Choosing a surgery

I decided to start investigating weight loss surgery months ago. I never allow anyone to make decisions for me and I truly believe in (self) informed consent. When I attend my consultation appointment with the surgeon I want to already have an idea about which surgery I feel is the best fit for my life and what questions I want to ask.

According to my extensive research there are generally three surgical options offered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. I have reviewed each option, their advantages, disadvantages, complications and results.

By far the most common surgery is gastric bypass specifically roux-en-Y stomach bypass. This option has demonstrated to be the most successful tool used to reduce weight. Basically, the stomach is reduced to the size of one ounce or two tablespoons and the new small pouch is connected to the small intestine bypassing several inches of small intestine limiting caloric absorption. It is the latter half of the surgery that concerns me. Along with limiting caloric absorption, vitamin and mineral absorption is also limited. I feel this will be a problem for me. Plus the other side effects I find less than desirable. Some of the side effects that concern me the most are bowel obstructions, ulcers, and dumping syndrome. The nutritional deficiencies are also concerning. Deficiencies in calcium, iron, vitamin B12, thiamine, and vitamin A are all things that lead to serious problems. However, it seems all of these problems can be managed with supplements.

The next most common form of surgery is adjustable gastric banding. I heavily considered this option after learning about all the potential complications of gastric bypass. This option allows for slower weight loss and no malabsorption issues. However this form of weight loss surgery allows for the least amount of excess weight loss. I find the side effect profile for this surgery bothersome as well. First, what is called the lap band may become dislodged, it may cause gastric erosion, and certain foods have a high propensity to become stuck in the opening. This surgery is by far the safest but considering I weight 365 lbs I do not think it is the right choice for me.

The least common form of surgery is sleeve gastrectomy. This surgery preserves the pyloric valve and does not cause malabsorption issues since there is no small intestine bypassed. However, the suffix –ectomy means removal and 85% of the stomach is removed which makes this surgical procedure irreversible. The new stomach size is about two ounces or four tablespoons. Because a majority of the stomach is removed the production of a hormone called ghrelin is significantly reduced. This hormone is responsible the feeling of hunger. The side effects of this surgery are ulcers and gastric leakage. This surgery also may lead to inadequate weight loss or weight gain from overeating, which causes the new stomach to stretch. The weight loss results and ultimately success is heavily dependant on the size of the stomach after surgery. This depends on which size bougie the surgeon uses during the surgery. Most recommendations state the use of a 32-french bougie results in superior weight loss but some surgeons may use a bougie as large as 40-french. This surgery has the potential of achieving the weight loss results of gastric bypass.

Because of everything I have learned, I am heavily considering the sleeve gastrectomy procedure. I will only consider this surgery if the surgeon uses a 32-french bougie. I do not want a stomach that is bigger than two or three ounces. If for some reason this surgery cannot be performed to these specifications then I will choose gastric bypass.