Weight Loss Surgery - Your Main Options

Ramsay Health Care UK | 29/07/2014

Weight Loss Surgery - Your Main Options

There are a number of weight loss treatments. Each differs in their complexity, invasiveness and the amount and speed of weight loss.

Factors that affect your choice of treatment

The type of weight-loss procedure that is best for you depends on your individual situation. Your consultant surgeon will take many factors into account, including your body mass index, eating habits, health problems, any previous surgery and the risks of each procedure. You and your surgeon will make the decision together about which weight loss technique is the most appropriate for you.

Restrictive and malabsorptive weight loss surgery

There are two types of weight loss surgery:

• Restrictive - as the name suggests, works by restricting the size of your stomach. The smaller your stomach the less you can eat, resulting in weight loss.
• Malabsorptive/restrictive surgery are more invasive and restrict the size of your stomach and additionally remove or bypass parts of your digestive tract, making it also harder for your body to absorb calories.

Gastric balloon

A gastric balloon is usually inserted into the stomach for six months and works by helping you to feel full whilst you undertake a weight loss programme. It’s a popular choice if you want to ‘kick start’ your weight loss whilst you work towards changing your lifestyle and eating habits to help keep the weight off.

What is it?

A gastric balloon is a soft silicon balloon that is inserted whilst deflated into your stomach. It is passed through your mouth and down into your stomach using an endoscope (a thin, flexible tube that has a light and a camera on one end).The balloon is then filled with sterile saline or air and left in your stomach for six months.

The balloon partially fills your stomach, giving you a feeling of fullness more quickly after smaller meals. After six months the balloon will be deflated and removed.

The pros

• A non-surgical and less invasive weight loss technique that takes only 15 minutes under a mild sedative allowing you to go home the same day.
• The balloon is removable and temporary offering support whilst you initially lose weight and become more active.
• The balloon can be filled with more saline to make less room in your stomach if your weight plateaus.
• A gastric balloon is a useful way to lose weight if you don’t meet the criteria for the other types of weight loss surgery such as you are too obese.¹
• The procedure is much less expensive as it doesn’t involve anaesthetics or longer hospital stays.²
• Many patients achieve satisfactory weight loss in the six month period whilst the balloon is used.

The cons

• It offers a short term solution and you may gain weight after the balloon is removed.
• You may have intolerance to the balloon and not achieve your desired weight loss.
• Weight loss can be less and slower than surgical weight loss options.

For more details read our blog post - 11 Things You Need to Know About a Gastric Balloon

Gastric banding

Gastric banding is a restrictive procedure and is one of the least invasive weight loss procedures and also one of the most commonly-used. Gastric banding physically restricts the amount of food you can consume at meal times and works mainly by decreasing the quantity of food you can eat at any one time .

What is it?

Gastric banding involves placing an inflatable silicone band around the top part of your stomach .It creates a small pouch at the top of the stomach which will take less food to fill and so it will take less food to make you feel full. It resembles an hour glass.

The food passes slowly through the opening from the top part of the stomach into the lower part of your stomach and continues on as normal. Gastric banding is done routinely as minimally invasive surgery using a tiny camera called a laparoscope. It is often referred to as laparoscopic adjustable gastric banding.

The pros

• It's simpler, less invasive and has fewer complications than a gastric bypass and other operations.
• Gastric banding is carried out under general anaesthetic, which means you will be asleep during surgery and will not feel any pain.
• Recovery is usually faster than other weight loss surgery. You should be able to go home the day after the operation and most people recover within one - two weeks after the operation.
• The band can easily be inflated or deflated with saline solution to control the size of the opening into the lower part of the stomach and the rate at which food passes from the upper pouch to the lower section of your stomach, depending upon your needs.
• The procedure can be reversed by surgically removing the band.
• On average people lose around half of their excess weight.³

The cons
• You are likely to have a less dramatic and more gradual weight loss than if you opt for more invasive surgery.
• You will need to attend several outpatient appointments to adjust the gastric band.
• You may regain some weight over the years.
• If you are severely obese then laparoscopic surgery may not always be possible.
• Weight loss can be more variable with gastric banding than other procedures.³

Mr Stuart Andrews – Consultant Upper GI/Bariatric and General Surgeon at Mount Stuart Hospital commented: “The gastric balloon and gastric band are the safest and least invasive forms of bariatric surgery, which are reversible. They are highly effective but selecting the correct patient for the most suitable procedure is key to maximising the effectiveness of any form of bariatric surgery.”

Sleeve gastrectomy

Sleeve gastrectomy or gastric sleeve surgery is also a restrictive procedure. During a sleeve gastrectomy your stomach is physically made smaller but the way that it functions remains unaltered unlike with a gastric bypass so side effects are reduced.

As your stomach size is reduced after a sleeve gastrectomy you will only be able to eat a small meal and you keep a feeling of fullness for longer.

What is it?

A sleeve gastrectomy permanently removes a portion of your stomach, reducing its size by about 75% and leaving a narrow tube or sleeve. The operation is usually done with a laparoscope, sometimes referred to as keyhole surgery.

Occasionally, a sleeve gastrectomy can be used as a first step in a sequence of weight loss procedures . It can be followed up by a gastric bypass or biliopancreatic diversion, if more weight loss is needed. However, in most cases, it is the only surgery you need.

