What are the different types of weight loss surgeries?

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Weight loss surgery procedures include:

  • Gastric bypass. This procedure reduces the size of the stomach and reroutes the small intestine (the gold standard for bariatric surgery).
  • Adjustable gastric band. A silicone band is placed around the top end of the stomach, shrinking the stomach capacity and restricting food intake.
  • Gastric sleeve. This procedure removes a section of the stomach, causing a reduction in food intake, reducing hunger sensation.
UCLA Health
Administration Specialist

A number of surgeries are available to people who wish to lose weight.

The laparoscopic adjustable gastric band (Lap-Band) is a surgical procedure in which an inflatable band is used to create a smaller stomach pouch to limit food intake and reduce appetite. "We know that in about 20 percent of people, this surgery works very well," says Erik Dutson, MD, UCLA bariatric surgeon, "but there is no standard way of knowing who will benefit." The device can do damage while it’s in, and when it comes out, patients tend to gain weight back rapidly. In addition, he notes, other weight-loss surgeries have a much higher complication rate if the patient has previously had the Lap-Band.

Three alternatives to the Lap-Band have proven track records with better long-term results. The first, known as the duodenal switch procedure, removes between half and two-thirds of the stomach and reroutes a significant portion of the intestine. The combination of reduced calorie intake and much less absorption of calories results in a high weight-loss success rate and resolution of medical issues. But the procedure can result in serious complications and represents about only 2 percent of weight-loss surgeries in the United States.

The Roux-en-Y gastric bypass accounts for approximately 80 percent of U.S. weight-loss surgeries. In the procedure, the doctor creates a smaller stomach by rerouting a portion of the intestine—but less than the duodenal switch. This avoids the issue of significant calorie malabsorption and reduces the level of risk associated with the duodenal switch procedure.

Another type of weight-loss surgery is the vertical sleeve gastrectomy. It offers benefits of the gastric bypass and the adjustable band without many of the risks that go with either. The sleeve procedure reduces the stomach by at least two-thirds, but without rerouting the intestines.

Dr. Dutson notes that the best weight-loss strategy involves lifestyle changes that include a healthy diet and exercise. Indeed, none of the weight-loss surgeries work without being performed in conjunction with lifestyle changes. The surgery simply allows people to get much more benefit out of proper eating and physical activity. Although weight-loss surgeries are not without risk, for people who qualify (typically those with a body mass index of at least 35, along with conditions such as diabetes and hypertension), the risk of not having the surgery is often greater.

Our understanding of how the stomach works has allowed us to develop bariatric surgeries that manipulate the physiology of the stomach and the digestion process, to help people better control their weight. While several different surgical procedures exist for weight loss, they all fall into two kinds of options:

  1. Restrictive procedures limit the room in your stomach and thus the amount of food you can eat (sort of like saying you can't cram any more people into a phone booth—there's only so much it can hold). Restrictive bariatric surgeries include gastric banding.
  2. Malabsorptive procedures change your body so you can't absorb all the excess calories.

As an illustration, if you've ever taken a driving trip of any distance, you know the difference between Route 1 and Alternate Route 1. Route 1 may take you right through the city's downtown so you can stop at the shops, see the houses on the historical register and putter through the 35 traffic lights within a half-mile drag. Fine, in some cases. But if you're just trying to get to the other side of town, then you'll take Alternate 1—the loop that goes around the town, avoids the lights and gets you from the Post Office to the pet salon without having to worm along in traffic that's slower than a sedated slug.

A malabsorptive bariatric procedure is Alternate Route 1—it cuts out the gastrointestinal main street so food can go toll booth to exit ramp without having to stop at fat-storing traffic lights along the way. Malabsorptive bariatric surgeries include the duodenal switch procedure.

Some procedures combine the best of both tactics (gastric bypass is both restrictive and malabsorptive). Nearly all varieties of weight loss surgery can now be done laparoscopically, without cutting your muscle wall.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.