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Choosing the Right Bariatric Surgery

Posted 6/14/2018 by UHBlog

Not all bariatric surgeries are created equal, depending on your health conditions and chronic diseases. Talk to us about which bariatric surgery option is right for you.

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If dieting and exercise haven't helped you lose the excess weight that's bogging you down, bariatric surgery may help to reduce you to a healthier, happier size. But which procedure is best?

Bariatric surgery refers to a procedure that reduces the amount of food a person is able to consume, says bariatric surgeon Leena Khaitan, MD, MPH.

“It is usually a last resort to weight loss after other methods have failed,” she says.

A variety of surgical and non-surgical procedures are available to limit food intake and to help control a person's appetite. Some common options include:

  • Gastric bypass. During a gastric bypass, most of the stomach is tied off, leaving a ping-pong ball-sized pouch intact, while a portion of the small intestine is bypassed to reduce the body’s absorption of calories.
  • Gastric sleeve. The sleeve is created by surgically reducing the size of the stomach. Normally, a person’s stomach can blow up to about the size of a football. After surgical reduction, the stomach takes on the size and shape of a banana. Both the bypass and the sleeve, while reducing the size of the stomach, also alter the production of hunger hormones resulting in a decreased appetite and increased fat burning.
  • Intragastric balloon. An intragastric balloon is a non-surgical procedure during which a silicone-filled balloon is placed into the stomach – usually through the mouth. The balloon fills much of the stomach, causing the person to feel less hungry and limiting the amount of food she can consume.

Each bariatric option has pros and cons, says Dr. Khaitan. Your doctor can help you choose which procedure is best for you.

“The main consideration is patient preference,” she says. “Normally, by the time patients come in for weight loss surgery they have done a lot of research on it. They may have spoken to people who have had a procedure.”

Among the other factors to consider are existing medical conditions and tolerance for anesthesia during a surgery. For example, people who suffer from acid reflux should probably not choose a gastric sleeve, which could make the reflux worse.

For people with diabetes, a gastric bypass may be a good option. This procedure has been shown to improve or even resolve the disease. If you have heart or lung problems, however, you may want to avoid the longer surgery and anesthesia time required for a bypass.

To qualify for weight loss surgery, patients must have a body mass index (BMI) above 40, or an obesity-related disease like diabetes, hypertension, sleep apnea or joint pain for people with a BMI above 35. Many times, these chronic conditions can go away with weight loss.

Finances may also play a factor in your decision. Endoscopic procedures like intragastric balloons generally aren't covered by medical insurance, Dr. Khaitan says.

According to Dr. Khaitan, people who undergo weight loss surgery can expect to lose 50 to 75 percent of their excess weight, depending on the procedure. The failure rate of the procedures, she says, is less than 10 percent.

"Ninety-five percent of the failures happen when people go back to their old habits of eating too much and not exercising," she says. "That's why lifestyle counseling is a big part of the program."

The benefits of weight loss can be profound.

“A lot of health conditions can go away, like sleep apnea, diabetes, high blood pressure, high cholesterol and chronic pain in the back and knees,” she says. “A patient might be on 15 medications before weight loss surgery, and six months later all they're taking is vitamins. There can be a huge impact on quality of life and self-confidence.”

Leena Khaitan, MD, MPH is a bariatric surgeon and director, Bariatric Surgery Program at University Hospitals Cleveland Medical Center and University Hospitals Geauga Medical Center. You can request an appointment with Dr. Khaitan or any other doctor online.

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