How Will I Know Which Weight Loss Surgery is Right For ME?

May 15, 2023

How Will I Know Which Weight Loss Surgery is Right For ME? Congratulations on making the decision to undergo weight loss surgery! This will likely be one of the most monumental decisions of your lifetime. Battling the disease of obesity can be frustrating, to say the least. The good news is that multiple studies have shown that bariatric surgery is the most effective, long-term treatment for obesity.  This means that you can now look forward to all of your weight-loss efforts producing effective, long-lasting results!

Now the question is, which surgery is right for you? There are multiple types of weight loss surgery, including the Adjustable Gastric Band, Sleeve Gastrectomy, Roux-en-y Gastric Bypass, Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI), and Duodenal Switch. All of these surgeries are performed with minimally invasive laparoscopic or robotic techniques. Choosing which procedure is right for you can be quite overwhelming. This article will help guide your decision by discussing which factors should be taken into consideration and how these are impacted by each surgery.

Weight Loss and BMI

The amount of weight you want to lose is important to consider when choosing which surgery is right for you. Statistically, the percent of excess weight loss increases with the complexity of the surgical procedure. The gastric band, which is an adjustable and reversible ring placed on the upper part of the stomach, involves the least amount of change to the body, because it does not remove any part of the stomach or entail surgery on the intestines. Patients with a higher BMI may choose not to have the gastric band because it typically causes the least amount of weight loss. The other surgical procedures cause greater weight loss because they result in permanent changes to the digestive tract. As a result,  hormonal changes occur in the body that allow for less hunger, greater feelings of fullness, and more consistent burning of calories. The sleeve gastrectomy involves removal of approximately 75% of the stomach, and most patients achieve over 50% excess weight loss. The gastric bypass involves the creation of a small gastric pouch and rerouting of the small intestine so not all calories and nutrients are absorbed in the body. Patients can expect to lose up to 75% excess weight with the gastric bypass. The SADI and duodenal switch involve both the removal of part of the stomach and a long length of bypassed intestines, leading to the most weight loss but also the greatest risk of nutritional deficiencies. Typically, patients with a BMI over 55 are the best candidates for the SADI and duodenal switch.

Smoking and Alcohol Consumption

Smoking and excessive alcohol consumption should be avoided after any bariatric surgical procedure in order to ensure the safest and most effective weight loss. Smoking causes decreased oxygen delivery to the stomach and intestines and can cause ulcers and increase the risk of postoperative leaks. This is especially true after the gastric bypass, duodenal switch, and SADI because the rerouting of the intestines makes them even more susceptible to ulcer formation. For this reason, these procedures should be avoided at all costs in patients who think they might be prone to picking up the habit again even years after surgery. 

GERD

GERD stands for Gastro-Esophageal Reflux Disease, and is also known as acid reflux or “heartburn.”  It occurs when acid from the stomach refluxes into the lower esophagus causing inflammation. Whether or not you suffer from severe GERD is an important consideration when choosing a bariatric surgical procedure, because gastric bypass is the only bariatric procedure that is known to successfully treat this condition. The other procedures may actually worsen acid reflux, especially if a patient has moderate to severe symptoms requiring daily antacid medication. Longstanding acid reflux can cause changes to the lower esophagus called Barrett’s esophagitis, and left untreated, this can be a precursor for esophageal cancer. This is why many bariatric surgeons require their patients to undergo an upper endoscopy preoperatively, whereby the esophagus can be examined for evidence of reflux-induced injury. If Barrett’s esophagitis is diagnosed, the surgeon will likely recommend a gastric bypass for the patient since it will help treat the condition. It is important to note that patients with mild, intermittent heartburn after eating spicy foods, for example, should be able to safely choose the sleeve gastrectomy, duodenal switch or SADI procedure. Most of these patient’s acid reflux symptoms will improve with weight loss and temporary antacid medications.

Diabetes and Other Comorbidities

Your overall medical health and surgical history are important to discuss with your surgeon when deciding on a particular weight loss surgery. Here are some factors to consider:

Diabetes

Nearly all patients with diabetes who undergo any type of bariatric surgery will show improvement in their blood sugar levels. The greatest improvement in diabetes health, however, occurs after the duodenal switch, SADI, and gastric bypass. The sleeve gastrectomy also leads to dramatic improvements in blood sugar levels and reduces complications from diabetes, although the results are less than that of the procedures that involve rerouting of the intestine. The gastric band results in the lowest percentage of diabetes remission.

Prior surgeries

For most patients, prior abdominal surgery should not pose a problem for bariatric surgery.  However, patients who have had multiple abdominal surgeries may be advised that the sleeve is a better option because scar tissue from previous operations may preclude the gastric bypass, SADI, and duodenal switch.

Medications

Certain medications can increase the risk of ulcers, especially after the gastric bypass. NSAIDs (Nonsteroidal Anti-inflammatory Drugs) are medications such as Advil, Ibuprofen, Motrin, Aleve, and Naproxen. Patients who must take these medications should avoid the gastric bypass. The sleeve gastrectomy is a safer option for these patients as well as for patients who require chronic oral steroid usage, which also increases ulcer risk.

Chronic anemia and other vitamin deficiencies

The gastric bypass, duodenal switch, and SADI alter the digestive tract, decreasing the absorption of certain vitamins and minerals. Patients with chronic anemia or severe vitamin deficiencies should avoid these operations and choose the sleeve gastrectomy, which has a much lower incidence of protein and vitamin malnutrition.

Conclusion

There are many factors to consider when choosing a bariatric surgery. It is important that you and your surgeon have a conversation to decide which procedure is the safest and most effective one for you.

Dr. Angela Glasnapp is providing compassionate care to her patients at New York Bariatric Group

ABOUT THE AUTHOR Dr. Angela Glasnapp worked at a Bariatric Surgical private practice in New Jersey for 10 years before becoming Director of Bariatric and Minimally Invasive Surgery at Staten Island University Hospital – Northwell Health. In her new administrative role, Dr.Glasnapp used her experience to help grow a Bariatric Surgical practice while providing compassionate care to her patients. She is excited to be joining New York Bariatric Group in her home state of New Jersey, where she resides with her husband and two children.

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