BARIATRIC SURGERY

Each type of bariatric surgery has pros and cons. Be sure to talk to your doctor about them. Here’s a look at common types of bariatric surgery:

• Gastric bypass. This procedure is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat in one sitting and reducing the absorption of fat and calories. The surgeon cuts across the top of the stomach, sealing it off from the rest of the stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Typically, the stomach can hold about 3 pints of food.

Then, the surgeon cuts the small intestine and sews part of it directly into the pouch. Food goes into this small pouch of the stomach and then directly into the small intestine, sewn to it, bypassing most of the stomach and the first section of the small intestine. Instead, food goes directly into the middle part of the small intestine.

• Sleeve gastrectomy. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can’t hold as much food. It also produces less appetite-regulating hormone ghrelin, which may lessen the desire to eat.

Advantages of this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than most other procedures.

• Biliopancreatic diversion with duodenal switch (BPD/DS). This is a two-part surgery usually performed in one setting. The first step involves performing a sleeve gastrectomy.

During the second step, the surgeon closes off the middle section of the intestine and attaches the last part directly to the first part of the small intestine, called the duodenum. This is the duodenal switch. The separated section of the intestine isn’t removed from the body. Instead, it’s reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into this part of the intestine. This is the biliopancreatic diversion.

This surgery limits one’s eating ability and reduces nutrient absorption. While it is highly effective, it carries more significant risks, including malnutrition and vitamin deficiencies.

• Single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S). Like BPD/DS, the SADI-S procedure has two steps, the first of which is a sleeve gastrectomy.

During the second step of the SADI-S procedure, a section of the small intestine known as the duodenum is closed off just below the new stomach sleeve. This opening below the new stomach is connected to a part of the lower small intestine called the ileum. This is the duodenal-ileal bypass.

The bypass routes food through only about 10 feet of the small intestine instead of the usual 25. This means the body has less time and distance to absorb fat and calories.