The following is a brief description of the different bariatric surgeries:
Laparoscopic Sleeve Gastrectomy:
The sleeve gastrectomy procedure has been done since the year 2000 and has long term data on its safety and efficacy. It involves removing almost 2/3rd to 3/4th of the stomach and leaving behind a banana shaped tube-like stomach. The average volume of the stomach left behind is about 150 ml and can accommodate about 3-5 bites a meal. The size does loosen up after a year and meals do reach up to 6-8 bites. The surgery takes an hour to perform and hospital stay is 1-2 nights. The stomach removed was responsible for many of the hormones causing obesity, hence those hormone levels are reduced. The surgery helps lose about 60-70% of the excess weight over a year and can help treat 60-70% of diabetes. After this surgery most patients report to have an improvement in their acid reflux symptoms while some may complain of increased acid reflux symptoms. The part of the stomach removed helped in the absorption of iron and vitamin B12 therefore it is necessary to take vitamin supplements after this surgery.
Laparoscopic (Roux- Y) classic gastric bypass:
The classic gastric bypass procedure is one of the earliest bariatric surgeries and has been done for over 50 years with a strong safety and efficacy profile. The surgery does not remove any part of the stomach and is therefore reversible. It involves creating a small stomach (gastric) pouch that is separated from the upper part of the stomach. After creating the pouch, the early part of the small intestine is disconnected from the duodenum. Then two connections are made, one connection is between the early part of the small intestines and gastric pouch while another connection is between the duodenum and later part of the small intestine. The larger separated stomach naturally leads to the duodenum, hence both of these structures are bypassed by the food that enters the small stomach pouch and routed to the small intestines. It is believed that both these structures are responsible for the hormones that lead to obesity and bypassing them helps to dramatically reduce those hormone levels. Hence the procedure is called a gastric bypass. The small gastric pouch will initially only take 3 bites a meal but later will loosen up and allow up to 6-8 bites as well. The surgery takes about 2 hours and the hospital stay is also 2 nights. The surgery will help lose about 70% of excess weight and can help treat 80% of diabetes. The effects of this surgery are better longer lasting than the sleeve gastrectomy. Most acid reflux symptoms disappear after this surgery and the chances of having acid reflux after this surgery is quite low. It is necessary to take vitamin supplements after this surgery as well.
Laparoscopic Mini-Gastric Bypass (one-anastomosis)
This is another type of gastric bypass where the stomach pouch is slightly larger and has only one small intestine connection called a gastro-jejunostomy. This surgery involves bypassing a longer length of the small intestine in addition to the stomach and duodenum. Though the weight loss and diabetes control are almost the same as a classic gastric bypass, the weight loss is slightly more durable and longer lasting but the chances of vitamin deficiencies is also slightly increased. The vitamin supplements should be taken more cautiously after this surgery.