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.
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.
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)
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.
Newer Procedures
The newer procedures, without proven long-term data, offered today are:
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.