What are the Different Types of Surgery for Obesity?

Many obese people are turning to stomach surgery to help them get on the road to a healthier life. Learn about the different procedures doctors are performing for weight loss.

Interview Transcript

ANNOUNCER: Obesity in the United States is reaching epidemic proportions with some 8 million Americans falling into the category of morbidly obese. Being morbidly obese puts individuals at an extreme risk for a host of serious medical conditions.

To overcome obesity, there are a variety of non-surgical weight loss strategies that people are encouraged to try. However, the chances of a morbidly obese person obtaining long-term weight loss with these tactics are slim, leading many people to turn to surgery.

JEFFREY ALLEN, MD: Each year more and more patients in America are undergoing some form of a bariatric operation or a weight loss operation. Two years ago, it was 100,000. In 2004, it's estimated that it was about 125,000. And in 2005, there might be 150,000. So it's increasing in number.

ANNOUNCER: Currently, weight loss surgeries can be divided into two main categories: restrictive procedures and malabsorptive procedures.

JEFFREY ALLEN, MD: A restrictive operation in some capacity or another decreases the size of the functioning stomach. And with the decrease in the size of the functioning stomach, patients can't eat as fast. They can't eat as much at one time. They have to chew their food thoroughly. And the net result of that is eating less by fooling the body into thinking that there's more food in than there really is.

The other type is a malabsorptive operation. And what a malabsorptive operation is is limiting how much of the food is absorbed. The absorption of nutrients, vitamins and fatty foods and carbohydrates occurs in the small intestine predominantly. And if some of that is bypassed or not part of the normal food stream, then that's a decrease in the amount that can be absorbed.

ANNOUNCER: The two most common procedures are gastric banding and gastric bypass. Gastric banding is a restrictive operation and there are two broad classifications of gastric bands: non-adjustable and adjustable. Adjustable gastric bands are most commonly used. Some examples of adjustable gastric bands are the LAP-BAND® System, the MIDBAND®, and the Swedish Adjustable Gastric Band®. Currently the LAP-BAND System is the only one available in the US.

CHRISTINE REN, MD: The LAP-BAND® is the implementation of a silicone ring around the very top of the stomach. This ring narrows the stomach so that a small pouch forms above the ring

JEFFREY ALLEN, MD: It's almost like a belt, but it has a balloon on the inner surface, and from time to time we inject saline into the band to tighten the belt down to increase the restriction.

CHRISTINE REN, MD: And food fills the small pouch and then goes through the narrowing into the rest of the stomach.

ANNNOUNCER: The gastric bypass is a combination of restrictive and malabsorptive techniques.

JEFFREY ALLEN, MD: The gastric bypass is a bit of a hybrid. It's a combination of a restrictive procedure; the stomach is stapled in a very small pouch about the size of an egg or less is created. And then a portion of the small intestine is bypassed, and so that portion of the small intestine is not involved in digestion. It's not involved in absorption.

ANNOUNCER: If you are considering a weight reduction surgery it is important to understand the differences between restrictive and malabsorptive procedures.

JEFFREY ALLEN, MD: Restrictive operations are nice because of a couple reasons. First of all, the concern about vitamin and mineral deficiencies are very low. Furthermore, there's no rerouting of the intestine. There's less permanent damage done to the inside of the body.

CHRISTINE REN, MD: The downside of restrictive operations is that they absorb all their calories. So, therefore, if one is drinking high-calorie drinks such as juices or regular soda or milkshakes, all of those calories are being absorbed and, therefore, the person will not lose that much weight.

The upside or the advantage of malabsorptive operations is that there is a dramatic weight loss and the individual can really eat a larger portion of food.

However, the downside of this operation is that, because they're excreting almost all of their food, then also they're excreting a lot of their nutrients and their vitamins. And so they have to take up to fifteen pills a day in terms of vitamins in order to prevent any nutritional problems.

ANNOUNCER: Data suggests that the success rates of all weight loss operations are similar long-term.

BRAD WATKINS, MD: Regardless of the operation, patients tend to lose between 50 to 75 percent of their excess weight at two years after surgery. If you look at average results, bypass patients tend to lose more pounds in the first year than band patients. But two or three years down the road, all of these operations have exactly the same average results.

ANNOUNCER: However, weight loss surgery is major surgery and comes with risks.

JEFFREY ALLEN, MD: The complication rates themselves are very similar. The difference is the severity of the complications.

The gastric bypass, which is the most common operation, has about a 1 percent chance to 2 percent chance of dying when you're in the hospital. This can be from a variety of causes, the most feared being a leak, where the tube the piece of small bowel and the stomach are sewn together.

The gastric band, on the other hand, has a similar rate of complications, but the severity is less. So if you look at the chance of dying with, for instance, a gastric band, maybe 1 in 1,000 or 1 in 500. So significantly less.

ANNOUNCER: Weight loss surgery is not for everyone and an individual must meet strict criteria for surgery to be considered. For those who do qualify for surgery, deciding on which procedure is the right one for them can be difficult and should only be done in close consultation with a surgeon.

BRAD WATKINS, MD: Most commonly when a patient chooses a restrictive operation such as LAP-BAND® over a gastric bypass, they're mostly doing that because of the difference in the risk between the two procedures. A purely restrictive operation such as a gastric band is far less risky than a gastric bypass: lower death rate, lower rate of severe complications, things like that.

LAP-BAND® patients tend to lose the weight slowly and steadily and reach the average results of a gastric bypass after two or three years. The band is adjustable; the bypass is not adjustable. The band is reversible; the gastric bypass is irreversible.

When a patient chooses a gastric bypass over a LAP-BAND®, it's mostly because they've known someone that's lost a lot of weight with gastric bypass. They really like the relatively rapid weight loss in the first year with gastric bypass. It's also covered by more insurance companies; it's been around for a long time.

ANNOUNCER: Although chances of success with weight loss surgery are high, patients should know there is no guarantee. Additionally, there are many things patients need to do after surgery to keep the weight off, including adopting a healthy diet, exercising regularly, attending support groups, if necessary, and meeting regularly with your surgeon for follow-up consultation.

Still, weight loss surgery is currently the most effective way for morbidly obese people to lose the weight and keep it off. And the first step for anyone interested n weight loss surgery is to contact you doctor for help in finding a surgeon.

CHRISTINE REN, MD: If a person wants to have bariatric surgery, they really should treat it like everything else. Go someplace to someone who's done a lot of them, who has experience, because the success and the rate of complications after surgery really are dependent on the experience of the surgeon and the experience of the hospital and the hospital staff.

Bariatric surgery is an amazing treatment for this population of people. It provides tremendous improvements in quality of life. There's no other happier person than a former morbidly obese person.

Produced on: April 30 2005