Weight Loss Surgeries – Which Ones Are The Riskiest?

Bariatric or weight loss surgeries have become very popular in the last decade, especially with over 35% of American adults having excess weight or being morbidly obese. There are a lot of weight loss surgeries performed today with different variations targeting specific needs of patients. Compared to a decade ago, such bariatric procedures have showcased significantly less complications since they are performed via a less invasive laparoscopic method compared to an open surgery way.

All weight loss surgeries focus on two main aspects of achieving gradual weight loss, reducing the size of a stomach and reducing a digestive tract’s ability to absorb calories from foods. As of today there are three major approaches to weight loss surgeries according to Bariatric Surgery Resource, namely, gastric bypass, gastric sleeve and a lap band procedure. Additionally, each of these surgeries has its own set of risks and complications involved depending on a patient’s medical history and surgical outcomes.

Gastric Bypass Weight Loss Surgeries

The types of weight loss surgery that are very popular are gastric bypass and its variations. The classic and traditional gastric bypass variation is a Roux-en-Y procedure (RNY) that reshapes a patient’s stomach to resemble a Y shape by rerouting it and bypassing a duodenum responsible for absorbing fats from the foods. First, a small upper part of the stomach is detached with staples from the rest of it and rerouted to connect with small intestines. The end result is a much smaller stomach pouch and bypassed duodenum that helps patients accomplish their weight loss results. However, because such a large portion of the stomach is bypassed, it creates serious digestive issues like a dumping syndrome resulting in undigested portions of foods to be “dumped” straight from the stomach to small intestines. Over time it also leads to malabsorption of nutrients, essential vitamins and minerals from foods. The surgical risk of this procedure is moderate with a hospital stay of 2 or 3 days.

Recently a mini gastric bypass no surgery variation has entered the scene which was initially developed in 1997 but is still considered a rather experimental in nature. The mini gastric bypass is considered a safer, less invasive and less costly compared to the traditional RNY operation. Less cutting of the tissue is involved because it is performed through laparoscopic incisions resulting in less hospital stay and less complications down the road. During this procedure a patient’s stomach is reduced by 90% with gastric enzymes and bile still being able to enter the stomach. Because much more of the intestines are being bypassed, it can carry some other long term complications like malnutrition and gastric bile reflux disease.

Duodenal switch is yet another variation of the classical bypass surgery which is also known as bilopancreatic diversion focusing on reducing the ability of the GI tract to absorb fats from foods. The surgery is one of the riskiest of all gastric bypass surgeries because it removes almost 85% of a patient’s stomach and shapes it in a form of a banana. Another aspect is reducing the size of the duodenum resulting in less calories absorbed. It’s reserved for patients with severe obesity and with BMI indexes of 45 and over.

Gastric Sleeve Weight Loss Surgeries

Gastric sleeve is one of the irreversible weight loss surgeries that is often compared to gastric bypass. The gastric sleeve vs. gastric bypass discussion will often be done so that the patient knows which is better for them in achieving that preferred weight. Gastric sleeves differ from gastric bypass in that large sections of the stomach are removed including parts with hunger producing hormones, whereas with gastric bypass small pockets are created in the stomach arena so that enormous sections are not removed. Gastric sleeves carries low to moderate surgical risks but sometimes is considered riskier than a bypass option because these are not reversible compared to other stomach reduction surgery methods. The ability of the stomach to absorb nutrients is only somewhat reduced so a patient must carefully watch nutritional intake. Gastric sleeve diet is not as restrictive as a gastric bypass so weight gain after this surgery is at much higher risk.

Lap Band Weight Loss Surgeries

Weight loss surgeries such as the lap band procedure are known to be the safest, but there are some risks involved as well including band erosion, slippage and tissue necrosis due to constriction. A lap band is executed via placing a constricting hollow band over the top portion of a patient’s stomach to restrict the volumes of foods which can be ingested at a time. The adjustable gastric band can be later filled with a saline solution to control weight loss progress or loosened if necessary. Among all weight loss surgeries, it is considered one of the most conservative and reversible as a band can be simply removed if necessary. This surgery is associated with fewer risks compared to other methods but since there’s no malabsorption component patients must work harder to maintain a proper diet and exercise regimen.

Upon revising all the weight loss surgical interventions, it’s impossible to pin point which weight loss surgeries are the riskiest for a certain patient because even a seemingly easy medical procedure can result in serious complications and death depending on a patient’s individual reactions. However, procedures like a gastric sleeve or a bilopancreatic diversion appear to be theoretically the riskiest because they involve complete removal of significant portions of the stomach leading to potential short and long term complications.

References:
http://www.surgicalservicesinternational.com/gastric_sleeve_vs_gastric_bypass.htm

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