Types of obesity surgery

The surgical treatment of obesity has been transformed during the last decade or so, largely due to developments in laparoscopic (keyhole) techniques and anaesthetics. Two types of surgical procedures used to promote weight loss are:

Restrictive surgery

During these procedures the stomach is made smaller so that it holds less food, making you feel full with smaller portions. Because you can only eat small quantities, your calorie intake falls and you lose weight. Restrictive procedures do not interfere with normal digestion and absorption of nutrients.

Malabsorptive surgery

This approach changes the body’s ability to absorb calories from food. By re-routing food in such a way as to exclude (bypass) a section of the small bowel (intestine), much of the calories and nutrients pass through without being absorbed. Again, fewer absorbed calories means weight loss.

Most modern surgical treatments for obesity involve pure restriction or a combination of restriction and malabsorption. The two most commonly performed operations for obesity are:

1. Laparoscopic adjustable gastric banding (LAGB) also known as lap banding/gastric banding

and

2. Gastric bypass ( combining both restrictive and malabsorptive elements)

Gastric banding is a purely restrictive procedure whilst gastric bypass combines restriction with a small malabsorptive component. Other less commonly performed procedures include biliopancreatic diversion (BPD), duodenal switch (BPD/DS) and variants.

A summary of the main benefits and risks of these two procedures is shown below:

TABLE 1 Laparoscopic Adjustable Gastric Banding versus Gastric Bypass
Laparoscopic adjustable gastric banding (LAGB)	Gastric bypass
100% restrictive procedure	70% restrictive, 30% malabsorptive
Takes around 45 minutes	Takes around 1.5 – 2 hours
Hospital stay 1 night	Hospital stay 3 nights
Recovery time 10-14 days	Recovery time up to 6 weeks
Fully reversible procedure	Not easily reversible
50-60% excess weight loss	60-70% excess weight loss
<5% early complication rate	5-10% early complication rate (haemorrhage, staple-line leakage etc)
Mortality 1: 1000 (0.1%)	Mortality 1:200 (0.5%)
No risk of metabolic complications	Risk of metabolic complications including vitamin and mineral deficiency
Vitamin and mineral supplementation recommended but not essential	Lifelong vitamin and mineral supplementation essential
Regular band adjustments required to achieve desired weight loss	Regular blood tests required to prevent anaemia, protein deficiency etc

Healthier Weight's expert team will advise you regarding which of these procedures – or other alternatives – is the most appropriate for you.

Obesity surgery guide index

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The information within this guide to obesity / weight loss surgery is provided by Healthier Weight. Intuition Communication Ltd bears no responsibility for information published in this guide. Read Disclaimer in full.