5 Types of Bariatric Surgery: A Guide to Making the Best Decision

Bariatric surgery may be used for people who have excess body weight, who are unable to lose weight in other ways, and who are at risk of obesity-related conditions. Several different surgeries are used to treat obesity, and each has its own concerns. 

This article will discuss the different types of bariatric surgery, why they might be used, and the potential complications. 

Types of Bariatric Surgery

The goal of bariatric or metabolic surgery is to promote weight loss. It is also used to treat or prevent diseases related to obesity (such as diabetes). Surgery accomplishes this by restricting the amount of food that can be held and/or absorbed by the stomach.

Several types of surgery can be performed to accomplish these goals.

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

In duodenal switch surgery, a major portion of the stomach is removed. Then, the middle section of the small intestine (jejunum) is detached from the first (duodenum) and last (ileum) sections. The duodenum and ileum are now connected together.

Food doesn’t travel through the jejunum anymore. The jejunum is kept and is connected to the small intestine to allow digestive juices to flow. This means that fewer calories and nutrients are absorbed from the food that travels through the remaining connected sections of the small intestine.   

Adjustable Gastric Band

Gastric band surgery is done through the placement of a silicone ring around the top of the stomach. This divides the stomach into two parts. The upper part of the stomach holds less food and the person feels full with eating less food. The band is adjustable and can be made larger or smaller as needed. This surgery is also reversible.

Sleeve Gastrectomy

In sleeve gastrectomy (also called gastric sleeve surgery), a large part of the stomach is removed. This could be about 80% of the stomach. The part of the stomach that’s left is about the size of a banana.

The small intestine is left in place. Food flows from the esophagus, into the smaller stomach, and down through the intestines.

The stomach can hold less, so a person might eat less to feel full. Plus, it removes the part of the stomach that releases the hormones that make a person feel hungry.

Roux-en-Y Gastric Bypass

This surgery may also be called gastric bypass surgery. Staples are put into the stomach to section it off into two parts. Food only goes into the small top section. The small intestine is also divided. Part of the small intestine is connected to the small, working part of the stomach.

The other part of the small intestine is left connected to the bottom part of the stomach that is no longer receiving food. The end is connected to the lower part of the small intestine. Food doesn’t travel through this part of the intestine anymore, but digestive juices flow through it.

Food travels through the small part of the stomach, part of the small intestine, and into the large intestine. This results in fewer calories and nutrients being absorbed, promoting weight loss.

Single-Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy (SADI-S)

In this surgery, most of the stomach is removed. The small intestine is divided, and the upper part of it is closed off. The lower part of the small intestine is connected to the smaller part of the stomach that remains.

This means that food bypasses the upper part of the small intestine. The food flows from the stomach into the lower part of the small intestine. However, digestive juices can still flow from the upper part of the small intestine to the lower part, where its connected to the stomach.

Comparing Types of Bariatric Surgery

The different types of weight-loss surgery have various results when compared to one another. Decisions about which surgery to use will be different for each person.

Results 

The main reason for having bariatric surgery is often thought of as weight loss. However, these surgeries might also be used for managing diabetes, high blood pressure, and cholesterol levels. A healthcare provider can help in determining which type of surgery might be the most effective.

BPD/DS: This surgery offers good results for weight loss and managing type 2 diabetes. In one study, people with a body mass index (BMI) over 50 lost more weight with this surgery and had better outcomes in resolving diabetes than with a Roux‐en‐Y gastric bypass.

Gastric band: Less and slower weight loss is seen than with the other types of surgery. One study showed that this surgery resulted in less weight loss than a sleeve gastrectomy or a Roux‐en‐Y gastric bypass.

Roux‐en‐Y gastric bypass: This surgery is effective for weight loss and long-term weight control. In one study, people with this surgery lost more weight at the five-year point than people who had a sleeve gastrectomy.

SADI-S: This surgery has been shown to be effective in both long-term weight loss and diabetes control. One study showed that it has results comparable to Roux-en-Y gastric bypass. However, people who had a SADI-S procedure lost more weight in the first year than those with a gastric bypass.

