Guide to Types of Weight Loss Surgery
About Weight Loss Surgery
Dieting and exercise are not effective and durable solutions for people who attempt to lose weight and keep it off. Weight loss surgery is a proven way to fight obesity. Bariatrics shifts the body’s set-point, also known as a metabolic thermostat, resulting in rapid and long-term weight loss.
Weight loss surgery can cure obesity and its related diseases, like hypertension, type 2 diabetes, and heart conditions. It also lowers the risk of virus exposure, such as COVID-19 Coronavirus.
Mechanism of Action
Weight loss surgeries, also known as “Gut Cut,” can be classified into three broad categories, depending on the way the operation achieves weight loss; restrictive, malabsorptive, and a combination of restrictive & malabsorptive.
1. Restrictive
Restrictive procedures ‘restrict’ the stomach’s capacity, thereby reducing caloric intake. The smaller stomach capacity will induce the feeling of fullness quicker than normal, prompting the patients to eat less. This method is seen in procedures such as adjustable gastric banding, vertical sleeve gastrectomy (gastric sleeve), and gastric balloon.
2. Malabsorptive
Malabsorptive procedures reroute, rearrange, or remove part of the digestive system to reduce the body’s absorption of calories from food. They produce more weight loss than restrictive but also come with higher rates of complications and side effects. There are no stand-alone malabsorptive procedures being performed today, as all malabsorptive procedures are combined with restriction.
3. Combination
Combination procedures use both techniques (restrictive and malabsorptive) to produce high amounts of excess weight loss. Common combination procedures include gastric bypass and duodenal switch.
All the bariatric surgery options are done laparoscopically (minimally invasive) unless there are issues, like scar tissue from previous operations, that calls for traditional open surgery.
Learn More: Which Bariatric Surgery is Best for Me?
Common Types of Weight Loss Surgery
Below are the five primary weight loss surgery options that are typically accepted and practiced by bariatric surgeons in the United States, Canada, Mexico, and Europe. Other countries, aside from the United States, like Europe and Mexico, are quicker to approve more experimental procedures.
Surgery Type | Gastric Sleeve | Gastric Bypass | Mini Bypass | Duodenal Switch | LAP-BAND | Gastric Balloon |
|---|---|---|---|---|---|---|
| Procedure Diagram |  |  |  |  |  |  |
| Method | Restrictive | Restrictive & Malabsorptive | Restrictive & Malabsorptive | Restrictive & Malabsorptive | Restrictive | Restrictive |
| Duration | 60-90 mins | 90-120 mins | 60-120 mins | 180-240 mins | 60-90 mins | 20-30 mins |
| Hospital Stay | 2 days | 3 days | 3 days | 3 days | 2 days | Outpatient |
| Average Weight Loss | 50-70% | 60-80% | 65-80% | 70-90% | 40-50% | 10-15% |
| Digestive Alteration | No | Yes | Yes | Yes | No | No |
| Risk of Malnutrition | Low | Moderate | Moderate | High | Low | Low |
| Reversibility | No | No | Potentially | No | Yes | Yes |
| Maintenance | Low | Moderate | Moderate | High | High | Moderate |
| Possible Complications | Leakage Stricture | Dumping syndrome Nutritional deficiencies | Dumping syndrome Ulcers | Vitamin deficiencies Protein malnutrition | Band erosion Slippage | Nausea Deflation |
| Candidate Efficacy | BMI of 30+ | BMI of 35-55 | BMI of 35-55 | BMI of 40-45+ | BMI of 30+ | BMI of 27+ |
Obesity Treatment Options
Popular Procedures
Vertical Sleeve Gastrectomy, RNY Gastric Bypass, Mini Gastric Bypass, and Duodenal Switch procedures are mainstream. There is enough long-term data for its safety and effectiveness to cure morbid obesity.
Gastric Sleeve Surgery is one of the most innovative bariatric surgeries performed in the Tijuana bariatric center today by our medical staff. It is the fastest-growing bariatric surgery type and overtakes gastric bypass as the “gold standard” or general surgery procedure for weight loss surgery.
