Bariatric surgery (weight loss surgery) covers a variety of procedures performed on people with obesity.
Long-term studies show that Bariatric Surgery procedures cause
- significant long-term loss of weight
- recovery from diabetes
- improvement in cardiovascular risk factors, and
- a mortality reduction from 40% to 23%
There are three main types of Bariatric Surgery
Gastric Banding (Lap Banding) – weight loss is achieved by reducing the size of the stomach with a gastric band.
A gastric banding procedure involves an adjustable band being placed around the top of the stomach via keyhole surgery, and an access port inserted deep under the skin which is connected to the band by special tubing. From six weeks post surgery, adjustments are performed at two to four week intervals until the optimal level of restriction is reached.
How does gastric banding aid in weight loss?
The gastric band allows you to eat much less, while still enjoying your food and feeling satisfied, by:
- Portion control: it allows you to feel full and satisfied with smaller meals, preventing overeating.
- Hunger control: you feel less hungry in between meals.
Initially, very little to no fluid is inserted into the band to allow the band to ‘settle in’ after the operation.
Six weeks post surgery, band adjustments begin. A small amount of fluid is injected into the access port to expand the band and increase restriction on the stomach. Adjustments are made at two to four week intervals until optimal restriction is reached. This is the so-called ‘sweet spot’, where you will be able to eat a small amount of most foods without obstruction, but also without feeling hungry after or between meals.
Through all of this, patients work closely with our dietitians and psychologist to make the lifestyle and behavioural changes needed to achieve and sustain their weight loss.
How much weight can I expect to lose after Gastric Banding?
On average, patients lose 50 per cent of their excess weight. By comparison, non-surgical weight loss options achieve an average weight loss of 5 to 10 per cent.
The best results are achieved when a multidisciplinary team supports patients through both surgical and lifestyle options.
Our patients have lost up to 100 per cent of their excess weight with our program.
What are the potential benefits of a gastric band?
Gastric banding is very safe. It is safer than other forms of weight loss surgery. No surgery is completely risk free, but remember that chronic untreated obesity also has risks.
Gastric banding is popular because:
- It is removable
- It does not involve stapling the stomach, removing part of the stomach or bypassing parts of the intestine
- When patients follow a balanced diet, it does not lead to deficiencies in vitamins and minerals since food is absorbed exactly the way it was before surgery. If however, there are problems with over-restriction, the patient will start to develop dysfunctional eating patterns with an unbalanced diet and they can develop nutritional deficiencies
- Gastric banding has a proven track record. It has been performed in Australia since 1992 and long-term results are available
What are the potential disadvantages of a gastric band?
The average weight loss after gastric banding is lower than after a sleeve gastrectomy or gastric bypass. Typically, excess weight loss after gastric banding is 48 per cent compared with 67 per cent after a gastric sleeve or bypass.
Weight loss is less predictable. After a gastric band, the amount of weight loss varies from person to person as the patient learns to use their gastric band as a tool to assist them with behavioural and lifestyle changes. There is a wider range of weight loss after a gastric band compared to after a sleeve or bypass, because a band is more dependent on patient behaviour.
Gastric band has the highest rate of re-operation over the long term. Up to one in five people who have had a gastric band will require a further operation. This re-operation rate is much higher than after a sleeve gastrectomy (approximately three in 200 people) or gastric bypass (15 in 200 people).
A gastric band does not alter metabolism. It restricts the capacity of the stomach but does not affect the complex biochemical pathways regulating appetite and metabolism, therefore patients typically do not experience the same shift in food preferences, away from sugary or fatty foods, as with a sleeve gastrectomy or gastric bypass.
After gastric banding, re-operation may be required for:
- Infection of the port or the band
- Slippage of the band and pouch dilatation which, if untreated, leads to weight gain and indigestion or gastro-oesophageal reflux
- Leakage of saline from the connecting tube or the balloon of the band
- Dislocation of the port
- Erosion of the band through the stomach wall
- Insufficient weight loss
- Obstruction of the band where it may suddenly become over-restricted or obstructed. This frequently requires an urgent adjustment. Under these circumstances it is best to be close to an appropriate facility that is familiar with gastric bands and can perform an adjustment competently. For this reason, a gastric band is less suitable for people living in remote areas, or for those who travel to remote destinations
- Less effective at resolving obesity-related health problems including type 2 diabetes. After a gastric band, only five out of 10 patients have a remission of their disease – compared to eight out of 10 people after a sleeve gastrectomy or bypass. Resolution after gastric band is dependent on weight loss and takes longer compared to sleeve or bypass procedures
Who gets the best results from gastric banding?
People who get the bests results from gastric banding are those who:
- Do not need to lose a very large amount of weight
- Have been able to lose weight quite easily in the past with diets and exercise, but struggle to keep the weight off
- Are well motivated to make behavioural and lifestyle changes with the support of our multidisciplinary team
A sleeve gastrectomy, also known as gastric sleeve surgery, is a weight loss operation in which a thin vertical sleeve of stomach is created using a stapling device via keyhole surgery.
How does a sleeve gastrectomy work?
