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Choosing the right procedure is key in weight loss surgery

Learn more about the benefits and risks of each of the four main types of weight loss surgery.
When she reached her highest weight of 434 pounds, Betty Haskins' body was breaking down. Undergoing a duodenal switch surgery was the beginning of Betty’s ongoing journey to better health. Betty lost 334 pounds and has kept it off for more than two years by adhering to a strict eating plan. Her sleep apnea has improved, and she has a renewed outlook on life.
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Is surgery an effective option for losing weight? And what types of weight loss surgery are available?

Bridget Slusarek, BSN, RN, the nurse manager of University of Minnesota Health’s Weight Loss Management and Surgery program, says surgery is just one treatment option for weight loss.

“Surgery can be a good choice for people who need to lose a significant amount of weight,” she said. “But it’s important to have an evaluation from a care team to determine if surgery is option and, if so, which surgery is most suitable. Each one carries different benefits and risks.”

Care teams at University of Minnesota Medical Center offer four types of weight loss surgery:

  • Adjustable gastric banding
  • Sleeve gastrectomy
  • Roux-en-Y gastric bypass
  • Duodenal switch

Slusarek described each of these options—including the key benefits and risks.

Adjustable Gastric Banding
During this procedure, a surgeon places a band around the uppermost part of the stomach, dividing it into a smaller portion and a larger portion. Because food passes slowly from the upper portion to the lower portion, people who have this procedure feel full longer. If a patient is 100 pounds overweight, average weight loss with this procedure is 30 to 40 pounds.

This procedure doesn’t require an opening or removal of any part of the stomach or intestines. Food passes through the digestive tract in the usual order, allowing the body to fully absorb the nutrients.

However, it is possible to “eat through” the operation and lessen its effectiveness. If patients don’t follow the prescribed diet, nausea and vomiting are likely. And because the band is a foreign body, a patient may need another procedure later in life.

Sleeve Gastrectomy
During this procedure, a surgeon removes approximately 60 to 80 percent of the stomach, so that it takes the shape of a tube or “sleeve.” Because stomach volume is decreased, food intake is restricted. If a patient is 100 pounds overweight, average weight loss with this procedure is 50 to 60 pounds.

This procedure doesn’t alter how the stomach functions or affect the intestines, so patients can consume most foods in small amounts. Patients also don’t experience dumping syndrome (rapid gastric emptying accompanied by cramps, nausea and diarrhea).

This procedure is not reversible because the surgeon removes part of the stomach. In addition, the leak rate (the risk that stomach contents will leak through the area affected by the surgery) is slightly higher with this procedure than with Roux-en-Y gastric bypass.

Roux-en-Y gastric bypass
With this procedure, a surgeon sections off a portion of the stomach to create a small pouch. The surgeon doesn’t remove the rest of the stomach, but completely staples it off from the pouch. Because the pouch holds only about one ounce of food or less, food intake is restricted. The outlet from the pouch empties directly into the lower portion of the intestines, which limits the calorie absorption. If a patient is 100 pounds overweight, average weight loss with this procedure is 60 to 70 pounds.

Surgeons have been doing this procedure since 1967, and studies show that it results in sustained weight loss and improvements in weight-related problems such as Type 2 diabetes.

But patients must take daily supplements to prevent chronic conditions such as anemia and B12 deficiency caused by poor nutrient absorption. Hypoglycemia can occur with intake of carbohydrates after this procedure as well.

Duodenal switch
This procedure has two parts: removal of a portion of the stomach and formation of a bypass of the small intestines. Bypassing the small intestines creates malabsorption (poor absorption of food), which facilitates weight loss. If a patient is 100 pounds overweight, average weight loss with this procedure is 70 to 90 pounds.

This surgery can produce the greatest weight loss because it provides the most malabsorption—making it a good procedure for people who have a body mass index greater than 50, or are 200 or more pounds overweight. Patients can be successful at maintaining weight loss long-term if they follow a strict diet, exercise and behavioral plan.

But after this surgery, patients will need close, lifelong monitoring for protein malnutrition and bone diseases. Vitamins can cost more than $100 per month. Patients may also experience abdominal bloating, malodorous stool, gas and frequent bowel movements.

Choosing the right procedure
University of Minnesota Health’s Weight Loss Management and Surgery program can help people determine whether weight loss surgery is a good option for them. For long term success people need to follow strict dietary and exercise guidelines.

“There is no universal approach to weight loss,” Slusarek said. “Our goal is to help our patients find the right solution that brings the most benefits with the fewest risks.”


For more information about medical and surgical weight loss, visit our Weight Loss Management and Surgery program website.

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