When weight gain becomes unmanageable and the body mass index exceeds a certain threshold, the condition is classified as obesity. Obesity on its own can pose life-threatening risks, which only increase if additional health issues such as diabetes or hypertension arise. Under these circumstances, diet and exercise are essential for weight control. However, if a patient cannot lose weight through diet and exercise, obesity surgery may become necessary.
Within the field of obesity surgery, different surgical techniques are available. Alongside bariatric surgery procedures, there are methods that specifically target the stomach. The choice of which stomach-reduction procedure to use is made by the physician, who will thoroughly evaluate the patient and interpret lab results to determine the most suitable approach. If the patient has any health issue that might prevent surgery or anesthesia, that issue must be addressed first.
For example, if a patient is morbidly obese, they may need to lose some weight beforehand. Alternatively, weight-loss surgery might be scheduled after other health problems are treated. In certain cases, a non-surgical method may be chosen if the patient is not a suitable candidate for surgery.
What Is Weight-Loss Surgery?
Weight-loss surgery (also referred to as bariatric surgery) typically involves procedures that reduce the size of the stomach and sometimes alter the intestines to promote weight loss. When performed laparoscopically, only a few small incisions are made in the abdomen. Surgical instruments are inserted through these incisions for detailed visualization.
Various types of weight-loss surgery have been practiced worldwide for many years. Duodenal switch procedures date back further, whereas sleeve gastrectomy (commonly known as the gastric sleeve) has been performed since the 1980s.
The surgeon’s experience is critically important, whether the approach involves bariatric or other types of surgery. Additionally, factors like operating room conditions and proper hygiene play a significant role. Anyone considering weight-loss surgery should first consult a general surgery specialist, who will then guide the patient through the necessary steps.
Types of Weight-Loss Surgery
When weight-loss surgery is mentioned, sleeve gastrectomy often comes to mind first. In a sleeve gastrectomy (also called “tube stomach” surgery), only the stomach is modified, and the intestines remain untouched. While there are other surgical options, some patients may be deemed unsuitable for them—for instance, pregnant or breastfeeding individuals should postpone surgery, and people with alcohol/substance dependence should first address their addiction.
Patients with psychological conditions that impair their understanding of the surgery may need psychological support before proceeding. Certain previous stomach surgeries could also disqualify a patient. Lastly, those who are ineligible for anesthesia or have severely abnormal blood pressure or blood sugar levels may need to manage these conditions before surgery can be safely performed.
Sleeve Gastrectomy (Tube Stomach) Surgery
Among the various obesity surgery options, sleeve gastrectomy is particularly notable. This operation removes about 80% of the stomach, leaving behind a slender, tube-like portion. By shrinking the stomach, patients feel full with smaller meals. Additionally, because the portion of the stomach that produces the hunger hormone is removed, the patient’s appetite is reduced for a longer period.
Compared to gastric bypass procedures, sleeve gastrectomy carries a lower risk of complications. After surgery, patients may lose 35–40 kilograms, provided they follow the recommended dietary guidelines. This program progresses from clear liquids to puréed foods, then gradually to solid foods. By adhering to these stages for about a year, patients often reach their target weight.
Gastric Bypass Surgeries
Gastric bypass is one of the most commonly performed modern weight-loss surgeries. Unlike sleeve gastrectomy, it involves altering nutrient absorption. First, the stomach is made smaller (similar to a sleeve gastrectomy). Then the newly formed small stomach pouch is connected directly to the small intestine. Gastric bypass not only assists with weight loss but can also help prevent or manage conditions like diabetes.
Mini gastric bypass is another weight-loss procedure in which, unlike traditional gastric bypass, the intestine is not cut; the bypass is created in a different configuration. In a duodenal switch operation, the stomach is reduced in size and connected to the final part of the small intestine, significantly reducing nutrient absorption and promoting rapid weight loss. This procedure is often chosen for patients who regain weight after sleeve gastrectomy, but it comes with a higher complication risk than other surgeries, making thorough patient education essential.
Gastric Band (Stomach Band)
A gastric band, commonly referred to as a stomach band, divides the stomach into two parts without extensive surgical alteration. The upper portion, which is about the size of a walnut, forms a small pouch. Food passes slowly from this small pouch to the larger lower section of the stomach because of the band. This delayed passage helps the patient feel full for a longer time.
During the operation, the patient is placed under general anesthesia. If the band causes side effects or once the desired weight loss has been achieved, it can be removed.
Weight Loss with a Gastric Balloon
A gastric balloon is often preferred for patients who fear surgery or are not suitable candidates for invasive procedures. There are two main types of gastric balloons:
- Endoscopic gastric balloon – inserted via endoscopy under anesthesia.
- Swallowable gastric balloon – enclosed in a capsule that the patient swallows, which is then inflated, often without anesthesia.
The swallowable balloon eventually exits the body naturally, whereas the endoscopic balloon has to be removed via endoscopy. Both balloon types can lead to a loss of roughly 15–20% of the patient’s total body weight. However, if the patient does not adopt a healthy diet afterward, there is a risk of insufficient weight loss or regaining the weight.
The Postoperative Weight-Loss Process
Occasionally, patients might feel regret after a sleeve gastrectomy, but most of these complaints stem from inadequate surgical expertise. When performed by a qualified surgeon, weight-loss surgery can free patients from both excessive weight and obesity-related health problems. As with all surgical procedures, potential risks exist. Yet, an experienced physician significantly lowers those risks and prevents complications.
Patients also have specific responsibilities: strictly following the dietary program provided by a nutrition specialist and complying with all other medical instructions. This is key to reaching one’s ideal weight safely and preserving overall health.
Advantages of Weight-Loss Surgery
It would be inaccurate to claim that one particular weight-loss procedure surpasses all others. However, the various forms of weight-loss surgery share several common benefits:
- Treating a serious condition like obesity can be life-changing.
- Surgery can also help resolve conditions such as diabetes, high blood pressure, and sleep apnea.
- Weight loss often boosts self-confidence.
- Everyday activities become easier with increased mobility.
- Patients typically lose weight faster compared to other non-surgical methods.
- Procedures that reduce hunger signals or limit food absorption can simplify weight loss for the patient.
Weight-Loss Surgery Costs
The cost of obesity surgery varies depending on the surgeon’s expertise, the chosen procedure, and the hospital or clinic involved. Each facility may have its own pricing. Usually, after a detailed evaluation, your physician will discuss the fees with you. While cost is a factor, the surgeon’s experience and the cleanliness and modernity of the clinic should be top priorities when considering weight-loss surgery.
