What you need to know before considering weight-loss surgery

Without addressing the underlying metabolic illness of severe obesity, diets and exercise often fail.

“Obesity is not just about calories in and calories out,” says Dr. Sunil Bhoyrul, medical director of bariatric surgery at Sharp Coronado Hospital. “It’s a complex medical illness in which the body stores excess amounts of fat.”

Obesity changes how people metabolize food and alters the hormones that control appetite and hunger. Bariatric surgery is a tool that can help address these issues to help people lose weight and keep it off.

When it comes to weight-loss surgery, there are several options available to patients. Each type has its own benefits, and like all surgeries, a potential for risks.

• Lap Band — This surgery involves adding an adjustable band across the upper part of the stomach to limit how much food it can hold. Lap Band is not commonly performed; many surgeons prefer newer procedures that have better long-term outcomes. With Lap Band, there is also a risk of the band moving out of place or causing tissue damage.
  

• Sleeve gastrectomy — This procedure involves removing part of the stomach, reducing its size by about 80% so it can hold less food. It also decreases production of the hormone ghrelin, known as the “hunger hormone.” Risks can include leaks, or openings, where the stomach is stapled, but this risk is less than 1%.
  
  “A sleeve gastrectomy is the most common bariatric procedure performed and has been shown to have excellent outcomes with relatively fewer complications,” says Dr. George Mueller, medical director of Bariatric Surgery at Sharp Memorial Hospital.
  

• Roux-en-Y gastric bypass — This surgery involves reducing the stomach to the size of an egg. A surgeon then connects this small stomach pouch to a piece of the intestine downstream, bypassing the rest of the stomach. This allows the stomach to absorb fewer calories and changes the way the body processes food. Risks can include malabsorption from lack of nutrients and “dumping” syndrome, when sugary foods process quickly and cause discomfort. Leaks and bowel obstructions are other, though rare, risks of the surgery.
  

• Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) — This newer surgery combines the benefits of sleeve gastrectomy with gastric bypass. A surgeon performs a sleeve gastrectomy, then connects the new, smaller stomach to a part of the intestine downstream. This procedure has a lower risk of dumping syndrome and is most beneficial for patients with a higher body mass index. Risks can include reflux, malabsorption and leaks, though leaks are rare. This is also an excellent surgery for patients who have gained weight after a previous sleeve gastrectomy.

The right surgery for you depends on several factors. This can include how much weight you want to lose, medical conditions you may have, and how much support you will need after surgery.

Bariatric surgery can be performed with a minimally invasive approach, using small incisions or with new robotic-assisted technology.

“With robotic surgery, there’s a misconception that the robot does the surgery by itself, when actually, the surgeon is in constant control of the robotic surgical platform,” says Dr. Pascal Bortz, a board-certified surgeon affiliated with Sharp Coronado Hospital.

“It’s important to remember that bariatric surgery is a tool,” says Dr. Bhoyrul. “It’ll help you lose weight, it’ll help you keep it off, but surgery alone is not going to do this. You have to be committed to making healthy food choices and staying active.”

To help guide patients through their journey and navigate lifestyle changes, Sharp offers online bariatric support groups through the Bariatric Surgery Programs at Sharp Memorial and Sharp Coronado. Both programs are nationally accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which certifies bariatric surgery centers that have undergone an independent, voluntary and rigorous evaluation to ensure safe, high-quality care for patients.