A bariatric surgery is any surgery designed and performed primarily to assist with weight loss and management. Bariatric surgery encompasses several procedures that alter the digestive system to induce weight loss. These surgeries can be performed through open surgeries or, more commonly, via minimally invasive methods.
There are a number of different bariatric procedures performed. One procedure is not “better” than another, and each comes with their own advantages and considerations. For this reason, the initial bariatric evaluation includes an in-depth interview with Dr. Bailey to discuss your medical comorbidities, relationship with food and prior weight loss attempts, and weight loss goals. The bariatric evaluation is essential for determining which surgical procedure is best for you individually.
The sleeve gastrectomy, gastric sleeve, or just “the sleeve” is the most common weight loss surgery performed in the United States. In this surgery, a large portion (about 80%) of the stomach is removed to help facilitate weight loss. During this procedure, the portion of the stomach that is kept is measured, and the “excess” stomach is removed with a surgical stapling device, creating a narrow tube of stomach. The remaining portion can hold about 12 ounces. The sleeve is usually performed laparoscopically or robotically.
The gastric bypass, or Roux-en-Y gastric bypass, is one of the oldest weight loss surgeries still performed, and as a result, has the longest set of data to support its success. The procedure involves making a small functional stomach (about the size of an egg), which can hold about 4 ounces. After this, the intestines are rearranged by connecting the stomach to the middle of the intestines and making a connection further down to another section of intestines. This bypasses the first part of the intestines, which are no longer used for digestion.
The Adjustable Gastric Band is a silicone device placed around the top part of the stomach to limit the amount of food consumed, leading to weight loss. The band creates a small pouch above the band. The use of the band has declined in recent years due to less weight loss and higher complication rates compared to other surgeries.
In patients with morbid obesity, few (1 out of 20) are able to achieve adequate weight loss and maintain this over a long period of time with diet and exercise alone. Weight loss with bariatric surgery is maintained in some studies up to 40 years. On average, patients undergoing bariatric surgery maintain weight loss of 50% of their excess weight 5 years out from surgery. In addition to weight loss, patients see many benefits, including:
Dramatic improvement in overall health
Many medical problems are resolved (controlled, off medications) or improved (better control, less medications)
Type 2 diabetes - 92% remission rate
Hypertension - 75% remission rate
Obstructive sleep apnea - 96% remission rate
Dyslipidemia - 76% remission rate
Cardiovascular disease - 58% remission rate
Reduction in mortality
40% decreased incidence of cardiac death rates
46% decreased incidence of stroke death rates
96% decreased incidence of diabetes death rates
60% decreased incidence of cancer death rates
Decrease in cancer risk
42% lower risk of breast cancer
50% lower risk of endometrial cancer
54% lower risk of pancreatic cancer
When determining if a patient qualifies for bariatric surgery, many factors are considered. Proper candidate selection for bariatric surgery is vital to ensure patient safety and the likelihood of successful long-term outcomes. It involves a thorough evaluation of an individual's health status, medical history, and their ability to adhere to the dramatic lifestyle changes required post-surgery.
Some of the most common comorbidities in patients exploring bariatric surgery include high blood pressure, high cholesterol, type 2 diabetes, and sleep apnea, among others. The health criteria often involve a certain body mass index (BMI) threshold and may also consider the patient's age and overall risk profile. These criteria ensure the benefits of surgery outweigh the risks and the patient is capable of undergoing the procedure both physically and psychologically.
Qualifications often include:
BMI ≥35 kg/m2, regardless of presence, absence, or severity of comorbidities
Patients with Type 2 diabetes and a BMI ≥30 kg/m2
BMI of 30–34.9 kg/m2 who do not achieve substantial or durable weight loss or co-morbidity improvement using non-surgical methods
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**Weight-loss results may vary for each individual, and specific results are not guaranteed.