food intake. In this case, the stomach is formed into a banana-shaped "sleeve" that is around 25% of the original size. Unlike gastric bypass, however, this procedure does not involve rerouting the intestines to affect nutrient absorption. Gastric sleeve surgery is also a laparoscopic procedure that is considered minimally invasive because large incisions are not required. 
  • Duodenal switch: In a way, the duodenal switch (technically known as bilio-pancreatic diversion with duodenal switch) is a combination of a sleeve gastrectomy and gastric bypass. The first step in the procedure is to perform a sleeve gastrectomy so that the stomach is smaller and helps limit food intake. The second part uses a similar intestinal rerouting effort as gastric bypass; this allows the limited food that can fit in the stomach to bypass much of the small intestine where most nutrient absorption takes place.  
  • Adjustable gastric banding: Adjustable gastric banding represents another approach to bariatric surgery that involves placing a silicone band around the upper part of the stomach to create a small pouch. Rather than removing any of the stomach, though, the band segments it into two parts. Since the top part is where food enters first, the smaller size limits the amount of food that can be eaten in the same way as other procedures. The band, as the name implies, is adjustable and can be tightened or loosened depending on an individual’s needs. Unlike the other procedures mentioned above, the gastric band is reversible (though it is intended to remain indefinitely).    
  • Gastric balloon: Gastric balloons are one of the most flexible options because they are only intended to be used for a set amount of time (usually six months). In this procedure, a deflated silicone sphere is placed in the stomach. Once inside, it is filled with a harmless saline solution until it reaches the size of a grapefruit. The basic idea is that the presence of the balloon in the stomach leaves less room for food, and this fact promotes portion control and healthier eating habits. One of the other important differences between this procedure and true bariatric surgery is that the balloon is inserted endoscopically through the mouth and esophagus; in other words, no incisions are required and thus it brings none of the inherent risks of surgery.  

What are the Benefits of Bariatric Surgery?  

The main reason bariatric surgery has become more common is that it has an impressive track record of success, especially when compared with methods that rely on lifestyle changes like diet and exercise. In one recent study, for example, participants were able to lose 15-25% of body weight and only regain 1-3% after seven years. But even beyond meeting weight loss goals, there is substantial evidence that bariatric surgery can also lead to improvements in various aspects of health and reduced risk for developing obesity-related medical conditions:   

  • type 2 diabetes
  • hypertension (high blood pressure)
  • high cholesterol
  • fatty liver disease
  • thyroid problems
  • gastrointestinal problems
  • sleep apnea

Alternatives to Bariatric Surgery

As effective as bariatric surgery can be, the fact remains that there are risks to any surgical procedure. Even with laparoscopy, small incisions are still incisions that can bleed or become infected. Also, some people with morbid obesity have additional health problems that make surgery a non-starter. Others may not be able to qualify for surgery because their BMI (índice de masa corporal) is high but not high enough. In light of all of these concerns, state-of-the-art alternatives have been developed that aim to have similar effectiveness without the risks of actual surgery. 

One of the most impressive sets of alternatives is known as endobariatric weight loss procedures. Rather than using laparoscopy as most other methods require, an endobariatric procedure is performed using endoscopy as in the gastric balloon example above. But besides simply placing a gastric balloon in the stomach, an endoscope can be fitted with surgical tools that offer more options. A great example of what the endoscope can do—and one of True You’s specialities—is called endoscopic sleeve gastroplasty (ESG).  

ESG is a non-surgical, incisionless, minimally invasive procedure that works in a way that is similar to a sleeve gastrectomy. Yet rather than removing part of the stomach through laparoscopic incisions, special surgical tools on the end of the scope allow the surgeon to close off a large portion of the stomach by suturing it shut from the inside. The entire procedure takes 30-45 minutes and is done while the patient is under sedation (as opposed to full anesthesia). All of this means that the patient will have a much shorter recovery time and a greatly reduced chance of complications.  

True You Weight Loss Solutions   

At True You, we recognize that every weight loss journey is unique, and there are some people who may benefit from bariatric surgery. But all surgery has risks, and procedures like ESG offer a distinct alternative that can open up new possibilities. If you’d like to learn more about ESG or any of our other non-surgical weight loss solutions, please contact us today to request a consultation. We are dedicated to helping patients find the freedom they’ve been looking for with long term weight loss success

Dr. Christopher McGowan
Dr. Christopher McGowan
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