Bariatric Surgery

Which weight loss procedure is right for me?

There is no single right answer for all patients. The choice of procedure is a personal decision. When you satisfy the medical criteria for weight loss surgery and are committed to making lifestyle changes, you will lose weight and keep it off.  There are three common choices: gastric sleeve, gastric bypass and Adjustable lap band. All procedures provide the benefits of weight reduction and resolution of co-morbid conditions such as type 2 diabetes and reduced cardiovascular risk and overall mortality. Common risks include nutritional deficiencies, GERD, bowel obstruction, dumping syndrome (diarrhea, nausea and vomiting), gall stones, hernias, low blood sugar, and malnutrition. Surgical risks include adverse reactions to anesthesia, blood clots, breathing problems, and infection. Bariatric surgery is major surgery.

Laparoscopic Gastric Sleeve surgery (LSG)

LSG surgery is newer and is best for people with a BMI of at least 40 but may be offered with to patients with a BMI of 35 who have a serious medical condition like type 2 diabetes or heart disease, that can be treated or reversed with weight loss surgery. LSG involves the removal of up to 80% of the stomach volume and the creation of a small sleeve-shaped stomach using staples. The result is restricted food intake, less hunger and faster digestion. LSG resets the metabolic system which increases metabolism and treats hormone changes that facilitate weight loss. You may go home the day after surgery. Recovery takes about 3-5 weeks.

How much weight can you lose and how fast?

You can expect to lose 53.25% of your excess weight at five years after surgery and sustainable weight loss over the long term (10 year or more).

What are the risks and potential complications?

Complications include abdominal pain, leakage of stomach contents, stricture, fatigue, bloating, dumping syndrome, scarring that can lead to a bowel blockage, narrowing at the middle of the stomach which may require stretching, inflammation, and gall bladder disease. If revision is necessary, gastric bypass surgery is the choice.

Laparoscopic Gastric Bypass surgery (LGB)

LGB surgery is widely used to treat morbid obesity because it offers the greatest amount of weight loss. This surgery involves changing how your food is treated in the stomach and small intestines. First, the stomach is made smaller using staples, which creates a pouch the size of a walnut that can hold only about 1 oz. of food. The second step is the bypass where the surgeon connects a small part of the small intestines to a small hole in the stomach pouch. When you eat food passes into the small intestines faster which means you absorb fewer calories. A short hospital stay is needed, but recovery is relatively fast

How much weight can you lose and how fast?

You can expect to lose 63% of your excess weight at five years and which is sustainable over the long term (10 year or more).

What are the risks and potential complications?

Early postoperative serious complications include leak, obstruction and hemorrhage. The most serious is a leak but this affects less than 5% of patients. Bowel obstruction occurs in less than 5% of patients, similar to other abdominal and pelvic surgeries. Hemorrhage  occurs in less than 1% of all bypass patients. Dumping syndrome is expected in the first few months after surgery. Long term complications can result in reoperation in 3-20% of cases. 10-15% of patients fail to achieve weight loss goals or regain weight after bypass surgery.

Laparoscopic Adjustable Lap Band surgery (LALB)

Adjustable lap band surgery involves inserting a silicone band around the upper part of the stomach which decreases the size of the stomach and restricts the amount of food you can eat until you are full. It is minimally invasive and is reversable and adjustable. Adjustments can be made in the doctor’s office. This is often an outpatient procedure. 

How much weight can you lose?

Weight loss is slower than with other surgical procedures. You can expect to lose about 50% of your excess weight at two years and sustain that weight loss over the long term (10 year or more). After the procedure you can expect to be able to eat no more than 3/4ths of a cup of food. If you try to eat more, you can become nauseous and vomit.

What are the risks and potential complications?

LALB is effective at inducing weight loss and improving comorbid conditions. This procedure poses fewer risks than gastric sleeve and bypass. Long term complications include slipping of the band or mechanical problems, band erosion, and infection. Some complications can be managed in the office. However, LALB fails in 20-60% of cases either due to insufficient weight loss and/or complications. In that case, revision surgery may be necessary.  After failed a LALB, revisional surgery options include laparoscopic gastric bypass and gastric sleeve. Revisional surgery with either procedure is safe and effective, but gastric bypass surgery ensures greater weight loss at 24-month follow-up.

Your surgeon at Advanced Surgical and Bariatric of New Jersey, will discuss all your goals and options with you and make recommendations, so that you can make an informed choice about what is right for you.

This page was modified on Nov 3, 2020 by Dr. Sadek (Surgeon) of Advanced Surgical & Bariatrics
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