Frequently Asked Questions about Weight Loss Surgery
JANUARY 01, 2015
A Q & A with Daniel Jones, MD
Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center, answers these common questions about weight loss surgery and the different types of procedures.
Q. What are the options for weight loss surgery?
There are three FDA-approved operations that we offer at BIDMC — Roux-en-Y gastric bypass, sleeve gastrectomy and laparoscopic adjustable gastric band (LAGB).
Increasingly, the most popular weight loss surgery in the United States is the laparoscopic sleeve gastrectomy. This operation removes part of the stomach, leaving a narrow gastric tube or sleeve — downsizing the stomach from about the size of a cantaloupe to about the size of a banana. With a large part of the stomach removed, there are fewer hunger signals to the brain, which may lessen the desire to eat. Also, with a smaller stomach, you feel full with a smaller meal.
In Roux-en-Y gastric bypass surgery, a small pouch is created at the top of the stomach. This portion of the stomach is where food is received. Because of the smaller size, you feel full with smaller meals. The pouch is connected directly to the small intestine, bypassing the lower part of the stomach. This procedure can be done open — through one large incision — or laparoscopically, with smaller incisions and the use of a tiny camera to help guide the surgeon to the proper areas of the stomach. Studies have shown the laparoscopic version yields a quicker recovery time for the patient.
The laparoscopic adjustable gastric band procedure places a ring around the top of the stomach, which is tightened, as in the bypass procedure, to create a small pouch at the top of the stomach. With the band in place, the stomach size is restricted, so you feel full sooner. The band is also adjustable through a port placed outside the body, allowing the physician to decrease the size of the stomach over time without re-operation, creating a greater opportunity for weight loss.
Q. I’ve heard that gastric bypass is a more risky procedure than the band or sleeve, so why would anyone chose it?
On average, people lose more weight, more quickly, with the gastric bypass procedure. However, because it involves the rerouting of the intestine, patients need to be particularly careful about avoiding sweets and fatty foods, as the body no longer is able to process these foods. Gastric bypass patients should also avoid non-steroidal anti-inflammatory medications (NSAIDS), like aspirin and ibuprofen, to reduce the risk of developing ulcers.
For more and more patients, sleeve gastrectomy is a nice compromise. It has become the most common weight loss operation because it’s not as radical as gastric bypass and the rules against NSAIDS are not as stringent. Additionally, an advantage the gastric sleeve has over the band is that there are no devices involved and therefore, no adjustments that need to be made down the road. The sleeve is almost as effective as the gastric bypass and almost as safe as the lap band.
As part of your initial visit, your medical team will help you decide which procedure may be best for you to consider.
Q. How much weight will I lose?
Gastric bypass, gastric banding and sleeve gastrectomy are great “tools” to make achieving weight loss success easier, but how much weight is lost ultimately depends on the individual patient. Even after surgery, weight loss is still a matter of how many calories you take in versus how many calories you burn through activities and exercise.
With bypass, most patients will lose 50 to 70 percent of their excess weight. That means if you’re 100 pounds overweight, you might lose 50 to 70 pounds with proper diet and lifestyle modifications.
Patients who have the band procedure lose between 35 and 70 percent of their excess weight. The wide variation with the band is because it’s easier to cheat.
Sleeve patients typically lose over half of their excess weight in the first two years. It’s usually faster and with greater weight loss than the band, but usually a little less than with gastric bypass.
Note : As with any weight loss plan, if you “cheat” by, say, drinking high calorie liquids, you could conceivably gain weight.
Donna Foley-Hodges is one of many BIDMC weight loss surgery patients who is proud of her success.
Q. How will my diet change?
Your post-surgery diet will be similar in all three procedures. You will start with liquids and gradually progress to a solid diet. The biggest change will be that you will be eating less after surgery. Your stomach will be smaller, so you will need to dish out small portions and take small bites, chewing well and eating slowly.
With gastric bypass you’ll need to be especially careful to avoid sweets and fatty foods that may cause “dumping,” a condition that happens when solids get “dumped” directly from the stomach into the small intestine without being digested. This can feel uncomfortable and can lead to malnutrition if not treated.
It’s important to follow whatever dietary guidelines your weight loss program nutritionist has outlined for you.
Q. What if I eat too much?
If weight loss is the goal, then it’s important to remember that your old eating habits will need to change to accommodate a focus on weight control. With all three procedures, because the size of your stomach is now much smaller, only so much food and liquid will fit. If you eat too much, you may feel abdominal pain or experience nausea and vomiting.
It can be helpful to join a group, or work with a therapist or weight loss coach for support while you’re making this major change in the way you eat.
Q. Are these procedures reversible? What if I find I just can't adjust to eating this way?
While some weight loss surgeries are reversible as a last resort — the band can usually be removed and bypass can be reconnected to restore continuity — these are serious procedures that carry some real risk and must be thought of as permanent.
Before any patient is approved for surgery, they must be ready to make a commitment to this new way of eating and exercise. In an experienced and accredited weight loss surgery center, like the one at BIDMC, all patients work with a nutritionist, exercise physiologist, psychologist, and social worker in addition to a surgeon to ensure they are ready mentally as well as physically for this change.
Q. What are the risks associated with weight loss surgery?
As with any major surgery, these procedures carry risks including bleeding, infection, potential problems with the heart or lungs, and also the risks of general anesthesia. The chance of these complications is quite small, but they can be life-threatening.
A recent Washington University School of Medicine analysis of international surgery studies reported an overall 30-day serious complication rate of 0.96 percent for sleeve gastrectomy, 1.25 percent for gastric bypass and 0.25 for gastric banding.
The study also reported that the rate of a gastrointestinal leak, considered a serious complication, was 0.3 percent for sleeve gastrectomy patients, compared with 0.4 percent for gastric bypass patients. And the percentage of surgeries that ultimately required reoperations because of complications was 15.3 percent for the gastric band, 7.7 percent for gastric bypass and 1.5 percent for sleeve gastrectomy.
It’s important to bear in mind that the potential health benefits obtained through successful weight loss may outweigh the risks associated with surgery. Still, it’s best to talk with your health care team about your risk, especially as it relates to the specific procedure you’re considering and your individual health concerns.
Q. When will I be able to go back to work?
With laparoscopic bypass, band or sleeve procedures, most patients return to work within two to three weeks, depending on the type of work you do. Recovery with traditional gastric bypass is typically longer.
Q. How much does the procedure cost and will my insurance cover it?
The procedure costs between $25,000 and $30,000. Most insurance plans do cover most of the cost for those patients who are appropriate candidates for the procedure. Patients should check with their insurer to find out more.
Q. What should I consider when selecting a weight loss surgeon/surgery program?
In 2004, a panel convened by the State Department of Public Health recommended that all doctors who perform weight loss surgery receive rigorous, ongoing training. They also reported that complications are most likely to be minimized when the surgery is performed by high-volume surgeons (those doing 50 to 100 cases per year) operating in properly equipped, high-volume weight loss centers with integrated and multidisciplinary treatment. In addition to asking your surgeon how many procedures he or she has performed, we also emphasize the importance of finding the right fit. You need to feel comfortable with your weight loss team in order to be successful.
BIDMC is a Metabolic & Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited center.
*Complication rates from The Executive Report of the Betsy Lehman Center expert panel on weight loss surgery, Commonwealth of Massachusetts, 2004.