In the Gastric Sleeve procedure, about 85% of the stomach is removed, restricting the amount of food you eat, and you feel full fast. You also feel less hungry as most of the “hunger hormones” are removed. Gastric Sleeve is an excellent option as it doesn’t change your digestive tract and allows patients the widest possible dietary choices. However, it does vary per individual.
Advantages:
- Quick, minimally invasive bariatric procedure
- Short recovery time
Disadvantages:
- Non-reversible
- Newer procedure than bypass, yet a very successful procedure
Expected Weight Loss (EWL) = ~65 % to 75%
Success Rate = ~80% to 90%
Gastric Bypass Surgery, also known as Roux-en-Y (RNY for short), was at one point the “gold standard” of bariatric surgery. Gastric bypass is a very effective weight loss procedure that creates a new egg-shaped pouch as the new stomach (restriction) while also rerouting the small intestines (malabsorption). RNY gastric bypass resolves metabolic diseases, such as diabetes type 2.
Advantages:
- High amount of expected weight loss
- Can improve medical conditions like type II diabetes, high blood pressure, and sleep apnea
Disadvantages:
- Chance of dumping syndrome and vomiting
- Higher risk of ulcers after the procedure
Expected Weight Loss (EWL) = ~70 % to 80%
Success Rate = ~80% to 90%
In the Single Incision Gastric Sleeve, only one incision is made through the belly button instead of traditional five incisions. Single-Port Sleeve Gastrectomy leaves little to no scars and is aesthetically pleasing. One incision site has added the benefit of reduced postoperative pain and faster recovery.
Patients with a BMI of less than 40 are a good candidate for single-incision gastric sleeve surgery. SILS has the same expected weight loss and success rate as a regular LSG.
Expected Weight Loss (EWL) = ~65 % to 75%
Success Rate = ~80% to 90%
Mini Gastric Bypass (MGB) is similar to Roux-en-Y gastric bypass. This procedure creates a new, small stomach pouch shaped like a tube, and only one anastomosis (Y connection) is formed instead of two. Therefore, the operation is faster and results in less risk of complications and side effects.
This operation is quickly gaining notoriety as being one of the safest and most efficient forms of bariatric surgery, surpassing the original Gastric Bypass surgery.
Expected Weight Loss (EWL) = 70 % to 80%
Success Rate = 85% to 90%
Duodenal Switch Surgery is a powerful weight loss and metabolic surgery with the highest expected weight loss of any bariatric surgery. The duodenal switch is composed of both restrictive and malabsorptive components, leaving this surgery to those who are morbidly obese and in the highest BMI bracket.
Duodenal Switch can be the second step after gastric sleeve as it removes about 70% of the stomach using the gastric sleeve method but reroutes a significant part of the small intestine. Single Anastomosis Duodenal Switch (SADI-S) is a newer version of DS surgery.
Advantages:
- 98% of patients with type two diabetes are “cured”
- Patients lose an average of 50% to 80% of their excess weight in the first year
Disadvantages:
- Extremely strict vitamins are required for life
- Higher complication rate than other bariatric procedures
Expected Weight Loss (EWL) = ~75 % to 85%
Success Rate = ~70% to 90%
Mexico Bariatric Center Gastric Sleeve Revision
Weight loss surgery can and does fail at times for a variety of reasons. Revisional Surgery is needed to rescue and/or correct unsuccessful bariatric procedures. One particular procedure that typically fails is Gastric Band Surgery. Patients with failed Lap-Band can opt to get the gastric sleeve or gastric bypass – this can be a one-time or a two-time process depending on the Lap-Band condition.
Sometimes, sleeve patients do not reach the targeted weight and need to revise their gastric sleeve to gastric bypass / mini gastric bypass or duodenal switch. Gastric bypass patients who were not getting their ideal goal have fewer options to alter their surgery: 1. the pouch can be reduced laparoscopically or endoscopically, 2. the Roux limb can be lengthened, 3. lap-band can be added or converted to Duodenal Switch. Some of the older surgeries, like Jejunoileal Bypass (JIB) and Vertical Banded Gastroplasty (VBG), can be converted to gastric sleeve or gastric bypass / mini bypass.