The pros

• Sleeve gastrectomy will dramatically reduce your calorie intake. You can eat normally but you will only tolerate very small portions and this can lead to dramatic weight loss in a relatively short period.
• A sleeve gastrectomy can also be used to treat extremely morbidly obese people (with a BMI of 60 or above)⁴.
• Because the intestines aren't affected, a sleeve gastrectomy doesn't affect the absorption of food, so nutritional deficiencies aren’t normally a problem.
• You can expect to lose around 60 percent of your excess body weight.³
• By removing the part of your stomach that contains cells with an appetite prompting hormone called ghrelin your hunger will be reduced more than with purely restrictive procedures such as gastric banding.

The cons

• Unlike gastric banding, a sleeve gastrectomy is irreversible.
• Weight loss is generally not as great as with a gastric bypass.
• You’ll need to stay in hospital between two-three nights which is longer than other weight loss procedures, and have a greater recovery time of 4-6 weeks after the operation.

For more details read our blog post - 9 Things You Need to Know About a Gastric Sleeve

Gastric bypass

Gastric bypass surgery is a highly effective weight loss procedure and one of the most common type of weight loss surgery. Gastric bypass surgery helps very overweight people achieve substantial and long-term weight loss and can also be highly effective with certain types of eater.

What is it?

A gastric bypass can be carried out by laparoscope (keyhole) or by open surgery (very rarely). It is usually performed as a type of laparoscopic surgery where possible with less pain afterwards and a faster recovery time.

Your stomach is divided into two parts and the upper section is connected directly to a section of your small intestine, bypassing the rest of your stomach, duodenum, and upper intestine. Your food intake is limited by a small upper stomach pouch.

Your intestines can be bypassed at several points. The most common gastric bypass is the Roux-en-Y bypass. A more complex surgery is called biliopancreatic diversion with duodenal switch as this re-routes food away from much of the small intestine and it also changes bile and other digestive juices that affect the body's ability to digest food and absorb calories.

The pros

• Weight loss tends to be more rapid and dramatic than other weight loss procedures. In general, gastric bypass patients will lose around 70 percent of their excess weight, sleeve gastrectomy patients will lose around 60 percent, and gastric banding patients will lose around 50 percent.³
• You'll probably feel dramatically better with rapid improvements in conditions affected by obesity such as diabetes, high blood pressure, high cholesterol, arthritis, sleep apnoea and heartburn.
• Gastric bypass offers good long-term results and many people are able to keep most of their weight off.

The cons

• You’ll need to stay in hospital between 2-3 nights which is longer than other weight loss procedures, and have a greater recovery time of 4-6 weeks after the operation.
• This procedure can put you at risk of nutritional deficiencies as it impairs your body’s ability to absorb food. You'll have to be careful with your diet, take multi vitamin supplements and you may need some nutrients in your blood to be monitored.
• ‘Dumping’ of your food into the intestines too quickly before it’s been properly digested is common and can cause nausea, bloating, pain, sweating, weakness, and diarrhoea. The upside of the effects of dumping means that patients tend to avoid these weight gaining foods that lead to dumping syndrome.
• A gastric bypass is generally considered irreversible and permanently changes how your body digests food.
• Because gastric bypass procedures are classed as major surgery the risks can be higher than with some other weight loss procedures.
• It may not be suitable for severely morbidly obese people.

For more details read our blog post - 11 Things You Need to Know About a Gastric Bypass


Here you can find our guide prices for weight loss surgery procedures.

Watch our video about weight loss treatments here.

Read more weight loss surgery blog posts to find answers to the most common questions including: pros and cons of gastric balloon and gastric sleeve, how to choose a weight loss surgeon, exercise after weight loss surgery etc.

Thank you

Big “thank you” to Mr Stuart Andrews – Consultant Upper GI/Bariatric and General Surgeon at Mount Stuart Hospital in Torquay for reviewing this article.

Following completion of his basic surgical training, Mr Stuart Andrews was awarded the Member of the Royal College of Surgeons of England in 2003, after which he commenced the Peninsular Higher Surgical Training Programme in General Surgery.

Read more about Mr Andrews’s qualifications, background and clinical interests.

About Ramsay Health Care Weight Loss Surgery Services

Ramsay Health Care is a leading provider of weight loss surgery in the UK. Whatever weight loss treatment option you are considering Ramsay offers weight loss procedures that are performed by highly qualified and experienced bariatric surgeons who have undergone intensive training in their speciality.

They will work in a multidisciplinary team who liaise with each other to provide the best plan of action for you. They include a dietitian who will meet with you and produce a bespoke eating plan, and specialist trained nurses who will be by your side during your journey to offer support and guidance to ensure that you achieve your goals.

This content is intended for information purposes only and should not replace advice that your Consultant Surgeon would give you.

Please contact us if you would like to discuss one of these procedures in more detail.

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References

¹http://www.nhs.uk/Conditions/weight-loss-surgery/Pages/how-it-is-performed.aspx#gastric-balloon
²http://www.health24.com/Diet-and-nutrition/Weight-loss/Intragastric-balloons-for-weight-loss-20120721
³http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/choosing-the-right-weight-loss-surgery-procedure
http://www.hscic.gov.uk/catalogue/PUB13648

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