Understanding the Alternatives to Gastric Bypass

Dr. Christopher McGowan
septiembre 29, 2020

“Easier said than done” is a phrase that applies to many things in life. Losing weight is definitely in that category. If you have been carrying excess body weight, and especially if you have a body mass index (BMI) above 30, you know exactly how hard it can be to drop pounds. 

For some people, exercise and changes in eating habits can eventually bring about results. Not everyone is in this category, though. There are some people for whom diet and exercise are not enough to achieve or maintain a healthy weight. If you are in this category and it seems all options have been exhausted, there is a chance your health care provider has begun talking to you about the very serious consequences of excess body weight. There is even a chance your doctor has mentioned something called gastric bypass surgery.

Gastric bypass surgery, or Roux-en-Y gastric bypass surgery, is one of the most well-known weight loss surgeries. Considered by some to be the gold standard in weight loss surgery, this life-altering surgery forever changes your stomach and intestines, making it all but assured you will lose weight. 

There are always trade-offs though, and gastric bypass surgery is no exception. The possibility of serious side effects, and the need to be extremely vigilant about your diet and nutrition for the rest of your life, can mean this surgery is not a good option for every candidate. 

What Are the Types of Bariatric Surgery Alternatives

Thankfully there are an increasing number of bariatric procedures available as alternatives to traditional bariatric surgery. Many of these procedures offer similar results while avoiding some of the potential downsides associated with gastric bypass. These include:

  • Gastric Banding
    This laparoscopic surgery, sometimes referred to as a lap band or gastric band surgery, involves placing a restrictive silicone band around a portion of the stomach to slow the rate food enters your digestive tract.
  • Laparoscopic Sleeve Gastrectomy
    LSG is a surgery where a large portion of the stomach is removed and the remaining part of the stomach is stitched together into a sleeve-like shape.
  • Gastroplastia Endoscópica en Manga
    Similar to gastric sleeve surgery, ESG is an out-patient procedure where a suturing device is inserted through the mouth and into the stomach to stitch a portion of the stomach together into a thin tube much smaller than your normal stomach volume.
  • Gastric Balloon Placement
    Unlike the many varieties of weight loss surgery that alter the size of your stomach, the ORBERA® Managed Weight Loss Solution fills the volume of your stomach with a saline filled balloon. This occupies space in your stomach, leading you to feel full sooner and therefore reduce the amount you eat.
  • Medical Nutritional Therapy
    This last option moves from minimally invasive to not invasive at all. Rather than changing the size of your stomach or the amount of food you can physically fit in your body, medical nutritional therapy is a comprehensive system designed to keep you in direct contact with a team of specialists who can work with you as you find your way to a healthy weight.

Who is Gastric Bypass Surgery For?

Gastric bypass surgery is typically only performed if you have a BMI greater than 40 and are also suffering from comorbidities such as type 2 diabetes, sleep apnea, or other serious illnesses where excess body weight can contribute to negative health outcomes. Your doctor will also need to have determined you will be able to live and eat successfully within the restrictions of the very specific diet you will need to maintain after surgery.

Many people do not qualify for gastric bypass surgery because, while they may be carrying excess body weight, their BMI is too low or they are not a good candidate for surgery for a number of other reasons. This is where alternative procedures come into play. ESG, for example, is considered for people with a BMI as low as 30. Less invasive procedures like ORBERA® can also be recommended to patients who don’t meet the cutoff of a BMI over 40. 

One of the main criteria for who might be a good candidate for bariatric surgery is how well you will be able to maintain the strict diet and lifestyle changes necessary after surgery. Some patients who are not expected to have a good outcome with the rigorous demands of gastric bypass surgery can find success with procedures like Spatz3 that allow you to change your eating habits slowly. Even procedures such as sleeve gastrectomy, which greatly reduce the volume of your stomach, still leave more of your natural digestive processes intact.

Choosing a Gastric Bypass Alternative

Asking what type of weight loss surgery is “best” is a bit like debating the perfect wine or sorting out the best pair of shoes. What works for some situations will not work so well in others. Where a hearty cabernet won’t work well with a light fish dish, but will complement a steak, each weight loss procedure or surgery fits best with a certain set of conditions and desired outcomes. 

The most important thing to understand is the trade-off between outcomes and risks. Gastric bypass and laparoscopic sleeve gastrectomy have been found to produce some of the most dramatic weight loss numbers, but these surgeries require longer recovery times and can create more problems later on than other procedures. At the other end of the spectrum, individuals who participate in the ORBERA® Managed Weight Loss System do not usually lose as much weight, but there is a very low incidence of serious complications and the procedure is 100% reversible. 

How you decide what bariatric surgery alternative is right for you will depend on a variety of factors. Many of these you will discuss with your doctor including:

  • BMI
  • history of intestinal problems
  • ability to follow dietary guidelines
  • likelihood of other digestive complications
  • presence of other conditions such as type 2 diabetes

The last factor in your decision is one you are more likely to discuss with your accountant than your doctor, and that is cost. Depending on your insurance coverage, some bariatric procedures may be covered, but for many people, weight loss surgery or weight loss procedures are not considered a covered expense. If you do not meet the criteria set out by your insurance carrier, such as hitting a high enough BMI, you could be looking to foot the bill for your procedure yourself. At this point, the wide difference in cost between the various procedures starts to become a serious consideration.

What are the Risks of Bariatric Surgery?

At the most serious, the greatest risk associated with bariatric surgery is death. Malnutrition, infection, a rupture in your stomach or intestine, or even chronic dehydration are all very real possibilities following gastric bypass surgery. These may seem extreme, but the risks of carrying excess weight are also severe. 

Overeating is one of the most common, and most dangerous risks with traditional gastric bypass surgery. You may not think a few extra bites could cause serious complications, but after surgery the volume of your stomach is so small that even the slightest indulgence could result in severe pain or a rupture to your new stomach.  

At the other end of the spectrum nutritional problems stemming from the malabsorption of your food will be the side effects you are most likely to face post surgery. The likelihood of negative outcomes differ among the various procedures and surgeries available.

Even between similar surgeries, the results and risks can vary. Laparoscopic sleeve gastrectomy, where the excess part of your stomach is removed completely, and endoscopic sleeve gastroplasty, where the extra volume of the stomach is simply closed off but left in place, are similar in their intended outcomes, but there are significant differences in long-term rates of complications and the amount of weight people lose from these seemingly similar options.

Can you get Gastric Bypass Results without Surgery?

The answer to the question of whether you can get weight loss results without gastric bypass surgery will depend on many factors. Patients that are surrounded by a good team of doctors, nutritionists, and dietitians are those who are most likely to achieve their weight loss goals. 

If you have been advised by your doctor that weight loss surgery may be an option for you, then selecting the right bariatric surgeon is essential. Your surgeon is going to lead the team that will guide you through the maze of options, roadblocks, and opportunities that stand between you and the freedom of finding a healthy weight you can live with. From your first consultation to the many rounds of follow-up appointments, working with the right team will make all the difference. 

At True You Weight Loss, we know well that gastric bypass surgery is far from a “one size fits all” solution. We are committed to finding more cost-effective, less invasive solutions that can give you the results you are looking for without risking some of the severe side effects of traditional bariatric surgery. Request a consultation today if you want to know more about the options on the table as you consider whether weight loss surgery is an option for you.

Dr. Christopher McGowan
Dr. Christopher McGowan
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