If I had 10,000 words to discuss each operation I would probably use them all and still leave many people feeling confused as to the effects of each. The web is full of clever, wordy articles (which many people can't understand). There is also no shortage of sales-type websites who sing the benefits of one particular surgery (the one they offer usually). I haven't seen many easy-to-understand, impartial, no-nonsense articles. So I tried to write one.
I have met many patients, corresponded with many more, met some learned surgeons and read the work of many more. Some things seem common to me:
- Most people think their surgeon is the best
- Most patients think their procedure is the best
- Most surgeons think they are pretty much the best
Whenever some poor soul nails his/her colours to the mast they will be universally unpopular. So here goes.
Here are a few things I have concluded after a few years' listening and trying to learn.
All of the main operations are good and I have seen good results with them all. The people who get matched with the best operation for them, sort out their aftercare and make ongoing dietary and lifestyle changes are the people who consistently have the best results.
Here is a very quick and rough summary of each of the operations and their plusses and minuses.
- Gastric Band
- RNY Gastric bypass
- Duodenal Switch
- Sleeve Gastrectomy
- Gastric Balloon
- Revision or Redo Surgery
An adjustable collar is fitted around the stomach, An adjustment port is fitted under the skin somewhere on your tummy. Regular appointments are needed to adjust the tightness of the collar by injecting a saline solution into it through the port.
Quickest, initially safest, low risk, cheapest, adjustable, no re-plumbing of the anatomy needed, easiest to perform, not long in hospital, not long off work. There is the least requirement of the operation types for vitamins, other supplements and blood tests.
Up to 1 in 5 people can need a further operation depending on aftercare and who you listen to. Weight loss is generally slower than with a bypass but it is sustainable and can last longer. Can require a lot of tweaking to get it just right and keep it that way. Some people don't like needles for fills. Shouldn't eat and drink at the same time. Many people find their enjoyment of food is curtailed. PBing (productive burping) is an effect suffered by those with very tight restriction and is unpleasant and can cause damage to the band.
RNY Gastric bypass
A new small stomach pouch is created and the intestine is divided and joined to new stomach pouch, thereby bypassing part of the intestine.
Faster weight loss, dumping (horrible side effect if you eat high sugar meal), requires less outpatient follow up than the band, better effect on diabetes
Increased risk - clots (DVT and PE) and leakage of internal joins where cuts have been made. Longer op than the band, longer in hospital, longer off work, more pain, more vomiting for some (although some have little or no vomiting at all). Not everyone gets dumping. Procedure is more risky than the band, about 1 in 200 people die within 28 days of surgery. Patient needs more monitoring about vitamins and diet. Shouldn't eat and drink at the same time. More chance of weight regain than with the band.
A new sausage shaped stomach is made and a long intestinal bypass made.
Needs most vitamins, minerals and follow up. Need to be disciplined to eat a regular high protein diet, and follow instructions. Expensive dietary regime which requires large quantities of good quality protein food, plus extensive nutritional supplements (not always prescribed on the NHS). Some people can get bowel problems, diarrhoea, a lot of bottom wind or constipation. Longest operating time of all the operations. Few surgeons perform this op in UK.
A new sausage shaped stomach is made, smaller than the original, but with no intestinal bypass. One of the newest operations, it can be done as the first part of another operation for larger people, or those with other high risk factors.
Quicker, easier and less time in hospital
Less convincing longer term weight loss and no help in maintaining weight loss.
Short term, patient can feel sick, balloon can burst, weight loss not sustainable after balloon taken out.
Revision or Redo Surgery
More risky, more specialised, can be difficult, less hard evidence of positive results afterwards.