Sleeve gastrectomy: This surgery is effective for weight loss but may not have as big of an effect on metabolism as other types of surgery. One study showed that this type of surgery was associated with less weight loss than a Roux‐en‐Y gastric bypass but more than an adjustable gastric band.

The study also showed that people with diabetes, those with a lower body mass index, or those who were over the age of 65 lost less weight with a sleeve gastrectomy. Black and Hispanic people in this study also lost less weight.

Safety 

Safety is a major concern for those considering bariatric surgery. The risks will be different for each person and should be discussed with a healthcare provider.

The risk of a leak at the surgical sites is small. However, both Roux‐en‐Y gastric bypass and BPD/DS had about a 1% risk of this complication.

One study showed that people with Roux‐en‐Y gastric bypass had more complications in the first 30 days than with sleeve gastrectomy or gastric band.

Bleeding is a risk in any surgery. Bleeding usually occurs soon after bariatric surgery, but it is uncommon.

Some people will have problems getting enough nutrients after surgery. Deficiencies in vitamin B12, vitamin D, iron, and calcium may occur. There may also be a risk of not absorbing enough protein. Working with a healthcare provider to monitor nutrition and avoid deficiencies is a part of after-surgery care.

Qualifying

Before having surgery, there is a need to be evaluated for various other concerns. This is done in part to help avoid complications after surgery. A team of healthcare providers will be involved in the process.

A surgery candidate will be evaluated:

• Psychologically: To screen for any disorders that may affect the surgery
• Nutritionally: To address any problems with deficiencies prior to surgery
• Medically: To ensure that there are not any major problems with the heart and lungs and that there are no concerns with the gastrointestinal system

Recovery 

Recovery will take time and will depend on how the surgery is done. Bariatric surgery that is more invasive may need more recovery time.

Laparoscopic surgery, which is done with small incisions, may help shorten the recovery time. After surgery, the diet will be expanded slowly. A liquid diet will be followed by a soft diet and then solid foods.

Physical therapy or another type of exercise program may be needed after surgery. The healthcare team will also aid in developing a nutrition plan. Other resources, such as support groups, can help in recovery.

During Each Type of Bariatric Surgery: What to Expect 

Each type of bariatric surgery will include meeting with various healthcare team members to address physical and psychological needs in the months leading up to the procedure. Each surgery is different, so the person will be given specific instructions before and after surgery.

A person will be admitted to the hospital for these surgeries. The hospital stay will be one or more days, depending on the type of surgery. The person is usually encouraged to get up and walk around soon after the surgery to minimize recovery time.

Pain will be managed after surgery so that the person is as comfortable as possible. The person will often be released to go home after being able to take in some food by mouth and go to the bathroom on their own.

BPD/DS

BPD/DS may be done through open or laparoscopic surgery. Laparoscopic will usually be preferred, but in some cases open will be needed. This is a major surgery, and the person will be asleep for it with general anesthetic. 

In some cases, this procedure may require two operations. If it is done with two surgeries, the stomach will be removed in the first and the intestinal bypass will be done in the second.

Adjustable Gastric Band

This type of surgery tends to take less than an hour. The gastric band will be put into place, usually with laparoscopic surgery. A port is placed under the abdominal skin in order to adjust the band. Some people may be able to go home the day after surgery.

Roux-en-Y Gastric Bypass

Most Roux-en-Y gastric bypass surgeries are done laparoscopically. This type of surgery normally takes a few hours. A person may stay in the hospital for two days or longer after having this procedure. 

Sleeve Gastrectomy

This surgery may take one to two hours and is usually done laparoscopically. The person usually spends one or two days in the hospital before being released to go home.

SADI-S

This surgery is usually done laparoscopically but may need to be done with open surgery in some cases. It may be done in one or two steps. If it’s done in two steps, the first step is to remove the stomach and the second is to divide the small intestine and reconnect it to the stomach.

After Each Type of Bariatric Surgery: What to Expect 

After surgery, recovery and ongoing management will include several steps. Each surgery will have specific care needs that the healthcare team will address.

The incisions will be sore after the surgery. The healthcare team will give instructions on caring for the surgical site. They will remove any stitches at a follow-up appointment.

