In this guide we provide answers to the most common questions asked by those considering bariatric surgery. We explain when the surgery is recommended, what type of bariatric procedures there are, how they are performed and what outcome can be expected.
Bariatric Surgery (also known as Weight Loss Surgery) is the umbrella term for a group of medical procedures that reduce the size/volume of various portions of the digestive tract to aid patients with weight loss. This is achieved by either restricting the intake of food by reducing the size of the stomach, or by restricting absorptive capacity by reducing the size of the small intestine.
Bariatric Surgery is usually pursued by and/or prescribed to individuals with severe obesity, and potentially other co-existing medical conditions, for whom traditional diet and exercise programs have not been effective. Worldwide, obesity is defined by having a Body Mass Index (BMI) over 30.
Body Mass Index (BMI) is a globally accepted measure of body fat based on the relationship between height and weight. While BMI is an effective screening tool to determine whether an individual is in a weight category that may lead to health problems, BMI alone is not a diagnostic of body fatness or the health of an individual.
To calculate BMI = Weight in Kilograms / Height in Meters2
The BMI Weight Categories are as follows:
below 18.5 = Underweight
18.5 - 24.9 = Healthy
25 - 29.9 = Overweight
30 - 40 = Obese
above 40 = Extremely Obese
Although qualification guidelines vary by country, generally, bariatric surgery can be recommended for any adult under the supervision of a medical professional who meets one of the following criteria:
It is generally recommended that bariatric surgery be utilized as a last resort for individuals who have not been successful with diet and exercise programs, regardless of whether they have been on adjunctive drug therapy.
Most bariatric surgeries today are minimally invasive, as they are performed laparoscopically.
Laparoscopic surgery (also known as keyhole surgery or bandaid surgery) is a modern surgical technique in which a surgeon can conduct an entire procedure through a few small incisions (usually .5-1.5cm in diameter), using a laparoscope (a long, fiber-optic cable) inserted through a needle-like tube. In most bariatric procedures, surgeons will make 2-4 laparoscopic incisions.
The main advantages of laparoscopic surgery to patients is that recovery times are much shorter, and there is a significantly reduced risk of pain and hemorrhaging post-procedure.
There are many different types of bariatric surgeries, with slight variations in technique and available innovation depending on the surgeon and and country in which the procedure is being performed. Below, the three main types of bariatric surgery are detailed. Each procedure may be tailored based on the custom needs and differing weight loss goals of the patient.
The Gastric Band, also known as the Adjustable Gastric Band, is a bariatric surgery that works by solely restricting the amount of food intake.
In this surgery, the surgeon places an inflatable band around the stomach, thereby reducing the size of the stomach. The inflatable band is filled with sterile saline, and is controlled through a port placed under the skin.
By reducing the size of the stomach, eating just a small amount of food will satisfy hunger cravings and promote a feeling of fullness. The capacity of stomach fullness depends on the size of the opening created by the inflatable band, which gets adjusted over time. The adjustments to the band, known as ‘fills’ (because the band opening gets smaller as the band is filled with more saline), are done by injecting saline into the port that has been placed under the skin. This is usually performed by a physician or other trained medical professional, but over time, can be done by the patient.
With the Gastric Band procedure, food is digested and absorbed as it normally would be--the main method of action is to reduce stomach size to the point that calorie intake is decreased, which leads to eventual weight loss. This particular bariatric surgery is reversible and has the lowest rate of post- operative complications. However, this type of bariatric surgery has much slower weight loss results, and since there is a foreign object (the band) remaining in the body, has the small risk of mechanical complications that would require re-operation.
The Gastric Sleeve, also known as a Sleeve Gastrectomy, or plainly, the sleeve, is a bariatric surgery that works by restricting the amount of food intake and regulating hormone production in the gut.
In this surgery, the surgeon removes approximately 80% of the stomach, leaving a banana-shaped pouch.
By drastically reducing the size of the stomach, the patient is physically limited in the amount of food (calories) that can be consumed. Additionally, because the stomach volume is reduced, hormones produced in the stomach that impact hunger, satiety, and blood sugar move into normal ranges.
With the Gastric Sleeve procedure, food is digested and absorbed as it normally would be, just in much smaller quantities. The main advantages of this particular type of bariatric surgery is that it induces rapid and significant weight loss, involves a relatively short hospital stay (usually around 2 days), and has shown similar results in short-term studies to more complex procedures, like the Gastric Bypass. The Gastric Sleeve is a non- reversible procedure and does have potential for long-term vitamin deficiencies if a proper diet is not maintained long-term. The U.S. Food and Drug AdministrationExternal Link Disclaimer (FDA) has approved use of the gastric band for people with a BMI of 30 or more who also have at least one health problem linked to obesity, such as heart diseaseExternal NIH Link or diabetes.
The Gastric Bypass, also known as the Roux-en-Y Gastric Bypass, is a bariatric surgery that works by restricting the amount of food intake in addition to reducing absorptive capacity of food ingested. This surgery is considered the ‘gold standard’ for weight loss surgeries.
