Weight Loss Surgery: What are the Options?

However, weight loss surgery isn’t something that should be entered into lightly and the options available to you can seem daunting at first.  In this article, bariatric surgeon Professor Sanjay Purkayastha talks through the most common surgeries available and the pros and cons of each.

Why should I have weight loss surgery?

Although an invasive option, weight loss surgery can have a very real impact – allowing for long-term weight loss and a generally improved quality of life. Your risk of getting conditions related to obesity will also be much reduced, such as type 2 diabetes and high blood pressure. However, you’ll need to be aware of the risks associated with surgery and be willing to make certain lifestyle changes, as weight loss surgery is not a ‘cure-all’.

You may qualify for weight loss surgery if:

• You’ve tried dieting and exercise but haven’t been able to lose weight
• You have a BMI of 40 or more, or a BMI between 35-40 and a condition such as diabetes or high blood pressure
• You are aware that you’ll need regular check-ups following surgery and to make certain lifestyle changes

The three most common forms of weight loss surgery are: gastric band, gastric bypass and sleeve gastrectomy surgery.

What are the risks associated with weight loss surgery?

The general risks common to all weight loss surgeries are:

• Inflammation of the stomach lining
• Heartburn
• Stomach ulcers
• Hernia
• Injury to the stomach, its surrounding organs or the intestines during surgery
• Infection of the surgical wound 
• Hernia

Also, as you’ll be eating less, you may absorb less nutrients overall.

Gastric band surgery

What is gastric band surgery?

During this surgery, a gastric band (an inflatable silicone ring) is placed around the top of the stomach, to control the amount of food passing from the stomach into the digestive tract.  A pouch at the top restricts the amount of food you need to eat before you get full, so you get full faster.

What are the advantages of gastric band surgery?

It’s a minimally invasive surgery, fully reversible and adjustable. It’s also a very quick outpatient procedure (taking between 30-60 minutes), so you can go home on the same day you have the surgery. You can continue with your day-to-day activities from the second day after the surgery.

What are the disadvantages of gastric band surgery?

Potential negatives of the surgery include:

• You often need to get the ring readjusted a few times. You may have to go back in following your surgery (usually 4-6 weeks after it), and possibly a few times more after this, before ideal tightness of the band is achieved.
• Following surgery, you’ll need to have a liquid-only diet for a month, slowly reintroducing only soft foods into your diet for 2 weeks afterwards (however, from 6 weeks onwards, you can resume a normal diet).
• Although you can resume normal activities 2 days after the surgery, in some cases you may need to take a week off work.
• Compared to other forms of weight loss surgery, it can take longer to see results from gastric band surgery.
• Your band can slip or malfunction, in which case it’ll need to be removed.

Gastric bypass surgery

What is gastric bypass surgery?

In a gastric bypass, surgical staples make a pouch at the top of your stomach. This pouch is then connected straight to your main intestine, bypassing your stomach. Similarly to a gastric band, this means that it will take less for you to get full. You’ll also absorb less calories from the food you do eat. A gastric bypass tends to be recommended for those with a BMI of between 40-55.

What are the advantages of gastric bypass surgery?

This form of weight loss surgery tends to have the most dramatic results: following surgery, on average, patients tend to lose 30% of their total body weight and 70% of excess weight (fat). In almost 90% of cases, gastric bypass can resolve type 2 diabetes. You will generally feel more satiated after a meal, with less of a desire to overeat.

What are the disadvantages of gastric bypass surgery?

Some negatives of the surgery include:

• Higher risk of complications during surgery, including small bowel obstruction, internal hernia and ulcers, compared to other weight loss surgeries 
• You’ll need to take vitamins and supplements long-term
• Occasions where you experience ‘dumping syndrome’. This is when food high in fat, sugar and calories travels to the bowel too quickly after eating – which can cause nausea for 20-30 minutes, sometimes alongside vomiting, diarrhoea, and overall weakness 
• To avoid ‘dumping syndrome’, you have to follow a restrictive diet for the rest of your life – high-protein, low-sugar, low-carbohydrate and low-fat
• Much more check-ups are required after surgery than for other forms of surgery – it is recommended that you see a dietician every 4-6 weeks for at least 6 months following surgery

Sleeve gastrectomy surgery

What is sleeve gastrectomy surgery?

A sleeve gastrectomy involves converting the stomach into a long, thin tube by stapling it along its length and excising (removing) the excess stomach. In essence, a big section of your stomach is removed. As with the other forms of surgery outlined above, this means you’ll get full faster, in this case because the stomach is smaller. 

What are the advantages of sleeve gastrectomy surgery?

Though the results are not as dramatic as gastric bypass surgery, you can still expect to lose around 60% of excess body weight in a year.

Other benefits include:

• Minimal long-term complications (for example, the intestine stays intact, so there’s less chance of complications in the intestinal area)
• Being able to tolerate most foods (not the case with gastric bypass surgery)
• Decreased appetite which aids weight loss

What are the disadvantages of sleeve gastrectomy surgery?

Some disadvantages of sleeve gastrectomy include:

• This surgery is not reversible
• If you overeat, you’re likely to experience nausea and even vomiting
• As your stomach is stapled, there’s a chance of leaks / other complications
• Your body still tolerates high-fat, carb-rich foods, so weight loss is harder than with a gastric bypass 
• If you have acid reflux prior to this surgery, you may find your symptoms are made worse following surgery

Other, less common options for weight loss surgery include: intra-gastric balloon, biliopancreatic diversion and primary obesity surgery endolumena.

If you’re considering weight loss surgery, talk to your surgeon about the options available. They’ll help you to decide which option is best for you.

More information

• If you’d like to explore your options for weight loss surgery, speak to your GP about possible treatments. (Don’t have a GP?)
• Mr Sanjay Purkayastha is a consultant general surgeon at King Edward VII’s Hospital with a specialist interest in bariatric surgery and can provide expert treatment, advice and guidance. Make an enquiry.