Significant weight loss may occur in the first few months after surgery. However, after this surgery, people may absorb fewer nutrients from their food. Some of the possible nutritional deficiencies include iron, vitamin B1, vitamin B12, and folate.

Most people will start with a liquid diet, go to a soft diet, and then to a regular diet as tolerated. Working with a dietitian will be important to ensure that nutritional needs are met. Some of the instructions that the healthcare team may give include:

• Avoiding foods with high sugar content
• Eating several small meals a day
• Eating slowly and chewing food carefully and thoroughly
• Staying hydrated by sipping water throughout the day but avoid drinking too many fluids around mealtimes
• Taking vitamin or mineral supplements as directed
  

Other self-care steps that may be given after having bariatric surgery include:

• Ask your healthcare provider when it is OK to return to work and activities such as driving.
• Avoid strenuous exercise or lifting anything too heavy until given clearance by the healthcare team.
• Get enough rest and quality sleep.
• Do breathing exercises as instructed to prevent pneumonia (lung infection).
• Engage in gentle movement each day, such as walking.
• Follow the healthcare team’s directions about bathing and caring for the incisions.
  

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

In the first few months after surgery, there may be significant weight loss. BPD/DS is associated with more weight loss than other forms of bariatric surgery. It might also lead to complications or vitamin or mineral deficiencies. Following healthcare provider instructions about after-surgery care, diet, and vitamin and mineral supplements will be important.

Adjustable Gastric Band

This surgery is being done less frequently because of the potential for poor outcomes, including failure and complications. The band around the stomach can be made smaller or larger during a follow-up visit with a member of the healthcare team.

There is a port installed during the surgery. Saline solution is put into or removed through the port to make the band smaller or larger. It may take some adjustment to make the band the right size.

Roux-en-Y Gastric Bypass

This surgery has the potential to be reversed. However, it is difficult to do so.

This surgery will mean feeling full after eating less. Because it affects the stomach and the intestine, there are also effects on the substances that these organs normally create. There could be a lack of appetite or changes to the microbiome (the community of microbes living in the gut). 

Sleeve Gastrectomy

This surgery is permanent. It creates a stomach about the size of a banana. This means that people who have this surgery will feel full after eating less food. Other effects may occur because the part of the stomach removed is involved in creating substances that affect appetite, metabolism, and the microbiome.

Single-Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy (SADI-S)

Weight loss may be comparable or slightly less in the long-term with this surgery than with Roux-en-Y gastric bypass. However, it may also be associated with less risk of malabsorption problems. 

There may be a risk of bile reflux after this surgery, with bile backing up into the stomach and esophagus. In some cases, there could be a need to have another surgery because of bile reflux. In one study, type 2 diabetes resolved in 93% of people who had SADI-S surgery.

How a Surgeon Helps Guide Your Decision

Deciding to have bariatric surgery and choosing which type includes many factors. The healthcare team will help look at the pros and cons of each type of surgery.

Weight loss surgery is usually reserved for people with a BMI over 40 or a body mass index over 30 and a condition such as diabetes, heart disease, or sleep apnea.

Bariatric surgery also comes with committing to lifelong changes to diet and lifestyle. People who are thinking of undergoing the surgery should also be advised of how their life will change. Changes to diet and lifestyle will be permanent. In addition, vitamin and mineral supplements will be needed to avoid deficiencies.

Lifestyle, other conditions, and costs are all considerations when choosing to have bariatric surgery. The decision is made only after understanding all the options, the potential risks, and the qualifications to have the surgery.

Plastic Surgery After Bariatric Surgery

Some people may find that they lose enough weight to have excess skin. The type of surgery that’s often used to remove it is called body contouring. It’s largely considered safe.

However, the risk of complications is increased for those who have the procedure when their BMI is higher than 30. The authors of one review study suggest that body contouring be done after there has been enough time for weight loss after the bariatric surgery.

Summary

Several different types of bariatric surgery are used to address obesity and other health conditions. They include duodenal switch, gastric band, gastric bypass, gastric sleeve, and SADI-S surgery. Each is different in which parts of the digestive tract are affected, the potential risks, and the expected outcomes.

For all surgeries, there is a need to make changes to diet and lifestyle to promote weight loss and avoid nutritional deficiencies.