04.Bariatric surgery: what's what?
The band is like an inflatable ring, placed around the top of the stomach. This slows down the speed of food travelling through the opening, and the sensation creates a feeling of satiety (fullness), leading to smaller meals. The device has an access port that lies underneath the skin, and the size of the band can be altered by injecting saline to make it tighter, or withdrawing saline to make it looser, without the need for even a local anaesthetic. This adjustability is a large part of its appeal – it means the size of the opening can be tailored very precisely to an individual’s needs, and even altered over time (during pregnancy or illness it can be loosened, for example).
Laparoscopic “tube” or “sleeve” gastrectomy
In this relatively new technique, your stomach is stapled down its length, leaving a wide tube running between the oesophagus and intestine. Volume is reduced from about 1L to 100mL-200mL. The procedure is done laparoscopically, and simply reduces the amount of food you can eat, not the type. Initial weight loss appears to be slightly higher than gastric banding, with a similar performance in terms of maintaining weight loss.
Because it’s a “set-and-forget” procedure, it may be a better option than banding for people in rural and remote areas who don’t have access to banding clinics. The procedure is relatively new, so long-term data are scarce. However, it can fail over time due to the tube stretching and creating a bigger pouch. If weight loss is insufficient, surgery to re-route food through the small intestine (a biliopancreatic diversion and/or duodenal switch), reducing absorption of fat and other nutrients, can be done at a later date.
This procedure combines restriction of stomach volume and reducing absorption of fat and other nutrients, and variations of the procedure account for more than half of all bariatric procedures performed worldwide. The stomach is divided into a small upper pouch and a much larger, lower pouch, and the small intestine is surgically “rearranged” to allow both pouches to stay connected to it.
This procedure has a long track record, with good rates of weight loss, and may be recommended for people likely to sabotage their own weight loss by eating sweets, chocolates, ice-cream, milkshakes and other low-bulk energy dense foods. This “dumping syndrome” means such foods go straight through, causing diarrhoea and foul-smelling stools. The procedure isn’t reversible, and you’ll need a nutritional supplement for the rest of your life.