Types of Weight Loss Surgery

Bariatric/Medical Weight Loss

All of the weight loss surgeries at IU Health Bariatric & Medical Weight Loss are minimally invasive or "laparoscopic" surgeries, unless there is a medical reason that would not allow minimally invasive surgery. This is a less invasive surgical option because it eliminates the need for a long incision to open the abdomen. A small video camera is inserted through the small incision made in the abdominal wall, and the surgeon views the procedure on a video monitor.

Studies have shown that this type of surgery offers the following benefits: less pain, easier breathing and increased lung function, fewer wound complications, and faster recovery times. Another type of minimally invasive surgery is the da Vinci Surgical System, which you can read about below.

Weight-loss surgery falls into two basic categories: restrictive surgery and malabsorptive surgery.

Operations that reduce the stomach size are known as restrictive surgery because they restrict the amount of food the stomach can hold. An example of this type of procedure is the adjustable banding.

Some operations combine stomach restriction with a partial bypass of the small intestine. These procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that absorb calories and nutrients. These are known as malabsorptive surgery.

A combination of restrictive and malabsorptive procedures tend to produce more weight loss than either procedure does on its own. An example of a combination is called Roux-en-Y Gastric Bypass Surgery. Today, this procedure is considered the "Gold Standard" for bariatric surgery.

Roux-en-Y Gastric Bypass Surgery

This operation is the most common and successful malabsorptive surgery. First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the amount of calories and nutrients the body absorbs. It is the primary surgery performed by IU Health Bariatric & Medical Weight Loss.

This operation can be performed either by a traditional open surgery or laparoscopically, a relatively new technology using a small video camera and a few customized instruments to perform surgery with minimal tissue damage. The Roux-en-Y technique is generally more effective in reversing health problems associated with severe obesity. Patients who have malabsorptive operations generally lose two-thirds of their excess weight within two years.

Gastric Band Surgery

Restrictive operations serve only to restrict food intake and do not interfere with the normal digestive process. To perform the surgery, doctors create a small pouch at the top of the stomach where food enters from the esophagus. Initially, the pouch holds about one ounce of food and later expands to hold more. The lower outlet of the pouch has a small opening to delay the emptying of food from the pouch and cause a feeling of fullness.

Restrictive operations for obesity include the Adjustable Gastric Band, which restricts the size of the stomach using a band.

Although restrictive operations lead to weight loss in almost all patients, they are less successful than malabsorptive operations in achieving substantial, long-term weight loss. Some patients regain weight. Others are unable to adjust their eating habits and fail to lose the desired weight. Successful results depend on the patient's willingness to adopt a long-term plan of healthy eating and regular physical activity.

Sleeve Gastrectomy

This operation involves the laparoscopic resection of about ¾ of the stomach, leaving behind a long slender gastric tube that is based on the lesser curve. The operation is typically completed in about one hour and most patients stay in the hospital one or two nights. Patients tend to tolerate this operation very well. The sleeve gastrectomy has a high safety profile since it is performed laparoscopically and because it does not include an anastomosis. The intestines are not manipulated in this operation, so it is an ideal option for those patients who have had extensive prior intestinal surgery or have dense adhesions.

Although the sleeve gastrectomy is a relatively new operation, it is undergoing rapid popularity among surgeons and patients. Emerging data on its weight loss and metabolic outcomes is promising; showing a 60% to 75% excess weight loss within the first postoperative year. Patients report a dramatic reduction in appetite and diminished capacity for food. Additionally, nutritional consequences are far less concerning since there is no intestinal bypass; and, although it may be considered a restrictive operation similar to the adjustable band, there is no foreign body, nor is there a need for any postoperative adjustments.

Revisional Surgery

The bariatric surgeons at IU Health Bariatric & Medical Weight Loss are all highly skilled and experienced in bariatric surgery. Because of their level of expertise, they are willing to perform revisional bariatric surgeries, which are corrective surgeries that repair previous weight loss surgeries that have failed. Our surgeons carefully screen all patients who need revisional surgeries, and they attribute the surgeries' successes to their meticulous approach and level of skill.

All surgery is risky, and bariatric surgery is no different. Listen closely to the information provided you by the surgeon and care team and consider your options closely. The following are the most common risks of bariatric surgery:

Respiratory problems
Cardiac problems
Blood clots
Leaks
Infection