The human stomach is a distensible pouch-shaped organ that can hold up to two litres. During a sleeve gastrectomy, the stomach is changed from a pouch to a thin, vertical sleeve using a stapling device. The newly-created gastric sleeve will only hold between 50ml and 150ml, and is about the size and shape of a banana.
The removed portion of the stomach, called the antrum, is also the part of the stomach that secretes many of the metabolically active gut hormones responsible for the neuro-hormonal response to food. Removing this portion can alter the body’s biochemical response to food, changing appetite and food preferences.
Despite being smaller, the stomach ‘sleeve’ still functions in a relatively normal manner:
- Food passes through the digestive tract in the usual order
- Acid continues to be made to assist digestion
- Vitamins and nutrients continue to be absorbed into the body
A sleeve gastrectomy allows you to eat much less, while still enjoying your food and feeling satisfied, by:
- Portion control:
The sleeve has a restrictive effect that allows you to feel full and satisfied with smaller meals, preventing overeating.
- Hunger control:
You feel less hungry in between meals. A sleeve gastrectomy not only reduces the stomach capacity, it also alters appetite by changing the patient’s biochemical response to food.
- Healthier food choices:
It changes the way the gut handles sugary and fatty foods, causing reduced desire for these foods and making healthier food choices easier.
- Altered metabolism:
It changes the blood levels of metabolically active gut hormones and affects the complex biochemical pathways regulating appetite and metabolism. This leads to changes in blood sugar metabolism, independent of weight loss.
How much weight can I expect to lose?
Patients typically lose between 65 to 70 per cent of their excess body weight. By comparison, non-surgical weight loss options achieve an average weight loss of 5 to 10 per cent.
What are the potential benefits?
It is one of the most effective weight loss procedures, with patients losing more weight after a sleeve gastrectomy than after a gastric band, and equal weight loss to that of a gastric bypass, with less risk of complications.
Sleeve gastrectomy effectively resolves obesity-related health problems including rapid resolution of Type 2 Diabetes in 80 per cent of patients by the time they are discharged from hospital, long before significant weight loss occurs.
A sleeve gastrectomy requires fewer follow-up appointments than a gastric band, and fewer potential post-operative problems than a gastric bypass.
- It is expected to cause fewer nutritional deficiencies than gastric bypass and therefore requires less frequent monitoring.
- Unlike a gastric band, a sleeve gastrectomy does not require follow-up appointments for adjustments.
- Patients are less likely to regain weight after a sleeve gastrectomy than a gastric band.
Typically, once a patient has recovered from a sleeve gastrectomy, there is minimal risk of potential complications. It can almost be called a ‘set and forget’ procedure.
What are the potential disadvantages ?
Fewer patients develop complications after a sleeve gastrectomy than after gastric band or gastric bypass surgery. However, if complications do occur, they can potentially be difficult to fix.
In just one per cent of cases, a staple line leak occurs. Early detection and management is crucial for a fast and smooth recovery. In some cases however, the recovery time can be lengthy. A leak will typically present in the first two weeks post surgery. After this time, there are few potential complications from sleeve gastrectomy.
Severe pre-existing reflux and heartburn may not be well controlled by this procedure. In some cases, a gastric bypass may control these severe symptoms more effectively.
In comparison to gastric band and bypass, sleeve gastrectomy is a relatively new procedure and therefore there is limited long-term data about weight loss maintenance. Published results up to 10 years after gastric sleeve surgery show that up to a third of people have some weight regain a few years after a weight loss operation. Weight regain after a sleeve gastrectomy is comparable with gastric bypass. Fortunately, after a gastric sleeve or bypass, the patient’s weight does not return to previous levels. This is not the case with patients who choose a gastric band, where if the restriction provided by a gastric band is removed, the patient typically regains the weight and sometimes more.
Who gets the best results from a sleeve gastrectomy?
A sleeve gastrectomy provides predictable, effective weight loss with resolution of obesity-related health problems, plus has a low risk of complications. A sleeve gastrectomy can also be performed as a revisional procedure in cases where a gastric band has become problematic or ineffective.
Gastric bypass is a surgical technique that alters the pathway of food from the stomach to the small bowel. The new pathway creates a smaller pouch of stomach, and diverts food from the first part of the small bowel. It is both a restrictive and malabsorptive form of bariatric surgery. The smaller stomach size restricts the amount of food that can be consumed. This aids satiety (the sensation of being full) and alters the release of gut hormones that control appetite. Through bypassing the first section of small bowel, the procedure also reduces absorption of nutrients and calories.
Pros: Up to 80% of people show no signs of diabetes after surgery. Plus, people usually lose 60% to 80% of their extra weight.
Cons: Your body can’t absorb as many vitamins and minerals as before, which could lead to health problems.
There are two main forms of gastric bypass surgery – Roux-en-Y gastric bypass surgery (RYGB) and single anastomosis gastric bypass, which is also known as Omega-Loop or ‘Mini’ gastric bypass (MGB) surgery. Both procedures are performed through laparoscopic (keyhole) surgery, but there are advantages and disadvantages to each technique that make each suitable for different people.