Obesity Surgery

Obesity surgery is a procedure that causes weight loss.

This is done through either restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or a combination of both.

These procedures are often performed using minimally invasive techniques.

Types of Obesity Surgery

Some of the most common bariatric surgery procedures are adjustable gastric band, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. There are advantages and disadvantages to each procedure.

Sleeve Gastrectomy

The laparoscopic sleeve gastrectomy removes approximately 80% of the stomach.

This decreases meal size and therefore calories consumed. It also affects the hormones that impact hunger, satiety, and blood sugar control.

Short term studies have shown that sleeve gastrectomy is just as effective as gastric bypass in terms of weight loss and remission or improvement of diabetes.

Gastric Bypass

This is considered the gold standard of weight loss surgery. It involves dividing the top of the stomach from the rest of the stomach, creating a small stomach pouch.

The first portion of the small intestine is then divided, and the bottom is attached to the newly created small pouch.

Then, the top portion of the small intestine is attached to small intestine further down, so that the stomach acids and digestive enzymes will eventually mix with the food.

This creates a smaller stomach which means smaller meals, and significantly less calories consumed. Furthermore, there is, to some degree, less absorption of calories and nutrients.

Rerouting the food stream also produces changes in hormones. This promotes satiety, suppresses hunger, and reverses on of the primary mechanisms by which obesity induces types 2 diabetes.

Adjustable Gastric Band

Often called the band, the adjustable gastric band involves placing an inflatable band around the upper portion of the stomach to create a small stomach pouch. It works b creating a smaller stomach which leads to fewer calories being consumed.

Where this surgery differs is that the band can be adjusted. Clinical studies show that the band seems to reduce hunger, which helps patients decreases their calorie intake.

Biliopancreatic Diversion with Duodenal Switch

Abbreviated as BPD/DS, this procedure has two components. First, a small, tubular stomach pouch is created, similar to the sleeve gastrectomy.

Next, a large portion (roughly 75%) of the small intestine is bypassed. So, when a patient eats, the food empties directly into the last segment of the small intestine.

The bypassed small intestine is reconnected to the last portion of the small intestine so that the bile and pancreatic enzymes mix with the food. Initially, this surgery helps to reduce the amount of food consumed. However, over time this effect lessens, and patients can consume near “normal” amounts of food.

Because so much of the small intestine is bypassed, there s significant decrease in the absorption of calories and nutrients, as well as nutrients and vitamins dependent on fat for absorption. Like the other procedures, BPD/DS affects gut hormones to impact hunger, satiety, and blood sugar control.

Among the ones listed here, this is considered the most effective surgery for treating diabetes. 

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