There is no crystal ball that will tell you or your surgeon what the “BEST” operation for you. Also, the surgery that worked for your cousin or your friend may not necessarily be the right choice for you. The surgery decision is a result of long, repeated, and honest discussions with your bariatric surgeon. If you are a good candidate for surgery, then it is very likely you could do well with ANY weight-loss operation. Ultimately it comes down to you knowing you. This guide may help you make the correct choice and hopefully avoid negative outcomes.
Overweight and morbidly obese patients can get lost in the available surgical options for weight loss.
"What procedure is best for me?"
This is the most commonly asked question...
The short answer is : " THERE IS NO SINGLE BEST ANSWER AS EVERY PATIENT IS DIFFERENT AND UNIQUE".
The ideal weight loss surgery depends on your health, weight, comorbid diseases, and body type. For instance, if you are very obese, or if you have had major abdominal surgery before, simpler surgeries might not be possible. Talk with your doctor about the pros and cons of each procedure. For example, if you have severe diabetes mellitus that is hard to control, Roux En-Y Gastric Bypass may be the procedure for you.
Schedule a consult with Selim Surgery Center as we specialize in weight loss surgery. Studies show that complications are less likely to occur when weight loss surgery is provided by experts.
Each of the most common weight-loss operations done today (gastric bypass, adjustable gastric banding, and sleeve gastrectomy) are effective when:
- They are performed by a competent and experienced surgeon
- They are done in a center that offers an aftercare program that focuses on dietary, behavioral, and exercise changes
- The patient has a regular follow up with his/her surgeon
- And most importantly, the patient is willing to work with their operation
No matter what procedure a patient chooses, the key to weight-loss surgery is getting the patient to use their weight-loss operation to implement lifestyle changes. Each of the available surgeries are truly a “TOOL” that will help to control hunger and reduce portion sizes, but that’s it! The rest is up to the patient.
Having said that, there are some differences between the available “tools.” Here are some of the things a patient should consider when deciding which surgery is right for them.
Considerations When Choosing a Surgery Type:
Each procedure has an expected Excess Weight Loss (EWL) that is inherited in its design.
Gastric bypass patients will lose around 70 - 85% of their excess weight,
Sleeve gastrectomy patients will lose around 60 - 70% ,
And gastric banding patients will lose around 50%.
All of this depends, however, on how well a patient follows up and if the patient works on all the necessary lifestyle changes that must occur to make them successful over the long-term.
Long term success of Weight-loss
Bariatric surgery patients almost always achieve the expected weight-loss outlined above. The long term results for surgical weight loss are much more stable than its medical weight loss counterpart. Regaining weight back is always a real concern. This will occur if they do not make the necessary lifestyle changes after their weight-loss surgery.
How fast weight loss can be predicted
Gastric bypass and sleeve patients will typically lose 5-7 pounds a week early on and will reach their expected weight-loss 12-18 months after their operation. On the other hand, gastric banding patients tend to see a slower, steadier weight-loss (losing 1-2 pounds per week) but will see this continue until they reach their expected weight-loss around 2-3 years after their operation.
Ability to Follow-up
Follow-up following bariatric surgery is an extremely important aspect of the entire journey. Some patients count on their surgeons to keep them "in line". Continuous counseling is proven to help patients reach their goals. Early recognition of patients bad behaviours and correcting them can improve early and long term weight loss results.
Any weight loss can produce nutritional and micro-elements deficiencies. Regular laboratory and blood testing is esssential to a healthy body.
Long Term Success
There are good studies looking at the long-term effects of gastric bypass and adjustable gastric banding. It appears that both of these operations are safe, leading to significant weight-loss and improvement in weight related medical problems, and most importantly, maintenance of the weight-loss.
The same cannot be said for the sleeve gastrectomy at this point. Certainly the studies currently available show this operation to be safe and effective, but because the operation is new, we do not yet know what is going to happen to patients 10 years after this operation. Will they see weight regain? Will there be problems due to removing so much stomach?
We started to see complications related to the sleeve gastrectomy if performed by surgeons who are not trained to do this procedure well. This is exactly what had happened with the Lap-Band procedure. Poor selection and poor operative technique led to vast complications.
Fear of Needles
Patient who have fear of needles have a hard time to comply with their mandatory “filling” of the band. A needle must be used to access the lap-band reservoir. The needle is small and fills do not cause pain or discomfort. If you are afraid of needles, it does not matter if the needle is small or large.
Gastric bypass patients will very likely experience “dumping” if they eat foods containing large amounts of carbohydrates (especially sweets). After eating such food, their heart starts racing, they may start to sweat and get severe abdominal cramping pain, dizziness and diarrhea. This really helps them stay away from those foods that may have caused their weight to increase in the past.
Some patients like the idea of knowing that if they “cheat” on their diet, the operation will punish them for it. There is no dumping with gastric banding or gastric sleeve patients so they need to be more disciplined with their food choices when it comes to sweets.
Foreign Body Consideration
Dr. Selim is seeing a higher number of consultations to remove the Lap-Band out of patients. These patients have been informed by their medical doctors that their band has been there for many years and has to come out for the fear of complications. This fear is not justified and almost non-scientific.
Gastric band patients need to be VERY comfortable with having the band inside their body for the rest of their lives. We do not take the band out if patients do not present a real indication to do so.
Some patients choose to have a lap-band because they believe it less invasive and reversible. While it is true that taking out a band is pretty straightforward, there are few reasons why a surgeon would remove a band.
A gastric bypass is reversible, believe it or not. Certainly it is more challenging to reverse a bypass than it is to remove a band, but it can be done. If a band is removed or a bypass is reversed, a patient almost always begins regaining weight as they no longer have the “tool” that controlled their hunger and portion size.
A sleeve gastrectomy, however, cannot be reversed as most of your stomach is already removed.
Many patients fear a gastric bypass because they feel it is “more invasive” and therefore more dangerous. While it is true that a gastric bypass and a sleeve gastrectomy are bigger operations, when we look at the complication rates of all three operations, they are the same: 10-15 percent of patients will experience a complication related to their operation at some point. Weight-loss surgery has NEVER been safer than it is today.
Loose skin is a reflection of significant weight-loss and it does not seem to matter if the weight-loss is slow or fast. If a gastric band patient, a sleeve patient, and a gastric bypass patient all lose 150 lbs, they will ALL have some degree of loose skin.
In most markets, gastric bypass and sleeve gastrectomy procedures are more expensive than adjustable gastric banding. While this is not as important if insurance is paying for the surgery, it is important to those that have to pay for their surgery out of pocket. At Selim Surgery Center we offer very reasonable options for surgery costs. We encourage “cash” patients to choose their operation first, figure out how much it will cost them, and how they plan to pay for it.