Non-Surgical (Incisionless) Procedures
Only 1% of eligible individuals undergo surgical obesity treatment. Endoscopic Bariatric and Metabolic Therapies (EMBT) are developed to fill up the gap between diet/pharmacotherapy and the operation.
The Intra Gastric Balloon (IGB) is an implant that places a fillable balloon in the stomach to reduce capacity. Patients who are not convinced of undergoing bariatric surgery, gastric balloon is an excellent non-surgical (via Endoscopic) option that allows patients to lose weight.
- Orbera Weight Management System
- Spatz3 Balloon System
- ReShape Duo Balloon
- Obalon Gastric Balloon
To get a jump start in losing weight patients can opt to IntraGastric Balloon and is NOT a permanent weight loss solution, and the balloon can only be in the stomach for up to one year.
Advantages:
- Non-surgical
- Reversible
- Balloon usually stays in stomach for 6 months to 1 year
Disadvantages:
- Lower expected weight loss
- Discomfort and potential complications
Endoscopic Sleeve Gastroplasty is a new procedure that aims to reduce weight without the need for invasive surgical options. The bariatric physician inserts a thin scope with a suturing probe endoscopically to accomplish a similar restriction as to the gastric sleeve surgery. Individuals interested in this non-surgical procedure must be considered obese with a 30 or greater body mass index (BMI). For sustainable weight loss after ESG, patients must establish an adequate diet, active exercise regime, and commit to a healthy lifestyle.
Experimental Procedures
Experimental procedures are either upcoming FDA approval or approved in another country other than the United States. These procedures could be promising, however, there is not enough data to support them like gastric plication.
Restrictive: Restrictive operations in the pilot study,
- Nissen Sleeve Gastrectomy (N-Sleeve) – Nissen anti-reflux valve is added to a standard Sleeve Gastrectomy to control acid reflux
- Primary Obesity Surgery Endolumenal (POSETM) Procedure
- Transoral Gastric Volume Reduction (TGVR).
Malabsorptive: EndoBarrier Gastrointestinal Liner (on hold due to safety concerns)
Laparoscopic Gastric Plication (LGP) is a rather new bariatric surgery procedure that uses the restrictive technique to achieve weight loss. The operation is very similar to gastric sleeve surgery in the restriction of the stomach.
There is limited data to support long-term effectiveness and outcomes associated with this procedure. Due to the adverse effects, MBC surgeons are NOT supportive of this procedure at present.
Outdated Procedures
Outdated procedures have too many complications and have less expected weight loss, like Vertical Banded Gastroplasty (VBG), Lap-Band (Gastric Banding), Jejunocolic Bypass and Jejunoileal Bypass.
Procedures like Jejunoileal Bypass was performed in the late 1960s after surgeons learned that patients who had lost a portion of their small intestine would lose weight. These surgeries are no longer performed due to their high complication rates and a slew of health problems including fatality.
Lap Band is a surgical implant that restricts the stomach capacity. The inflatable silicone ring placed over the stomach creates a small pouch and limit food intake.
This procedure was once the most prevalent bariatric surgeries in the United States and Canada. However, the lack of long-term weight loss and its safety concerns has mostly declined its use. Most patients with faulty lap-band are undergoing correctional surgery, converting gastric band to another surgery type, typically gastric sleeve or gastric bypass.
The gastric band is still used, however, to rescue other failed surgeries like gastric bypass.
Expected Weight Loss (EWL) = ~40 % to 50%
Success Rate < 50%
The Jejunoileal Bypass (JIB) was performed from 1950 to 1970 to cure morbidly obese patients with two variations: ES (end-to-side) and EE (end-to-end). The Jejunoileal Bypass is a malabsorptive procedure and bypasses most of the intestine.
JIB caused severe complications due to malabsorption, such as diarrhea, night blindness, osteoporosis, liver disease/failure, vitamin deficiencies, malnutrition, and death.
Vertical Banded Gastroplasty (VBG) was performed as a restrictive or combination of restrictive and malabsorptive surgery, also known as ‘stomach stapling.’ VBG was designed to be a safer alternative to RYGBP and the JIB. In this procedure, a gastric band and staples are utilized to create a small stomach pouch to restrict the amount of food content traveling down to gastrointestinal tract.
