Bariatric Surgery: More Than Weight Loss

Some people still think of bariatric surgery solely as weight-loss surgery. But the benefits extend far beyond a leaner body.

For people with obesity-related diseases, like diabetes, for example, bariatric surgery can immediately eliminate or improve them. Bariatric surgery can dramatically reduce the risk of developing a life-threatening illness, such as cancer or heart disease. It can also extend people’s lifespans.

Given the safety of today’s surgical techniques and the well-proven long-term health benefits to be gained, I tell patients who are considering it not to wait. Find out all you can. Today, there are a variety of options for you to consider and some additional options on the horizon. At MedStar Washington Hospital Center, these surgeries are done with minimally invasive techniques—meaning laparoscopically or robotically—to speed recovery and maximize safety for patients. And our team offers in-depth support before, during, and after surgery to help ensure that patients experience enduring health benefits.

Gastric Sleeve (Sleeve Gastrectomy)

Today, the gastric sleeve procedure is the most popular bariatric surgery technique nationwide and is selected by three out of four patients at MedStar Washington Hospital Center. It involves sectioning off about 80% of the stomach with a stapling device, removing it, and creating a smaller, vertical “sleeve” of stomach shaped like a banana. Not only does this reduce the amount of food you can ingest at any given time, it also decreases the level of hunger-signaling hormone that the stomach sends to the brain—so you have less of an appetite, amongst other metabolic changes. Patients often choose this surgical option, as it offers some metabolic improvements and sustained weight loss via a procedure that changes only the stomach.

Gastric Bypass

This second most popular technique, also called Roux-en-Y (ROO-en-why) gastric bypass, involves changing both the stomach and the intestines. Those additional changes to the body can offer extra health benefits. With this technique, we use a stapling device to section off a small egg-size pouch of stomach; the rest of the stomach remains. Then, part of the small intestine is rerouted and connected to the stomach pouch. As a result, the food you eat goes into the small stomach pouch, then directly into the connected lower section of small intestine, bypassing most of your stomach and the top portion of the small intestine. This works like the gastric sleeve to reduce the amount of food you eat and the release of hormones that send hunger signals to your brain. In addition, the rerouted intestine limits the absorption of food nutrients and calories. It also causes an even more drastic metabolic impact on your body.

Gastric bypass tends to be a little better than the sleeve procedure for creating more weight loss and resolving more weight-related health issues like diabetes, high blood pressure, and sleep apnea. It’s also a very good option for people with severe acid reflux as this procedure improves that condition. These healthy changes also tend to persist longer-term because the absorption in the intestine is changed. But on the flip side, patients have a slightly higher risk of malnutrition long-term. Typically, this can be managed with vitamins and supplements.

Today, this is a relatively safe procedure. I tell patients the risks of this versus the gastric sleeve after surgery are about the same, and the potential for greater health benefits may be worth considering.

Biliopancreatic Diversion with Duodenal Switch

Like gastric bypass, this technique involves making the stomach smaller and rerouting the intestine to reduce food absorption. The difference is that the reduced-size stomach is more similar to the gastric sleeve; in other words, it is larger than the gastric bypass pouch and patients are able to eat a little more. In addition, much more of the intestine is bypassed, starting at the duodenum (hence the name). So absorption of food, especially fat, is reduced even further, by more than 70%. While the weight loss is highest and most long-lasting, and the metabolic benefits are more profound with duodenal switch, the long-term risk for malnutrition is especially high. Close monitoring for vitamin, mineral, and protein deficiencies is a must.

Gastric Band

Also known as the adjustable Lap Band, this was the most popular bariatric surgery option more than a decade ago. It involves placing a flexible silicone band around the top part of the stomach and tightening it to create a narrowed passageway. It’s meant to limit how much food you can eat at any given time.

While it’s the least invasive approach, and completely reversible, it also doesn’t work very well for many people and has decreased in popularity. Patients tend to lose weight much more slowly and often regain it. And the gastric band doesn’t offer the metabolic health benefits that the other surgical options do. Also, more than 30% of people develop complications from the gastric band, such as heartburn or swallowing issues. While this option is still available, it’s not typically recommended, as newer techniques offer greater, more reliable health benefits.

Other Options on the Horizon

Several new alternatives are currently being evaluated. These include some endoscopic bariatric therapies, performed through a flexible tube inserted through a patient’s mouth rather than via abdominal incisions like traditional bariatric surgeries. Currently, the most well-known approach is the intragastric balloon, by which a fluid- or gas-filled balloon is placed in the stomach.  It makes you feel full faster and slows down stomach emptying so you may feel full longer.

Some centers also offer endoscopic sleeve gastroplasty, which is similar in some ways to a gastric sleeve surgery. Part of the stomach is closed off with sutures, which are placed using the endoscopic tube inserted through the patient’s mouth and down into the stomach.

Although there are no long-term data on their effects, these less-invasive approaches may be worthwhile for patients who are not safe candidates for traditional surgery.

At this time, severely obese patients have excellent options to consider.

How To Choose the Option That’s Right for You

If you’re considering surgery, sign up for an information session. These free sessions are typically offered online or in person, and they provide an excellent overview of the pros and cons of each surgical option the medical center offers. It’s a great opportunity to learn more and ask questions. From there, you can make an appointment with a bariatric surgeon to further discuss your options.

Find an information session here.

You should also choose an experienced hospital and medical team. At MedStar Washington Hospital Center, our program has been recognized as an American Society for Metabolic and Bariatric Surgery Center of Excellence and is fully accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

Our board-certified and fellowship-trained surgeons utilize the most current minimally invasive techniques, which can offer shorter hospital stays, less pain, and faster recovery. In addition, our surgeons are supported by a complete care team, including a gastroenterologist, nurse coordinator, psychologist, dietitian, and exercise physiologist to help ensure your needs are met and you are set up for long-term success. As a team, we also collaborate with your primary care physician. We typically start by evaluating your medical and weight history, diet and exercise habits, and the stomach itself. Then, we explain your options in detail and share the latest research findings to help you decide what’s right for you. Each patient ultimately chooses what they’re comfortable with, and we support them every step of the way.

As I mentioned earlier, I urge people who’ve thought about bariatric surgery not to put off learning more about it. Don’t wait until obesity makes you sick if you aren’t already. In many cases, the earlier this surgery is done, the better the outcomes in terms of your health, your productivity, and your overall length and quality of life in the years ahead.

It’s never too early for that.