Bariatric surgery is often a weight loss option for patients who struggle with obesity or morbid obesity and had previously tried and failed to lose weight alone. It may be difficult for some patients to lose weight with diet and exercise, which is why medically supervised weight loss programs may help patients achieve healthy goals. However, there are four different types of bariatric surgery — gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch (BPD/DS) — which have different characteristics and indications.
Prior to deciding on bariatric surgery, patients need to consider all medical recommendations and potential risks, while physicians analyze if the patients are eligible for bariatric surgery. In addition to deciding if a certain type of bariatric surgery is indicated to treat a specific patient and their needs, physicians also need to take into consideration factors such as how invasive the surgery is, its reversibility, and potential results, as well as the patient’s weight, comorbidities and overall health.
Bariatric Surgery Reversibility: Gastric Bypass
Gastric bypass or Roux-en-Y Gastric Bypass is the most common weight loss procedures conducted in the United States and it is conducted in two phases. The first phase consists of the creation of a small pouch in the stomach, while the second is the creation of a connection from the pouch to the small intestine. In addition to reducing the size of the stomach, the gastric bypass also rearranges the digestive system, which is why it is usually not reversible. The procedure also causes alterations in gut hormones, improving satiety, restricting the amount of food consumed and the absorption of calories.
Bariatric Surgery Reversibility: Sleeve Gastrectomy
Sleeve gastrectomy surgery is a procedure that permanently removes up to 90% of the stomach, reshaping the remainder of it into a sleeve, similar to the size and shape of a banana. Due to the characteristics of the procedure, a sleeve gastrectomy is an aggressive procedure that is unable to be reversed. It decreases the size and capacity of the stomach, influencing gut hormones responsible for hunger, satiety and blood sugar. The effectiveness of the surgery is proven, however, severe and fatal complications, while relatively rare, are possible.
Bariatric Surgery Reversibility: Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
The BPD/DS procedure is the most complex type of approved bariatric surgeries. Surgeons start by separating the small intestine into two parts, and continue to connect one to the stomach so that the food ingested passes directly from the newly created tubular stomach pouch into the last segment of the small intestine. It rearranges the digestive system and cannot be reversed. The purpose of the surgery is for food to bypass about three-fourths of the small intestine, which is a part of the digestive system that carries bile and pancreatic enzymes crucial for the protein and fat absorption.
Bariatric Surgery Reversibility: Adjustable Gastric Band
Gastric band is the second most common bariatric surgical procedure in the US, and it consists of the implantation of a band around the upper part of the stomach, creating a smaller pouch. Gastric band surgery is not only a more simple, minimally invasive, effective procedure with few severe complications, but it can be reversed and removed at any time with relative ease. Despite the fact that patients may need additional surgeries to readjust, reposition or remove the band, the band can remain in place over the long term, and removed once a patient has lose all of their excess weight and feels confident that they have made the necessary lifestyle changes to eat responsibly. Following the surgery, the stomach’s opening can be adjusted by filling the band with saline and its purpose is to reduce the opening and size of the stomach so that patients eat less and feel full faster.