Band, Sleeve, or Bypass: Which One is Best for Weight Loss?

In considering weight loss surgery for yourself, if you’ve heard of or read about different types of procedures, you may be asking yourself: Which one is best for weight loss? Rather than asking this question, the more important question you should be asking is: Which procedure is right for me?

The three most commonly known procedures in weight loss surgery today are laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass. All three are proven to be effective weight loss procedures. But each procedure is not right for everyone—each has its own method of weight loss, its own list of risks and benefits, and its own ideal patient type.

There are two types of weight loss surgery procedures: malabsorptive and restrictive. A malabsorptive procedure reduces your body’s absorption of calories, protein and nutrients, but also decreases the amount of food intake at one time. It does this by shortening your digestive tract, thereby limiting the number of calories and nutrients that your body absorbs. This type of procedure alters your body’s normal digestive process.

Both the laparoscopic adjustable gastric band and gastric sleeve procedures are restrictive procedures. A restrictive procedure reduces the amount of food your stomach can hold, thereby decreasing the amount of food intake at one time and promoting a feeling of fullness faster with a smaller amount of food. Restrictive procedures do not affect normal digestion.

The laparoscopic Roux-en-Y gastric bypass differs from both band and sleeve in that it is a combination procedure, which means it has components of both a malabsorptive procedure and a restrictive procedure.

All weight loss surgery procedures require commitment to lifestyle change and self-discipline in order to lose weight, keep weight off, and avoid malnutrition and nutritional deficiencies. In terms of which procedure is best for you, that depends on your weight and BMI, comorbidities and general health, your weight loss goals, your lifestyle, and other factors. This decision is best made following consultation with an experienced weight loss surgery specialist.

The laparoscopic adjustable gastric band is a purely restrictive surgical procedure in which a band is placed around the upper most part of the stomach, dividing your stomach into two portions—an upper, smaller portion and a lower, larger portion. Creation of the smaller stomach restricts the amount of food that can be consumed at one time. The procedure is reversible, and the band can be adjusted as needed after surgery to increase or decrease restriction.

The gastric sleeve is a purely restrictive procedure that reduces the volume of the stomach by almost 75%, allowing patients to feel full faster with less food intake. In addition to the restrictive aspect of the sleeve, other advantages of it are that it does not require placement of a foreign object, and the major part of the stomach that produces hormones responsible for stimulating hunger is removed. Because the sleeve procedure permanently removes part of your stomach, this is not a reversible procedure. Also, complications from the stapling of the stomach can occur, and for high BMI patients, sometimes an additional weight loss surgery is required to achieve the desired weight loss. The sleeve can be a good solution for patients whose conditions make them too high risk for other weight loss procedures.

The Roux-en-Y gastric bypass is the most common weight loss surgery performed, and the one proven to achieve the greatest percent of excess body weight in the shortest period of time. In this procedure, the surgeon permanently closes off a section of the stomach with staples, leaving only a small stomach pouch for food. The surgery also creates a Y-shaped piece from an upper portion of the small intestine that your surgeon attaches to the new smaller stomach pouch. Food enters the stomach pouch and bypasses part of the intestine that absorbs calories and nutrients. Your surgeon can increase the length of either intestinal segment to produce higher or lower levels of malabsorption.

Beyond how each procedure works, some of the other factors that you and your doctors will need to consider in procedure selection are your BMI, comorbidities, and general health, and your short- and long-term weight loss goals. In addition, you need to consider the following questions: Do you want a reversible procedure? Do you want a procedure that includes the ability to adjust the restriction component following your initial surgery? Do you feel comfortable with a surgery that alters your body’s normal digestive process via intestinal rerouting? Do you feel comfortable with a surgery that requires cutting and stapling your stomach? Do you feel comfortable with a foreign body such as the band being placed?

In terms of which of these procedures is right for you and will result in successful weight loss, beyond the factors you have read about here, it very much depends on your own personal health situation and goals for surgery, as well as the advice of a doctor. You should seek advice from a weight loss surgery professional who has a multidisciplinary team in place to help you with all aspects of your care. You not only want to be helped by a surgeon who can offer experienced care in the operating room, but who can offer ongoing care that sees you through your entire weight loss journey, in all of its phases and challenges. Talk to an experienced professional who can discuss the various surgical approaches and which would be appropriate for you.

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