What Are the Types Of Bariatric Surgery?

Laparascopic surgery (Image licensed CC BY 2.0)

In this post, we’ll delve into the types of bariatric surgery available and briefly cover information about each. Later posts will go more in-depth about the differences, pros, and cons of each type of bariatric surgery. Before getting into the types of surgery though, let’s look at bariatric surgery as a whole!

History Of Bariatric Surgery

Schematic of jejunoileal bypass

The first recognized bariatric surgery (a jejunoileal bypass) intended to induce weight loss was performed by Dr. A.J. Kremen in 1954. This operation consisted of leaving the stomach intact in it’s entirety and bypassing a large portion of the intestines. As a result of part of the intestinal tract being bypassed, malabsorption side effects were significant and common.

In 1983, Griffen et al published a study (The decline and fall of the jejunoileal bypass) in which they discovered through follow up that the number of patients who had significant problems after jejunoileal bypass was incredible. This study led to jejunoileal bypass being abandoned.

Schematic of gastric bypass

In the 1960’s, Drs Mason and Ito began performing gastric bypass operations (based off of observations of weight loss in patients who had partial stomach removals for other conditions). From that launch pad, laparoscopic operations and various other methods have evolved over the years.

Types Of Bariatric Surgery

There are many different bariatric surgical procedures available and of each option, most offer even further variation. We’ll be focusing on the types of bariatric surgery that the American Society for Metabolic and Bariatric Surgery recognizes as most common.

Those bariatric surgeries are as follows:

Sleeve Gastrectomy

diagram of the before and after of a vertical sleeve gastrectomy
Vertical Sleeve Gastrectomy Diagram

The sleeve gastrectomy (also known as the “sleeve”, VSG, and vertical sleeve gastrectomy) is performed by removing a substantial portion of the stomach and leaving a banana shaped sleeve of stomach behind.

The sleeve is becoming more common as it affects hunger by removing a large portion of the stomach responsible for signalling hunger to the body. By doing so, it allows for people who have had the operation to reach satiety (fullness) with less food and to lose weight by doing so. It is a simple surgery that can be performed quickly and can be completed as a bridge to other more restrictive bariatric surgeries. Possible side effects include reflux and heart burn.

Roux-en-Y Gastric Bypass

Diagram of the Roux-en-Y Gastric Bypass
Diagram of the Roux-en-Y Gastric Bypass

The Roux-en-Y Bypass (commonly referred to as “gastric bypass”) has been around longer than other types of bariatric surgery and began being performed laparascopically in the 1990’s.

Roux-en-Y is performed by making a small pouch out of the top portion of the stomach and routing it directly to the intestines, leaving the rest of the stomach present but not used for food. The part of the intestines that is bypassed during the operation leads to less absorption of nutrients and calories from food, which leads to weight loss.

Roux-en-Y gastric bypass is a more involved surgical procedure than the sleeve or the gastric band and can help those with heartburn. Possible side effects include vitamin and mineral deficiencies and “dumping syndrome“.

Adjustable Gastric Band

Lap Band Surgery Diagram illustration

Gastric band surgery is done by laparascopically placing a balloon/band around the stomach in a specific place to limit the amount of food necessary before reaching a point of fullness.

The gastric band is the least invasive bariatric surgical procedure and patients often return home on the day of their surgery. It also is the least likely weight loss procedure to cause vitamin and mineral deficiencies.

However, the lap band present several disadvantages due to the nature of it’s placement and utilization. Visits to have the band adjusted can be numerous and costly, the amount of weight lost is often less than other procedures, and the band can slip or erode the stomach. Lap Band also has a high rate of requiring additional operations.

Biliopancreatic Diversion with Duodenal Switch

The Biliopancreatic Diversion with Duodenal switch starts with a sleeve as in the gastric sleeve, but then is routed to skip a portion (roughly 75%) of the small intestine as well. Due to this combination of limited ability to consume and a even more limited ability to absorb nutrients, Biliopancreatic Diversion with Duodenal Switch presents some of the strongest results out of all weight loss surgeries. It is a more invasive and complicated procedure than the ones previously mentioned and can cause the issues with nutritional deficiencies, changes in bowel movements, and increased heartburn/reflux.

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy is a combination of intestinal bypass and a sleeve gastrectomy that isn’t as invasive as the Biliopancreative Diversion and uses more of the small intestine so nutritional absorption can be better. This procedure is newer than all of the other bariatric surgeries and has the least data to support it’s use, but time will tell how effective of a surgery it can be.

Types of Bariatric Surgery: In Conclusion

We’ve covered a few of the more common types of bariatric surgical procedures performed these days as an introduction to bariatric surgery. I’ll also be posting more in-depth information about each type of surgery in future posts. Have you had bariatric surgery? What procedure did you have? Let us know in the comments!