Weight Loss Surgery

Weight Loss Surgery

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.


Robert Daly

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 that studies show 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 Scott Shikora, M.D., chief of bariatric surgery at Tufts Medical Center in Boston. 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 Kelvin Higa, M.D., a clinical surgery professor at the University of California San Francisco. And, like gastric bypass, new medical evidence suggests that LAGB can help cure type 2 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.


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. The downsides are 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.


Biliopancreatic Diversion

With biliopancreatic diversion surgery, about half -- if not more -- of the stomach is removed and then the intestinal tract is 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 Shikora. Though effective, the surgery is permanent and technically more difficult than other bariatric procedures, so complications can occur.


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. Plus, 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 show a patient is likely to regain weight years after the surgery. Also, 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, via the vagus nerve, 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 wouldn'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 partitioning from the inside. By using an endoscope, or a long, thin, tube-shaped instrument, doctors can enter through the mouth to staple off or suture parts of the stomach, making only an internal incision. That means 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.