Newer Procedures
The newer procedures, without proven long-term data, offered today are:
vBloc® Therapy
, or vBloc neurometabolic therapy, is a Neuro-Metabolic Therapy approved by FDA to treat obesity. A benefit of the vBloc procedure is that it is safe, reversible, and doesn’t alter patient anatomy.
A pacemaker-like device controls the hunger signals between the brain and stomach to feel fuller longer and reduce the amount of food you want to eat. The vBloc, or vagal blocking, works directly with hunger signals to the brain, ultimately blocking the receptors that make you feel hungry. The electrodes placed on the trunk of the vagus nerve are minimally invasive.
The company reports an average of 28% excess weight loss (EWL) experienced in one year. The outcome of vBloc works similarly to the effect of a gastric sleeve, as the vBloc makes you feel full throughout the day will decreasing the food intake.
Serious Adverse Events (SAE) related to this procedure includes neuro-regulator malfunction, pain at the neuro-regulator site, vomiting, collapsed lung and gallbladder disease.
Aspire, or AspireAssist, is also a newly developed, FDA approved tool for weight loss and obesity treatment. The benefit of AspireAssist is being a non-surgical, outpatient procedure. It is used as a more effective weight loss strategy to that of dieting or physical activity.
It is a middle ground between dieting and bariatric surgery. The AspireAssist is reversible with the procedure only lasting 15 minutes. The Aspire procedure is a stomach pump with a small tube that directly connects to your stomach and can be drained after eating.
It removes around one-third of the food contained within your stomach, therefore absorbing one third fewer calories within your body. This procedure is considered “disgusting” by some reviewers as you literally pump food after you eat into the toilet.
Bariatric Arterial Embolization (BAE) for obesity is a minimally invasive technique that trans-arterially embolizes the gastric fundus.
Open vs. Laparoscopic vs. Single Incision vs. Endoscopic
In the past, bariatric procedures were performed with an open abdominal incision. Nowadays, most bariatric surgeries are performed laparoscopically with excellent results. Qualified bariatric surgeons are quite experienced with laparoscopic surgery, producing surgeries with lower recovery time, lower surgical complications, and aesthetically pleasing results.
Open Bariatric Surgery
Open surgery was done through a large incision in the abdomen for the entire surgery to perform. With the advancement of medical technolgies, open surgeries are rarely performed, due to longer recovery periods as well as higher risks of infection, adhesions, and cosmetic scarring.
Laparoscopic Surgery
Laparoscopic surgery is performed with medical instruments that have built-in cameras allowing surgeons to view the abdomen on nearby screens. The result is that there are five to six small incisions, rather than one large cut in the abdomen with open surgery.
Single Incision Surgery
Single Incision bariatric surgery allows patients to undergo bariatric surgery with fewer scars. The patient’s scars heal more aesthetically while speeding up the healing time. Single Incision bariatric surgery is only available on more simplistic surgeries such as the gastric sleeve surgery.
Endoscopic Surgery
The endoscopic procedure utilizes an endoscope, a flexible medical instrument inserted through the mouth, rather than making an incision in traditional surgery. In newer, experimental procedures such as such as Endoscopic Sleeve Gastroplasty, the endoscope is used to place sutures in the stomach and making it smaller.
Stomach Banding vs. Stomach Stapling
Many individuals may conflate stomach surgery and stomach stapling as both are bariatric (weight loss) surgery. Both are essential components in weight loss surgery, but are different, and thus, necessary to distinguish.
Stomach Banding
Stomach banding procedure relies on a medical device to wrap around and ‘band’ the stomach, thereby causing restriction – vertical banded gastroplasty and gastric banding.
Stomach Stapling
This type uses medical staples to recreate permanently and close a smaller stomach for individuals – gastric sleeve surgery and roux-en-y gastric bypass.
* Success is normally realized by losing 50% of excess weight (EWL) and it depends on the type of surgery, BMI before surgery, surgeon competency, and post-surgery diet & exercise.
