Which Bariatric Surgery is Best?

Which Bariatric Surgery Is Best? Surgeons Banner

Weight loss surgery saves lives. For those that have struggled to lose weight in the past and are living with or at risk for obesity related diseases, bariatric surgery is an option that has been medically proven to promote substantial weight loss, reduce or cure weight related diseases, and potentially increase your lifespan and quality of life.

If you and your doctor have decided that you are a good candidate for this type of procedure, the next step is determining which bariatric surgery is best for you. Some of this may be necessitated by your health. For example, some weight loss surgery procedures are not possible for those with a BMI of over 50, or those with an enlarged liver. But others are going to be a choice between you and your doctor.

Defining “Best:” How to Decide What is the Best Weight Loss Surgery Determining which bariatric surgery is best requires an analysis of what “best” means. For some, the best weight loss surgery is the one that contributes to the most average weight loss. In others, it may mean the surgical procedure with the least complications. For others, it may mean the best value for the price – especially if you are to pay out of pocket. Patients

It’s because the definition of “best” may differ between each patient that defining which surgical procedure is the best may be controversial. There are arguments for every type of bariatric surgery, including:

Each one has its advantages, which is why they are still in use today. However, the following are potentially the best surgical options, with an explanation for each choice and the considerations you may need to make before selecting the procedure.

The Best Bariatric Surgery for Weight Loss: Duodenal Switch

If you are looking for the bariatric surgery that leads to the most average weight loss, the answer is the biliopancreatic diversion with duodenal switch, known shorthand has the “Duodenal Switch.”

According to research, the average duodenal switch patient will lose roughly 70% of their excess body weight (EWS) by 18 months compared to other bariatric procedures, such as the gastric bypass (60% EWS). It also had a higher success rate, with 90% of patients losing at least 50% of their excess body weight by 18 months compared to 75% from other procedures. It is also considered the most effective strategy for patients with significant obesity, such as those with a BMI over 50.

Although the duodenal switch is very effective for weight loss, it is infrequently performed. Studies show that complication rates are higher, and often duodenal switch patients require significant lifestyle changes, including vitamin supplements to avoid deficiency, that make the procedure a last resort for many surgeons. The procedure itself is also more complicated than other bariatric surgeries, and often more expensive. Nevertheless, it is the most effective bariatric surgery currently available for promoting maximum weight loss.

The Best Reversible Weight Loss Surgery

Most bariatric surgery procedures make permanent changes to your body. Only a few are temporary. The temporary procedures are generally less successful overall than the permanent procedures.

Gastric balloon, for example, has been shown to successfully promote only 25% of excess weight loss at most (and with a lower success rate), but is removed after 6 months allowing the individual to make additional changes to their lifestyle in order to control their weight.

The best reversible weight loss surgery is known as the Adjustable Gastric Band. It may be referred to by its brand names, the LAP Band and the Realize Band. Using laparoscopic tools, a band is placed over the top of the stomach, thus shrinking the size of the stomach to reduce the amount of food you can eat, and improve your ability to feel full faster.

The LAP Band is known to promote an average of 50% excess weight loss. It also has very few serious complications, as the surgery is easier to perform than other forms of bariatric surgery and does not require any cuts to the stomach.

Still, while LAP Band is the best reversible bariatric surgery option, it has generally fallen out of favor among both surgeons and patients, for reason that include:

  • Frequent Minor Complications – LAP Bands often struggle to stay in place. They can lead to a greater frequency of acid reflux and other digestive challenges, hiatal hernias, as well as “Port” problems that affect as many as 1/5 th of all LAP Band patients.
  • Less Weight Loss – 50% EWS is still a significant percentage, but it is below other options like gastric sleeve (60%), gastric bypass (60%), and duodenal switch. For those that are looking for a lifesaving treatment, that extra percent combined with a higher frequency of successful weight loss attempts may be critical for fighting obesity related diseases
  • High Removal Rate – Though exact numbers are hard to find, it is believed that as many as 50 of all LAP band patients will have their band removed as a result of discomforts, complications and inadequate weight loss rates.

LAP Band is still an excellent option, and certainly the best of the reversible bariatric surgeries, but it is not considered ideal for many patients.

The Best Bariatric Surgery for Both Results and Complications

For many, the “best” weight loss surgery is one that combines a low complication rate with a high success rate. For that, the debate is between two procedures: Gastric Sleeve (vertical sleeve gastrectomy) and Gastric Bypass. There are successful arguments in favor of both procedures.

  • Gastric Bypass

Gastric bypass has a very high success rate. Most estimates put the excess weight loss (EWL) at 60%, with 80% of patients seeing success with the procedure. It is considered one of the most widely accepted forms of bariatric surgery available, with the most research of any other bariatric procedure. It also has a very high success rate at curing obesity related diseases, including diabetes.

It does come with some complications, with one of the most common being “dumping syndrome,” which is an uncomfortable and painful digestive issue where the body “dumps” food into the small intestine. The patient is also at risk for vitamin deficiency, so diet may require monitoring with supplementation.

  • Gastric Sleeve

Sleeve gastrectomy has a nearly identical success rate for excess weight loss, with a comparably small failure rate at roughly 15%. Average weight loss is slightly worse but within a few percentage points. Gastric sleeve is also popular for its ability to reduce hunger by controlling the amount of hunger hormone the body creates.

Gastric sleeve tends to have fewer complication rates overall. Since there is no change to the intestines, vitamin deficiency risk is very low provided the individual eats the right foods. There are also few to no food restrictions. One of the few complications is acid reflux, which is common but rarely severe enough to warrant revision surgery.

Comparison of Gastric Sleeve vs. Gastric Bypass

There are few mathematical differences to determine which is the best bariatric surgery procedure, and patient satisfaction is similarly comparable. However, it does appear that gastric sleeve is currently considered the best bariatric surgery option. It has fewer complications and dietary restrictions, which may mean a higher quality of life for the patient. It is also considered a simpler and safer procedure for the surgeon as well.

However, gastric bypass is a similarly effective procedure. Whichever procedure is chosen, it is likely to provide a similar outcome in most circumstances, making both the best overall bariatric surgery procedures.