What is Metabolic Bariatric Surgery?
Metabolic Bariatric Surgery is devoted to weight loss and treating metabolic conditions. Surgical therapy for morbid obesity (obesity that negatively impacts health) most often involves operations on the stomach or the stomach and small bowel, reducing stomach size and changing the hormones associated with hunger. Metabolic Bariatric Surgery can be classified as restrictive only or restrictive and malabsorptive. Restrictive operations work only by making a smaller stomach to limit the amount of food you can eat at one time. Malabsorptive operations work by decreasing the absorption of nutrients.
Weight loss surgery is not a cosmetic procedure even though it often results in a favorable cosmetic result. Surgical procedures for weight loss involve permanent changes in the patient’s anatomy and are not intended to be reversible. The decision to undergo such an operation should not be made lightly. As with all surgical procedures, some risks come with weight loss surgery. For this reason, weight loss surgery is only offered to those patients who meet the criteria of morbid obesity.
Metabolic Bariatric Surgical Procedure Options
In addition to revisional surgery, our program offers three metabolic surgical procedures: Roux-en-Y Gastric Bypass (Gastric Bypass), Biliopancreatic Diversion with Duodenal Switch (DS), and Sleeve Gastrectomy (Gastric Sleeve). All three operations are usually performed laparoscopically using fiberoptic cameras and instruments inserted through small incisions in the abdomen. However, when necessary, they can be performed “open” with a single large incision. The advantage of laparoscopic is that it results in less discomfort, a shorter recovery from surgery, and fewer complications compared to single-incision open surgery.
The Gastric Bypass is one of the oldest weight loss surgery procedures, having now been performed for more than 50 years. It is one of the most common operations and is effective in treating obesity and obesity-related diseases. It is considered the gold standard for Metabolic Bariatric Surgery. The Gastric Bypass procedure involves two mechanisms – creating a small stomach pouch and dividing the small intestine.
First, the stomach is divided into a smaller top portion (pouch) which is about the size of an egg. The larger part of the stomach is bypassed and no longer digests food. Second, the small intestine is also divided and connected to the new stomach pouch. The small bowel segment that empties digestive enzymes from the bypassed stomach is connected to the small bowel approximately 3-4 feet downstream, resulting in a connection resembling the letter Y. This Y-shaped configuration is called a Roux-en-Y, a French term meaning “in the form of a Y”. The Roux-en-Y introduces an element of malabsorption allowing the patient to lose more weight faster than with a purely restrictive procedure. Importantly, the modification of the food course through the gastrointestinal tract profoundly decreases hunger and increases fullness. The impact of the Gastric Bypass on hormones and metabolism allows the body to reach and maintain a healthy weight and makes this procedure a great option for patients with adult-onset diabetes and for those with more weight to lose.
Sleeve Gastrectomy (Gastric Sleeve)
The Gastric Sleeve is a relatively simple procedure. This operation involves removing approximately 80% of the stomach. The remaining tube-like pouch is about the size and shape of a banana.
The Gastric Sleeve works predominately by restricting the amount of food that the reconfigured stomach can hold. However, it also impacts the hormones in the gut that trigger hunger cues, making it a metabolic procedure. This can help with satiety (or feeling of fullness) with smaller amounts of food intake.
The simple nature of a sleeve gastrectomy makes it very safe without potential complications from surgery on the small intestine. However, this procedure may not be for patients with acid reflux (GERD) and heartburn as it can make those conditions worse. It also has less of a metabolic effect than a gastric bypass.
Biliopancreatic Diversion with Duodenal Switch (Duodenal Switch/DS)
The Duodenal Switch (DS) may be recommended for patients who are severely obese or have poorly controlled diabetes. Like the gastric sleeve, it begins with making a tube-like stomach pouch. The unused portion of the stomach is removed. The DS bypasses about 75% of the small intestine, which is the most of any other commonly performed procedure. The small intestine is separated from the end of the stomach pouch, and the latter part of the small intestine is attached to the stomach pouch. When the patient eats, the food goes through the sleeve-like stomach pouch and into the latter part of the small intestine. The smaller stomach allows the patient to feel full after eating less food, and bypassing much of the small intestine creates significant malabsorption of calories and nutrients. The DS has a powerful effect on intestinal hormones. This reduces feelings of hunger, increases fullness, and improves blood sugar control. For this reason, it is the most effective approved metabolic bariatric surgery procedure for treating type 2 diabetes.
The Duodenal Switch is a more complex surgery and takes longer than the gastric bypass or gastric sleeve, which may result in a slightly higher complication rate. DS patients must be vigilant about taking their vitamins and mineral supplements because of the degree of malabsorption. Like the gastric sleeve, this procedure may not be for patients with acid reflux (GERD) and heartburn as it can make those conditions worse. DS patients may experience loose and more frequent bowel movements.