Weight Loss Surgery

Weight Loss Surgery 101

By Laura Colarusso



Medical researchers are gaining new ground in the fight against unwanted fat. Revolutionary new procedures are making their way from the lab to the OR. And, these procedures are proving valuable in curing diabetes, sleep apnea and even reducing the risk of cancer in obese patients. With all of these new and in some cases unproven weight-loss surgery alternatives, what's the right solution for you? Here's a guide to help you wade through the pros and cons of the different options.


Roux-en-Y Gastric Bypass

The gastric bypass is the most common bariatric surgery in the United States. It may become even more popular now with new studies showing it may eliminate type 2 diabetes, owing to the fact that post-surgery patients are forced to drastically cut back on eating sugary foods. During the procedure, a surgeon creates a small stomach chamber usually a pouch that can hold about an ounce of food and reconnects it to the lower intestine. The procedure yields more weight-loss than dieting alone ever could, according to Shikora. In the first two years after surgery, a patient could lose up to two-thirds of their excess weight. However, as with any operation, blood clots or internal bleeding could occur.


Laparoscopic Adjustable Gastric Banding (LAGB)

LAGB uses a silicon band to loop around the upper part of the stomach and create a small pouch to hold food. The band limits food intake and increases digestion time. This surgery is customizable and can be fine tuned for a patient's individual needs, said Dr. Kelvin Higa, a clinical surgery professor at the University of California San Francisco. And, like gastric bypass, new medical evidence suggests that LAGB can help cure diabetes. Though it's considered safer than bypass surgery gastric banding isn't quite as effective for weight-loss. Another downside to the LAGB is that the silicon band itself could erode or become displaced.


Biliopancreatic Diversion

With biliopancreatic diversion surgery, about half -- if not more -- of the stomach is removed and then the intestinal tract is then attached to what's left. After this operation, patients eat less and their bodies only absorb a fraction of those calories. The surgery is often done for patients who weigh 500 pounds or more and aren't candidates for the traditional gastric bypass, said Dr. Scott Shikora, chief of bariatric surgery at Tufts Medical Center in Boston. Though effective, the surgery is permanent and technically more difficult that other bariatric procedures so complications can occur.


Vertical Sleeve Gastrectomy

With the vertical sleeve gastrectomy, surgeons cut away roughly 60 percent of the stomach to make it into a skinny tube between the esophagus and the intestines. There's little to no bypassing of the intestines, so theoretically there's no loss of vitamin and mineral absorption. One of the downsides is that researchers don't know enough about it yet and it's not reversible, Higa said. However, early indications are that this operation results in about as much weight-loss as a regular bypass. And, it could be safer for patients who are too big or sick for the bypass procedure.


Duodenal Switch

With the duodenal switch, the surgeon removes about 60 percent of the stomach. The bottom of the stomach is then attached to the lower intestine further down than it would be with a gastric bypass. The duodenal switch offers a patient the potential to lose up to 80 percent of their excess weight. And, they have the ability to eat larger portions than with gastric bypass or adjustable gastric banding, according to the Center for Obesity Study at Columbia University. However, because the body doesn't absorb as much food, a patient will have to be monitored for vitamin, mineral and protein deficiencies.


Vertical Banded Gastroplasty (VBG)

With vertical banded gastroplasty, or stomach stapling, the upper portion of the stomach is stapled to create a small pouch. Doctors place a band around the opening of the pouch to the rest of the stomach. This causes the food to move slower and creates a feeling of fullness. On the plus side, patients don't experience nutritional deficiencies like they do with other weight-loss procedures, according to the American Society for Metabolic & Bariatric Surgery. However, long-term studies that show a patient is likely to regain weight years after the surgery. And, the staples in the stomach can break down.


VBLOC Therapy

A newer technique known as VBLOC is in the clinical trial stage. With VBLOC, surgeons laparoscopically place electrodes at the point where the esophagus meets the stomach. The goal is to suppress appetite by blocking signals from the brain to the digestive system. The jury is still out on how well this therapy could work -- if at all -- in humans, said Shikora. However, if it does prove successful, the treatment would be less invasive than other surgeries. And it won't disrupt the shape of the stomach or its connection with the intestines.

Natural Orifice Transluminal Endoscopic Surgery

Instead of slicing open the body to partition off the stomach, doctors are researching ways to accomplish that from the inside. By using an endoscope or a long, thin, tube-shaped instrument that can be used to staple off or suture parts of the stomach doctors can go in through the mouth to make an internal incision. That means that patients can skip many of the complications like external scarring that are associated with other types of surgery. The potential benefits will also include less pain and a quicker recovery, according to Dr. Higa. However, the procedure is in the infancy stage so its effectiveness has not been established.