Types of Metabolic and Weight-Loss Procedures

Learn about the types of metabolic and weight loss procedures we provide.

Laparoscopic or Robotic Gastric Bypass

Gastric bypass is the original surgery for weight loss. The procedure separates the stomach, creating a small pouch at the top. The small bowel is divided and connected to this pouch. This bypasses the portioned-off section of the stomach and about 150 centimeters of the small intestine.

Gastric bypass works in several ways: First, it creates a much smaller receptacle for food, preventing you from overeating. Second, bypassing part of the intestines reduces absorption of nutrients and calories. Third, this surgery alters stomach and intestinal hormones, reducing hunger and diabetes in many people. Current research shows this is the best weight loss surgery option for people with diabetes.

Weight loss is often rapid after a gastric bypass procedure. The most rapid weight loss occurs in the first 6 months after surgery. On average, patients lose 30% or more of their total body weight.

Laparoscopic or Robotic Sleeve Gastrectomy

The most common weight loss procedure we complete at Lahey is the sleeve gastrectomy. Initial weight loss is a little less than the gastric bypass after one year.

This procedure removes the outer part of the stomach. It decreases the amount of food the stomach can hold by about 90%. This speeds the movement of food into the intestine, which is not altered. Sleeve gastrectomy changes your intestinal hormones, decreasing appetite and improving diabetes.

Sleeve gastrectomy provides some advantages. There are no connections between the stomach and intestine (anastomoses) and the intestine is not changed at all. This procedure carries less risk of long-term complications compared to gastric bypass.

Sleeve gastrectomy can cause heartburn or acid reflux in about 25% of patients. It is less effective in curing diabetes long term compared to the bypass.

Laparoscopic or Robotic Duodenal Switch/Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)

The most powerful procedure for losing weight is the laparoscopic duodenal switch. We perform this procedure less often. It’s reserved for people with obesity and a BMI of 50 or higher.

The duodenal switch does carry a higher complication rate. It is not recommended for people with multiple medical problems.

The duodenal switch can lead a 35-45% total body weight loss. It is highly successful at eliminating and preventing complications of obesity.

This procedure combines a sleeve gastrectomy and an intestinal bypass. This creates restriction and malabsorption. You can expect a hospital stay and recovery like a gastric bypass or sleeve gastrectomy.

Long-term complications are higher than with other procedures. They include diarrhea and vitamin and mineral deficiencies.

We provide conversion to a second surgery or revision surgery for several reasons:

• Regained weight
• Lost an insufficient amount of weight
• Have increased difficulty with controlling diabetes
• Have poorly controlled acid reflux
• Have a medical problem from a prior metabolic and weight loss surgery procedure

Conversion from Lap Band to Gastric Bypass or Sleeve Gastrectomy

About 90% of patients who get a lap band do not lose enough weight or regain weight. They may also develop reflux or difficulty swallowing.

If you experience these issues, your surgeon can laparoscopically remove the band. A gastric bypass or a sleeve gastrectomy is then performed at the same time.

The hospital stay and recovery from this procedure is like non-revisional surgery. We frequently perform these procedures at Lahey with excellent results.

Conversion from Sleeve Gastrectomy to Gastric Bypass

About 25% of patients may develop acid reflux after a sleeve gastrectomy procedure. This condition can be hard to control with medicine. You may not want to take medicine for the rest of your life. A revision surgery to complete a gastric bypass can improve control of acid reflux control.

Conversion from Sleeve Gastrectomy to Duodenal Switch or Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S)

Some patients do regain weight after a sleeve gastrectomy because of the many factors that cause obesity. Your care team can help.

You may be a candidate for a duodenal switch/single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). This procedure can help you achieve greater weight loss.

Both of these procedures also help improve poorly controlled diabetes or newly developed diabetes after a sleeve gastrectomy.

Revision of Gastric Bypass with Limb Distalization

Weight regain can occur after gastric bypass surgery. Studies show between 15% and 35% of patients do not achieve expected weight loss or have significant weight regain after surgery.

A limb distalization procedure helps reverse weight regain after gastric bypass for some patients. This surgery reduces that area of the small intestine that absorbs nutrients. This helps you lose more weight.

When undergoing this surgery, patients can experience significant weight loss. It is important to remember that the best results will come when revision is paired with healthy nutrition intake and regular structured exercise routines. Limb distalization can also lead to improvement in diabetes.

Revision of Vertical Banded Gastroplasty to Gastric Bypass

Vertical banded gastroplasty, known as stomach stapling, was popular in the 1980s. In about 50% of patients the staples failed. This led to poor weight loss, stomach ulcers and pain. We use gastric bypass to correct these complications.

Revision of Gastric Bypass

Complications can occur after a gastric bypass. These can be a connection (fistula) between the bypassed stomach and stomach pouch, or a pouch that is too large. These issues can cause poor weight loss and ulcers. Revision surgery closes the connection or makes the pouch smaller.

All surgeries carry risks. However, the risk of death from obesity-related problems is higher than the risks of metabolic and weight loss surgery.

The most common risks are short- and long-term, non-fatal complications. Overall, weight loss surgery carries 10% to 20% risk for problems.

Common short-term (within 30 days of surgery) complications are nausea and dehydration, with a 5% to 10% risk. Less common are bleeding (0.5-1.5% risk) and leaks (0.15-0.75%).

Long-term complications depend on the type of surgery.

Lap band complications include band slippage, band erosion or intolerance of the lap band. The risk of these problems is 50% or more and may require revision surgery.

Gastric bypass complications can include bowel blockage, ulcers, or vitamin and mineral deficiencies.

Sleeve gastrectomy can lead to vitamin/mineral deficiencies and 25% of patients may have heartburn or acid reflux.