In this surgery, there are two procedures that occur. First, the surgeon will create a small pouch out of the top of the stomach, about 1 ounce (30 milliliters) in volume, separating it from the rest of the stomach. Then, the small intestine gets divided into two segments as well. The small pouch created out of stomach is connected to the bottom portion of the small intestine, hence bypassing the top portion of the small intestine. The procedure is completed by attaching the top portion of the small intestine to the bottom portion of the small intestine, further down, so that stomach acids and digestive enzymes will eventually mix with the food ingested.
By reducing the size of the stomach (the new pouch), the patient is physically limited in the amount of food intake, and thus calories consumed. Additionally, the food that the patient does ingest (including calories and nutrients) is not absorbed by the small intestine to the same degree, as a large portion of the small intestine (where absorption occurs) is bypassed. The re-routing of the food stream also results in hormone changes that impact hunger, satiety, and blood sugar levels.
With the Gastric Bypass procedure, food digestion and absorption are altered to produce significant weight loss by reducing stomach size and small intestine size. The surgery itself has the highest rate of potential complications of all the bariatric surgeries as it is the most technically complex, however, it has the highest rates of long-term success. There is also potential for long-term vitamin and mineral deficiencies, so this type of bariatric surgery requires lifelong adherence to dietary recommendations, vitamin/mineral supplementation, and follow-up compliance. The Gastric Bypass is usually not reversible, but can be if medically necessary.
The length of the procedure varies based on which surgery is selected and each individual patient’s unique condition, but are generally completed in 2 to 6 hours, under general anesthesia. Most patients need to spend an additional 1 to 3 days in the hospital recovering post-surgery.
Immediately following the procedure, patients will need to rest and recover, but can return home within a few days of the procedure, and start resuming physical activity slowly, at the discretion of their physician. As the procedures are performed laparoscopically, scarring and swelling of the incision sites is minimal, but should still be treated with care.
Most surgeons will assign a specific eating plan post-procedure, supplemented by vitamins and minerals, to ensure that enough nutrients are being delivered. Patients will start seeing the results of weight loss within a matter of weeks, although some may need a few months.
The results of a bariatric surgery vary by individual patient, dependent on the starting weight, comorbidities, and type of surgery performed. On average, most patients lose 15% to 30% of their starting body weight in the first few months following bariatric surgery.
In longitudinal studies of patients who have had bariatric surgery, most patients manage to keep the majority of the lost weight off, with the help of behavioral changes to diet and exercise habits. Although some weight gain over time is expected, the weight gained is usually minimal as compared to the initial weight loss.
While individual results vary based on lifestyle changes implemented post- surgery, the amount of weight lost after gastric sleeve surgery and gastric bypass surgery is similar, while the amount of weight lost after gastric band surgery is much lower.
Beyond the weight loss, most bariatric surgery patients also see positive changes in their obesity-related conditions post-surgery, including type II diabetes, hypertension, high cholesterol, sleep apnea, knee/hip pain, etc., with some symptoms completely disappearing. Patients report higher levels of physical activity and mood improvements.
Laparoscopic bariatric surgery is a minimally invasive medical procedure. However, as with any surgical procedure, there are risks associated and potential side effects, which may include bleeding, infection, diarrhea, nausea, vomiting, blood clots, gallstones, hernias, and strictures. However, most patients report a positive change in general well-being and mood as the weight comes off within the first few months following surgery.
To minimize any postoperative complications, patients are advised to select an experienced bariatric surgeon and to follow all recommended post-operative care. Most surgeons will prescribe vitamins and minerals to prevent malnutrition, as well as medications to prevent gallstones, which can commonly occur after rapid weight loss. It is recommended that patients stringently follow the diet and physical activity plans laid out by their surgeons to maintain weight loss and effectively adapt to a new lifestyle.
As with any surgical procedure, the cost of a bariatric surgery varies based on the complexity of the procedure selected, the expertise of the surgeon, and what country the procedure is performed in. A comparison of average prices for bariatric surgery around the world can be found below.
In some countries, there is also the option for individuals undergoing bariatric surgery to have their medical costs covered by insurance. Although policies vary depending on the insurance provider, usually if an individual can provide letters of referral from health professionals indicating the medical necessity of the procedure, the costs can be covered or reimbursed in full as any other medically necessary procedure.
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The next step is to contact us for a complimentary consultation, where we’ll determine your goals and eligibility for the procedure. We’ll ask you to fill out a medical form so our medical experts can offer a recommendation on which option would be best to achieve your desired results. Then, once you decide on where you’d like to go for your bariatric surgery, we’ll do the legwork to get you the best price possible at the world’s leading weight loss facilities.
With Junomedical, you can be sure that you’ll get the best quality at the most affordable prices.
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Regardless of what hospital or treatment you choose, we’re with you throughout every step of your journey: during the booking process, during the hospital visit, and during your recuperation period.