The type of surgery that may be best to help a person lose weight depends on a number of factors. You should discuss with your doctor what kind of surgery might be best for you or your teen.
What is the difference between open and laparoscopic surgery?
In open bariatric surgery, surgeons make a single, large cut in the abdomen. More often, surgeons now use laparoscopic surgery, in which they make several small cuts and insert thin surgical tools through the cuts. Surgeons also insert a small scope attached to a camera that projects images onto a video monitor. Laparoscopic surgery has fewer risks than open surgery and may cause less pain and scarring than open surgery. Laparoscopic surgery also may lead to a faster recovery.
Open surgery may be a better option for certain people. If you have a high level of obesity, have had stomach surgery before, or have other complex medical problems, you may need open surgery.
What are the surgical options?
In the United States, surgeons use three types of operations most often:
- laparoscopic adjustable gastric band
- gastric sleeve surgery, also called sleeve gastrectomy
- gastric bypass
Surgeons use a fourth operation, biliopancreatic diversion with duodenal switch, less often.
Laparoscopic Adjustable Gastric Band
In this type of surgery, the surgeon places a ring with an inner inflatable band around the top of your stomach to create a small pouch. This makes you feel full after eating a small amount of food. The band has a circular balloon inside that is filled with salt solution. The surgeon can adjust the size of the opening from the pouch to the rest of your stomach by injecting or removing the solution through a small device called a port placed under your skin.
After surgery, you will need several follow-up visits to adjust the size of the band opening. If the band causes problems or is not helping you lose enough weight, the surgeon may remove it.
The U.S. Food and Drug Administration (FDA) has approved use of the gastric band for people with a BMI of 30 or more who also have at least one health problem linked to obesity, such as heart disease or diabetes.
Gastric Sleeve
In gastric sleeve surgery, also called vertical sleeve gastrectomy, a surgeon removes most of your stomach, leaving only a banana-shaped section that is closed with staples. Like gastric band surgery, this surgery reduces the amount of food that can fit in your stomach, making you feel full sooner. Taking out part of your stomach may also affect gut hormones or other factors such as gut bacteria that may affect appetite and metabolism. This type of surgery cannot be reversed because some of the stomach is permanently removed.
Gastric Bypass
Gastric bypass surgery, also called Roux-en-Y gastric bypass, has two parts. First, the surgeon staples your stomach, creating a small pouch in the upper section. The staples make your stomach much smaller, so you eat less and feel full sooner.
Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section farther down to the lower part of the small intestine. This bypassed section is still attached to the main part of your stomach, so digestive juices can move from your stomach and the first part of your small intestine into the lower part of your small intestine. The bypass also changes gut hormones, gut bacteria, and other factors that may affect appetite and metabolism. Gastric bypass is difficult to reverse, although a surgeon may do it if medically necessary.
Duodenal Switch
This surgery, also called biliopancreatic diversion with duodenal switch, is more complex than the others. The duodenal switch involves two separate surgeries. The first is similar to gastric sleeve surgery. The second surgery redirects food to bypass most of your small intestine. The surgeon also reattaches the bypassed section to the last part of the small intestine, allowing digestive juices to mix with food.
This type of surgery allows you to lose more weight than the other three. However, this surgery is also the most likely to cause surgery-related problems and a shortage of vitamins, minerals, and protein in your body. For these reasons, surgeons do not perform this surgery as often.
Most Common Weight-loss Surgeries
Gastric Band
What it is
Surgeon places an inflatable band around top part of stomach, creating a small pouch with an adjustable opening.
Pros
- Can be adjusted and reversed.
- Short hospital stay and low risk of surgery-related problems.
- No changes to intestines.
- Lowest chance of vitamin shortage.
Cons
- Less weight loss than other types of bariatric surgery.
- Frequent follow-up visits to adjust band; some people may not adapt to band.
- Possible future surgery to remove or replace a part or all of the band system.
Gastric Sleeve
What it is
Surgeon removes about 80 percent of stomach, creating a long, banana-shaped pouch.
Pros
- Greater weight loss than gastric band.
- No changes to intestines.
- No objects placed in body.
- Short hospital stay.
Cons
- Cannot be reversed.
- Chance of vitamin shortage.
- Higher chance of surgery-related problems than gastric band.
- Chance of acid reflux.
Gastric Bypass
What it is
Surgeon staples top part of stomach, creating a small pouch and attaching it to middle part of small intestine.
Pros
- Greater weight loss than gastric band.
- No objects placed in body.
Cons
- Difficult to reverse.
- Higher chance of vitamin shortage than gastric band or gastric sleeve.
- Higher chance of surgery-related problems than gastric band.
- May increase risk of alcohol use disorder.
What should I expect before surgery?
