Managing Obesity

Surgical Procedures

There are various surgical options to choose from when considering bariatric surgery. This section provides an overview of the procedures not a comprehensive guide. If you are considering surgery you will need to discuss the risks and benefits of surgery with your surgical team.

Adjustable Gastric Banding

The Adjustable Gastric Band involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band. 

gastric band

Gastric Bypass

Gastric bypass has been performed as a treatment for severe obesity since 1960’s. The surgery involves stapling across the stomach to create a small pouch (size of an egg), the ‘new’ stomach. The rest of the stomach remains but food does not go into this. The small intestine is re-plumbed creating a short cut from the new stomach to the mid-part of the small intestine, bypassing the first part of the small intestine.

Gastric bypass works by several mechanisms. Most importantly, the rerouting of the food stream alters gut signals leading to increased satiety, reduced hunger, changes in taste and improved blood sugar. In addition, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed.

On average people lose 20-30% of their total body weight. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance. The surgery can be reversed if required.

gastric bypass3

Sleeve Gastrectomy

Sleeve gastrectomy as a standalone procedure has only bee undertaken since 2008. The surgery involves removing 80% of the stomach, which is then removed. The rest of the gastrointestinal tracts remain untouched.

The surgery alters gut signals that regulate appetite, taste and blood sugar. The new stomach sleeve holds considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. Short-term studies show that the sleeve is as effective as gastric bypass in terms of weight loss and improvement or remission of diabetes.

On average people lose 20-30% of their total body weight. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance. The surgery is irreversible.

Sleeve Gastrectomy

Mini-Gastric Bypass

Mini Gastric Bypass is a relatively new operation first performed in 1997. This involves stapling the stomach starting from its lower part (known as the antrum) to create a long gastric pouch. The rest of the stomach remains but food does not go into this (hence the name bypass). The small intestine is then connected to the bottom of this pouch in such a way that the first part is bypassed. Few research studies have examined the changes after this operation but it is thought to work mainly through altering gut signals which control appetite, taste and blood sugar but also through restricting the size of the stomach. The re-plumbing means that bile contents can pass into the stomach and food pipe. At the moment it is unclear whether this might increase the risk of stomach cancer.

On average people lose 25-30% of their total body weight. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance.

Mini Gastric Bypass new3

Bilio-Pancreatic Diversion With Duodenal Switch (BPD-DS)

The stomach is stapled and the outer 80% is removed. The intestines are re-plumbed so that food passes from the stomach into the distal part of the small intestine (further down than with a gastric bypass). The surgery works by altering gut signals that regulate appetite, taste and blood sugar. In addition, the stomach size is reduced and the absorption of fats and nutrients is reduced.

On average people lose 30-40% of their total body weight. This operation carries the greatest risk of nutritional deficiencies and the sleeve component is irreversible.

duodenal switch2

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