�Different types of Obesity Surgery

There are several types of obesity surgery which fall into one of the following three categories:

• Restrictive
• Malabsorptive
• Combination (restrictive/malabsorptive)

The three most popular obesity procedures are gastric bypass, gastric band and sleeve gastrectomy. The gastric balloon is also proving a popular option for those patients who prefer not to have surgery.

Restrictive

This is the term given to a set of procedures which cause a physical reduction of the stomach volume. At present there are three procedures although one of them – Vertical Banded Gastroplasty is no longer recommended due to a high rate of side effects.

The two remaining procedures are:

• Sleeve gastrectomy (single technique)
• Gastric band

Food intake is reduced as result of smaller stomach capacity: and less food means a reduced calorie intake which will result in weight being lost.

Malabsorptive

A malabsorptive procedure is one in which the absorption of food is greatly affected. When food is ingested it passes down the gullet (windpipe) into your stomach. It is then broken down by stomach acids. As it leaves the stomach and enters the top part of the small intestine or duodenum, it comes into contact with digestive juices from the pancreas and bile from the gall bladder. These two cause a further breakdown of the food which means that vital nutrients such as vitamins and minerals are absorbed.

However, with a malabsorptive procedure this ability is vastly reduced. Food is not properly absorbed which means that important nutrients are lost. This can result in vitamin/mineral deficiencies. You will be given daily supplements to replace these.

Malabsorptive procedures, such as the jejuno-ileal bypass are no longer performed.

Combination procedures or ‘restrictive/malabsorptive’ procedures are the preferred option.

Combination (restrictive/malabsorptive)

These are ‘double whammy’ procedures: by this we mean that they are comprised of both a restrictive and malabsorptive element.

The restrictive element is the physical reduction of the stomach: which means that smaller meals will have to be eaten (reduced food intake).

The malabsorptive element refers to the rerouting of the small intestine (see gastric bypass for a more detailed description) which affects food absorption.

There are four procedures which fall into this category:

• Roux-en-Y gastric bypass
• Mini gastric bypass
• Biliopancreatic diversion (with or without duodenal switch)
• Sleeve gastrectomy with duodenal switch

These are all technically demanding procedures but when performed by an experienced surgeon can result in dramatic weight loss.