Before surgery, you will meet with several health care providers, such as a dietitian, a psychiatrist or psychologist, an internist, and a bariatric surgeon.
- The doctor will ask about your medical history, do a thorough physical exam, and order blood tests. If you are a smoker, he or she will likely ask you to stop smoking at least 6 weeks before your surgery.
- The surgeon will tell you more about the surgery, including how to prepare for it and what type of follow-up you will need.
- The dietitian will explain what and how much you will be able to eat and drink after surgery and help you to prepare for how your life will change after surgery.
- The psychiatrist or psychologist may do an assessment to see if bariatric surgery is an option for you.
These health care providers also will advise you to become more active and adopt a healthy eating plan before and after surgery. In some cases, losing weight and bringing your blood sugar levels closer to normal before surgery may lower your chances of having surgery-related problems.
Some bariatric surgery programs have groups you can attend before and after surgery that can help answer questions about the surgery and offer support.
What should I expect after surgery?
After surgery, you will need to rest and recover. Although the type of follow-up varies by type of surgery, you will need to take supplements that your doctor prescribes to make sure you are getting enough vitamins and minerals.
Walking and moving around the house may help you recover more quickly. Start slowly and follow your doctor’s advice about the type of physical activity you can do safely. As you feel more comfortable, add more physical activity.
After surgery, most people move from a liquid diet to a soft diet such as cottage cheese, yogurt, or soup, and then to solid foods over several weeks. Your doctor, nurse, or dietitian will tell you which foods and beverages you may have and which ones you should avoid. You will need to eat small meals and chew your food well.
How much weight can I expect to lose?
The amount of weight people lose after bariatric surgery depends on the individual and on the type of surgery he or she had. A study following people for 3 years after surgery found that those who had gastric band surgery lost an average of about 45 pounds. People who had gastric bypass lost an average of 90 pounds. Most people regained some weight over time, but weight regain was usually small compared to their initial weight loss.
Researchers know less about the long-term results of gastric sleeve surgery, but the amount of weight loss seems to be similar to or slightly less than gastric bypass.
Your weight loss could be different. Remember, reaching your goal depends not just on the surgery but also on sticking with healthy lifestyle habits throughout your life.
Weight-loss Devices
The FDA has approved several new weight-loss devices that do not permanently change your stomach or small intestine. These devices cause less weight loss than bariatric surgery, and some are only temporary. The devices may have risks, so talk with your doctor if you’re thinking about any of these options. Researchers haven’t studied any of them over a long period of time and don’t know the long-term risks and benefits.
- The electrical stimulation system uses a device implanted in your abdomen, by way of laparoscopic surgery, that blocks nerve activity between your stomach and brain. The device works on the vagus nerve, which helps signal the brain that the stomach feels full or empty.
- The gastric balloon system consists of one or two balloons placed in your stomach through a tube inserted through your mouth. Your doctor or nurse will give you a sedative before the procedure. Once the balloons are in your stomach, doctors inflate them with salt water so they take up space in your stomach and help you feel fuller. You will need to have the balloons removed after 6 months or a year.
- A new device uses a pump to drain part of the food in your stomach after a meal. The device includes a tube that goes from the inside of your stomach to a port on the outside of your abdomen. The port is a small valve that fits over the opening in your abdomen. About 20 to 30 minutes after eating, you attach tubing from the port to the pump and open the valve. The pump drains your stomach contents through a tube into the toilet, so that your body doesn’t absorb about 30 percent of calories you ate. You can have the device removed at any time.
What are the side effects of bariatric surgery?
Side effects may include
- bleeding
- infection
- leaking from the site where the sections of the stomach or small intestine, or both, are stapled or sewn together
- diarrhea
- blood clots in the legs that can move to the lungs and heart
Rarely, surgery-related problems can lead to death.
Other side effects may occur later. Your body may not absorb nutrients well, especially if you don’t take your prescribed vitamins and minerals. Not getting enough nutrients can cause health problems, such as anemia and osteoporosis. Gallstones can occur after rapid weight loss. Some doctors prescribe medicine for about 6 months after surgery to help prevent gallstones. Gastric bands can erode into the stomach wall and need to be removed.
Other problems that could occur later include strictures and hernias. Strictures—narrowing of the new stomach or connection between the stomach and small intestine—make it hard to eat solid food and can cause nausea, vomiting, and trouble swallowing. Doctors treat strictures with special instruments to expand the narrowing. Two kinds of hernias may occur after bariatric surgery—at the incision site or in the abdomen. Doctors repair hernias with surgery.
Some research suggests that bariatric surgery, especially gastric bypass, may change the way your body absorbs and breaks down alcohol, and may lead to more alcohol-related problems after surgery.
