Weight loss Surgery which procedure is most appropriate to use Gastric Bypass, Gastric Balloon or Gastric Band?

There is a great deal written to date about the various differences between weight loss procedures, not just in amount of weight loss achieved but also which is most appropriate for who? There is a lot spoken about the difference between sweet eater and spice eaters, volume eaters and “grazers”. To date there has been no research to back these claims. These claims are far to simplistic and do not take into account the patients own history. Trying to categorise people in this way may lead to them being given poor advice and choice of procedure that will work for them.

At Gateway health, we prefer to see patients as individuals, we have no preconceived idea of how someone will be when they meet us in clinic. We make decisions based on the latest published research, with our own experiences and research to help guide our specialists. Our proven results show that this system works as part of the whole process.

So what are the real differences between the procedures and which should you choose.

Gastric Bypass is the most invasive of all the procedures and requires a significant amount of surgical dissection. There are many different versions of the same operation, they all have a significant affect on the amount of bowel that is left to absorb nutrients form the food you eat. Surgeons will leave varying lengths of bowel, dependant on their preference and reading. There are 2 main areas of concern about this operation;

1. It carries a significantly higher risk than either of the others with little or no benefit long term. Research shows weight loss long term is similar to that of the Gastric band.
2. In some cases it may be possible to loose weight more quickly with a Gastric bypass than a band, however there can be difficulties maintaining healthy levels of nutritional absorption once excess weight has been lost.

There may also be a case for not doing this operation on young females who wish to have children, as it may cause problems ensuring that the unborn baby is fed. Potential problems also include “dumping syndrome” if a large amount of sugar is eaten, I understand this is not pleasant and can be quite painful. Also there is a potential to stretch the bypass allowing more food to be eaten. This again is down to “after care”. Patients must relearn to live with food, to ensure they do not over eat.

Gastric Band is the least invasive of the surgical procedures. It requires very little surgical dissection of tissues and is very safe if done correctly. As with all surgery though there is always a risk. The gastric band is adjustable to the patient needs/ activity and in theory can stay in for life. Although the operation is done well in the vast majority of cases, it is the “aftercare” that is sadly lacking and it is this aftercare that ensures the success of the patient with a gastric band. Many clinics will use techniques for adjustment using an X-ray to determine how much fluid is placed in the Gastric band. As no account is taken into how much the patient is able to eat, or when they are hungry, it is exceptionally difficult to see what evidence this is based on. All of the major centres that have produced research across the world use clinical adjustments, that rely on patient feedback to determine how much fluid is kept in the band. In fact that is exactly what the band manufacturers recommend. It is this potential for poor aftercare that is probably the majority of the reasons why patients my begin to fail with a band. Patients need to learn how to work with their band and there are a series of practices that need to be learnt that will maximise the effect that the band has. It may take several adjustments to get to the “sweet spot”, however once there patients are able to work much more effectively, having learnt how to cope with varying restriction.Gastric Balloon is a non surgical procedure. It can be undertaken by either a surgeon or Gastro Enterologist. It does not normally require a General anaesthetic and can be done in an Endoscopy room. It is very safe with the lowest complication rate of any of the Bariatric procedures. It is fairly unknown in the UK, probably because it is almost completely reliant on specialist care that is not readily available outside certain centres. It can be used on patients who will continue to follow the patterns of behaviour learnt during the first 6 months. Once the Gastric balloon is out at 6 months the patients will almost certainly re gain weight if they have not changed their behaviour with food and exercise. To be successful, it does require a determined approach by both the patient and specialist carer. It is more often used on patents with lower BMI, who have a short history of weight gain, or who can identify a single incident that changed their weight (baby, stop smoking etc). It can also be used to reduce weight to allow patients to undergo other procedures that weight loss would be of significant benefit to. Procedures such as hip or knee replacement, where activity has been lost and it is difficult to burn calories therefore weight loss becomes more difficult to achieve.

In all the above procedures, there are several key factors;

1. Get the correct procedure for you, not the procedure correct for someone else with similar eating patterns.
2. Have the procedure done by an expert, in a place where they are used to dealing with this type of surgery (BOSS registered surgeon)
3. Make sure the aftercare starts before the procedure and is delivered by the same people who will look after you after the procedure (NIOPPS accredited programme delivered by NIOPPS registered professional).