Guide to Types of Weight Loss Surgery

About Weight Loss Surgery

Dieting and exercise are not an effective and durable solution 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.

Method 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 tissues from previous operations, that calls for traditional open surgery.

Read benefits of weight loss surgery

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. In other countries, especially countries in Europe, are quicker to approve more experimental procedures.

Surgery Type

Gastric Sleeve

Gastric Bypass

Mini Bypass

LAP-BAND

Duodenal Switch

Procedure Diagram

Gastric Sleeve SurgeryGastric Bypass Surgery Schematic - Sleeve vs BypassMini Gastric Bypass Surgery Schematic - How it Works - Mini Bypass in MexicoLap Band - Adjustable Gastric BandDuodenal Switch Surgery Schematic

Method of Weight Loss

RestrictiveRestrictive & MalabsorptiveRestrictive & MalabsorptiveRestrictiveRestrictive & Malabsorptive

Stomach Alterations

~80% removed (1 to 3 ounces)small pouch (stoma)small sleeve shape pouchstomach size is reduced~75% removed like gastric sleeve

Changes to Intestines

no changessmall intestine is bypassedsmall intestine is bypassedno changeslast several feet of small intestine is switched

Operating Time

1 to 2 hours2.5 hours2.5 hours1 to 2 hours3 to 4 hours

Average Hospital Stay

2 days2 to 3 days2 to 3 days1 day2 to 3 days

Time Off Work

1-2 weeks2 to 3 weeks2 to 3 weeks1 week3 weeks

Recovery Time

3 weeks6 weeks6 weeks2 weeks8 weeks

Advantages

– no change to anatomy
– high weight loss
– helps with comorbidities
– high weight loss
– helps with comorbidities
– high weight loss
– helps with comorbidities
– reversible– very high weight loss
– helps with comorbidities

Disadvantages

– non-reversible– dumping syndrome– dumping syndrome– complications with the band– frequent bowel movement

Realistic Expectations

60% to 70% EWL in 1-2 years after surgery70% to 80% EWL in 2 years after the surgery70% to 80% EWL in 1 year after surgery40% to 50% EWL75% to 85% EWL in 1 year after surgery

Success Rate

85% to 95%80% to 90%85% to 90%40% to 50%85% to 95%

Post Surgery Diet

4 Stages Post-Op Diet4 Stages Post-Op Diet4 Stages Post-Op DietFollow a Liquid Diet for 3 weeks then slowly add solid foods4 Stages Post-Op Diet

Post-op Diet Info

Water, Protein, Calcium, B12, and MultivitaminsWater, Protein, Calcium, B12, Zinc, Iron, and MultivitaminsWater, Protein, Calcium, B12, Zinc, Iron, and MultivitaminsEat 3-5 Small Meals Daily, No More than 1,000 Calories/DayWater, Protein, Calcium, B12, Zinc, Iron, and Multivitamins

Candidate Efficacy

BMI of 30+BMI of 35-55BMI of 35-55BMI of 30+ disciplined in following diet/exerciseBMI of 40-45+

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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 Schematic - Bariatric Services in MexicoGastric Sleeve Surgery is one of the most innovative of bariatric surgeries performed in Tijuana bariatric center today by our medical staff. It is the fastest growing bariatric surgery type and is overtaking 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 thereby 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 for patients the widest possible dietary options. However it does vary per individual.

Advantages:

  • Quick, minimally invasive bariatric procedure
  • Short recovery time

Disadvantages:

  • Non-reversible
  • Newer procedure than bypass, yet very successful procedure

Expected Weight Loss (EWL) = ~65 % to 75%
Success Rate = ~80% to 90%

Gastric Bypass Surgery RNY Schematic

Gastric Bypass Surgery, also known as roux-en-y (RNY for short), was at one point the “gold standard” of bariatric surgery. The gastric bypass, or Roux en Y (RNY), 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).

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%

Single-incision gastric sleeve surgery, SILS

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 Surgery - Gastric Bypass vs Mini Gastric Bypass

Mini Gastric Bypass (MGB) is similar to Roux-en-Y gastric bypass. This procedure creates a new, small stomach pouch that is shaped like a tube and there is only one anastomosis (Y connection) 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 - How it Works - DS in Mexico

Duodenal Switch Surgery is a powerful weight loss and metabolic surgery, with the highest expected weight loss of any bariatric surgery. Duodenal switch is composed of both restrictive and malabsorptive components, leaving this surgery to those who are morbidly obese and are 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 50% to 80% of their excess weight in first year

Disadvantages:

  • Extremely strict vitamins 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

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 the 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.

In some occasions, sleeve patients do not reach the targeted weight and need to revise gastric sleeve to gastric bypass / mini gastric bypass or duodenal switch. Gastric bypass patients were not reaching their ideal goal have fewer options to alter their surgery – the pouch can be reduced, the Roux limb can be lengthened, 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 Procedures

Gastric Balloon in Mexico - Meixco Bariatric CenterThe 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.

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

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 it, like gastric plication.

Restrictive: Endoscopic Sleeve Gastroplasty Procedure (nonsurgical via Endoscopic), Primary Obesity Surgery Endolumenal (POSETM) Procedure, and Transoral Gastric Volume Reduction (TGVR).

Malabsorptive: EndoBarrier Gastrointestinal Liner (on hold due to safety concerns)

Gastric Plication Surgery Schematic - How it Works - Sleeve Plication in MexicoLaparoscopic 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 Schematic - Gastric Banding in MexicoLap 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%

Jejunoileal Bypass (JIB) Schematic - Mexico Bariatric Center

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 (VGB) Schematic New - Mexico Bariatric Center

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® TherapyvBloc Neurometabolic 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 AssistAspire, 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.

Open vs. Laparoscopic vs. Single Incision vs. Endoscopic

In the past, bariatric procedures were performed openly. Now, 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 Bariatric SurgeryOpen 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 Bariatric SurgeryLaparoscopic 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 SurgerySingle 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

Endoscopic Bariatric SurgeryThe 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.