Bariatric surgery is one of the fasting growing specialities in medicine. It’s no surprise given that obesity affects more than 30% of adults and bariatric surgery is the most effective form of weight loss. Initially the surgery was associated with significant morbidity (medical problems) and mortality (death) however rapid advances in technology and improvements in the techniques have made the procedures more effective and much safer. This article will review some of the more commonly performed procedures.
Bariatric procedures are categorized as restrictive procedures, malabsorptive procedures or a combination of both. The restrictive procedures decrease the capacity of the stomach thus limiting the amount of calories consumed. The advantage of these procedures is that the weight loss is more gradual. Malabsorptive procedures work by decreasing the effectiveness of nutrient absorption by shortening the length of the functional small intestine. This is done either by a physical bypass of the small intestine or by diverting the biliopancreatic secretions, which are used to facilitate absorption. This results in significant and more rapid weight loss but has a higher probability of causing nutritional deficiencies.
Roux-en-Y gastric bypass (RYGB) is the most commonly performed procedure. It represented 65% of all bariatric procedures in 2003 and had decreased to 47% by 2011. It is both a restrictive and malabsorptive procedure. The procedure creates a small gastric pouch and bypasses a portion of the small intestine, limiting the amount of calories absorbed. The expected weight loss after 2 years is approximately 70%.
Laparoscopic adjustable gastric banding (LAGB) involves the placement of a tight adjustable prosthetic band on the entrance to the stomach. It is a restrictive procedure and is the least invasive procedure in this group. It was performed 24% of the time in 2003 and it use has dropped to 18% in 2011. It has the lowest mortality rate of all the bariatric procedures and there is usually a 50-60% weight loss at 2 years. It however, requires more revisions and has a higher rate of individuals regaining the lost weight.
Sleeve gastrectomy (SG) involves the partial removal of the stomach, restricting the volume of food that can be consumed. In 2011 it was the 2nd most commonly performed bariatric procedure, representing 28% of all procedures performed. It is much safer and easier than a RYGB and has a weight loss of about 60% at 2 years. If the desired weight loss is not achieved with this procedure it can be easily converted into a gastric bypass or other procedure.
Other procedures include the biliopancreatic diversion with duodenal switch (BPD/DS) and the mini gastric bypass. They are both a combination of restrictive and malabsorptive procedures. The BPD/DS is a complex procedure with 70-80% weight loss at 2 years. It is performed in only a few centers in the U.S. The mini gastric bypass is a modification of the loop gastric bypass but much easier than the RYGB. It is also safe and easily revised, reversed and converted. Long-term data is limited but it appears to have a 50% weight loss at 18 months.
Bariatric surgery is a rapidly evolving area of medicine. The procedures are becoming safer, more effective and less invasive. This intervention should be seriously considered by individuals who have morbid obesity (BMI >40 kg/m2) or those with a BMI >35 kg/m2 who also have other health problems such as diabetes. In many cases the surgical risks are less than the health risks from obesity.
I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!