Over time, various operations have gained or lost popularity in Obesity and Metabolic Surgery as experience with them has evolved. Below is a short overview of the most commonly performed procedures in current practice. For more detailed information, feel free to explore our website or contact Dr. Güven Görkem and his team to get answers to all your questions.
1. Sleeve Gastrectomy (Vertical Sleeve Gastrectomy – VSG)
What It Is
- Sleeve Gastrectomy involves surgically removing about 75-80% of the stomach (the “left” or lateral portion) in a vertical (sleeve) fashion, leaving a tube-shaped stomach.
- It is currently the most commonly performed obesity surgery worldwide due to its effectiveness and relative technical simplicity.
Mechanism of Action
- Restrictive: The procedure reduces stomach volume, causing early satiety (feeling full sooner).
- Hormonal Effects: By removing the part of the stomach that produces certain hunger-related hormones, appetite can significantly decrease.
- No Intestinal/Absorption Changes: Because no intestinal bypass is done, nutrient absorption is not altered.
Points to Consider
- Weight regain can happen if one continues consuming high-calorie liquids (e.g., sugary drinks) or fails to adhere to lifestyle changes post-surgery.
- For younger or relatively healthy patients, it is often the first-choice surgery, since it can also be technically revised to another procedure later if necessary (for example, if weight regain or severe reflux occur).
2. RNY Gastric Bypass
What It Is
- In Roux-en-Y (RNY) Gastric Bypass, the top portion of the stomach is divided to form a small “pouch.”
- A segment of the small intestine (duodenum/jejunum) is measured out (usually 50–70 cm from the start) and connected directly to that small stomach pouch.
- The remaining intestines carrying bile and pancreatic juices are then reconnected 100–150 cm below the new pouch-intestine join.
Mechanism of Action
- Restriction – The small stomach pouch significantly limits food intake.
- Malabsorption – Part of the small intestine is bypassed, reducing nutrient and calorie absorption.
- Hormonal – By altering the route of ingested food and mixing with digestive juices, it helps improve insulin sensitivity and can correct metabolic issues like Type 2 diabetes.
Points to Consider
- More complex than sleeve gastrectomy, with strong metabolic (antidiabetic) effects and long-term outcomes.
- Patients must be attentive to vitamin and mineral deficiencies, as the bypassed intestinal segments reduce absorption of nutrients.
- It encourages patients to adopt healthier eating habits—foods high in sugars/carbohydrates can cause “dumping syndrome,” prompting patients to avoid them.
- Long-term weight regain rates can be lower than with sleeve gastrectomy, but it requires lifelong adherence to supplementation.
3. Mini Gastric Bypass
What It Is
- Similar principle to gastric bypass but technically simpler and often shorter in operative time.
- A long, narrow stomach pouch is created. Then, the intestine is looped (about 200 cm from its start) and directly attached to the new stomach. Unlike the RNY bypass, there is only one anastomosis (connection), simplifying the surgery.
Mechanism of Action
- Restriction: A smaller, tube-like stomach is created.
- Malabsorption: A certain length of small intestine is bypassed (around 200 cm), reducing calorie absorption.
- Bile and pancreatic juices meet the ingested food further down, so bile reflux can be a potential concern.
Points to Consider
- Shorter operative duration vs. RNY Gastric Bypass.
- Very effective as a revision procedure if a patient previously had a sleeve gastrectomy and experienced weight regain or other issues.
- Similar to other bypass procedures, requires vitamin and mineral supplements due to partial malabsorption.
4. Biliopancreatic Diversion with Duodenal Switch (BPD-DS)
What It Is
- BPD-DS is a more complex surgery with both a sleeve gastrectomy component (reducing stomach size) and a significant bypass of the small intestine.
- The duodenum is partially switched so that digestive enzymes from the pancreas and bile from the liver meet ingested food further along the intestinal tract.
Mechanism of Action
- Greater Degree of Malabsorption compared to other surgeries, leading to more dramatic weight loss and very robust metabolic improvements.
- Maintains the pylorus (the stomach’s outlet valve), but significantly reduces overall absorption.
Points to Consider
- Often used for severe obesity (very high BMI) or as a revision if prior surgeries did not yield sufficient weight loss.
- Vitamin and mineral deficiencies can be more pronounced given the extensive malabsorption. Lifelong supplementation is essential.
- Frequent stools and risk of foul-smelling stools can occur.
5. Adjustable Gastric Band (“Stomach Band”)
What It Is
- Known commonly as the “gastric band” or “lap-band,” this procedure places an adjustable silicone band around the upper stomach, creating a small pouch.
- The band’s tightness can be adjusted via a port placed under the skin.
- This method primarily restricts food intake with no malabsorption.
Current Status
- Once very popular, its use has significantly declined due to risks like band slippage, erosion into the stomach wall, and inadequate long-term weight loss for many patients.
- Many band patients eventually required a revision to another form of bariatric surgery.
- While still an option, most centers now favor sleeve gastrectomy or bypass techniques for better and more predictable outcomes.
Summary
Modern obesity and metabolic surgery offers various surgical approaches to help achieve sustained weight loss and improve or resolve metabolic conditions such as Type 2 diabetes, hypertension, and dyslipidemia. Each procedure has its advantages, disadvantages, and unique considerations regarding outcomes and suitability.
- Sleeve Gastrectomy (VSG): The most commonly performed procedure; simpler, effective, but purely restrictive.
- RNY Gastric Bypass: Both restrictive and malabsorptive, robust metabolic effects, beneficial for Type 2 diabetes, requires vitamin supplementation.
- Mini Gastric Bypass: Simplified bypass approach with a single connection; effective for revisions but may carry bile reflux risk.
- BPD with Duodenal Switch: Highly malabsorptive, used for severe cases or revision, demands stringent vitamin/mineral regimen.
- Adjustable Gastric Band: Outdated in many practices due to band-related complications and less long-term success.
Each operation should be individually tailored to the patient’s health condition, BMI, comorbidities, and personal factors. For more information and personalized advice, consult Dr. Güven Görkem and his team or fill out our contact form to begin your journey toward improved health.
