What type of weight loss surgeries are there?
Currently, there are 3 different types of bariatric (weight loss) surgeries available: Vertical sleeve gastrectomy, Roux-en Y gastric bypass, and Adjustable gastric banding.
Are Weight loss Surgeries Common?
There were an estimated 213,000 primary weight loss operations performed in the United States. In 2019, the vertical sleeve gastrectomy accounted for 152,000 of them. 46,000 patients had a Roux-en-y gastric bypass. Fewer than 2500 patients had adjustable gastric banding or duodenal switch performed.
The vertical sleeve gastrectomy and Roux-en-Y gastric bypass together account for more than 94% of primary weight loss surgery performed in the United States.
History of Bariatric Surgery
The first bypass surgery was performed in 1954 by Dr. A.J. Kremen. Dr. Mason performed the first gastric bypass in 1967. In the early 1970’s, the gastroplasty, commonly referred to as stomach stapling, was introduced as a safer alternative to the previous weight loss operations. Dr. Hess is credited with describing the duodenal switch in 1986.
In 1978, Dr. Wilkinson described banding the upper stomach. This concept was further modified and, in 1986, Dr. Kuzmak described the first adjustable gastric band. With improvement in technology, surgeons began to have the ability to perform abdominal surgery laparoscopically. This dramatically reduced the morbidity of weight loss surgery by eliminating the large incision.
The first series of laparoscopic Roux-en-Y gastric bypasses were performed by Dr.’s Whitgrove and Clark. The LAP-BAND received US FDA approval in 2001. The Vertical Sleeve Gastrectomy was first described in 1983 by Dr. Marceau. In 2003, Dr. Regan described performing laparoscopic vertical sleeve gastrectomy as part of a two-stage approach to overcome the challenges in super-morbidly obese patients.
The Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery position in the late 2000’s on Vertical Sleeve Gastrectomy as a standalone weight loss operation led to widespread adoption of the operation by surgeons throughout the world. As a result, the number of annual sleeve gastrectomies in the US rose dramatically over the next 10 years.
In 2011, there were 28,000 laparoscopic sleeve gastrectomies performed. In 2019, there were 152,000 sleeve gastrectomies performed while the overall number of primary weight loss operations in the US only increased from 149,000 to 213,000 operations. During that same decade, in 2011, there were 58,000 Roux-en-Y gastric bypasses performed and in 2019 there were 46,000 gastric bypasses performed. The number of patients choosing to have adjustable gastric banding performed decreased from 56,000 in 2011 to 2000 in 2019. Duodenal switch accounted for 1400 operations in 2011 and 2300 operations in 2019.
What is the safest form of weight loss surgery?
The laparoscopic adjustable gastric band is the safest, with the lowest operative morbidity and mortality rate of all weight loss operations. When considering the risk of reoperation for complications of the original weight loss operation, the Vertical Sleeve Gastrectomy is superior.
Adjustable gastric banding has the lowest operative risk of all the weight loss operations. It has the highest risk of reoperation and weight loss failure of all the operations.
The Intra-Gastric balloon gained FDA approval in 1985 but was withdrawn 7 years later. In 2015, the FDA approved the use of intra-gastric balloons. There are several competing devices approved in the US, some requiring endoscopy for placement and some done under x-ray guidance. The push was for a low cost, low morbidity, low mortality, reversible weight loss procedure.
What Is The Average Cost Of Gastric Balloon In The US?
The average cost of gastric balloon in the US is approximately $7000 to $10000 and typically includes two endoscopies, monthly office visits and the cost of the device. The FDA requires retrieval/removal of the band 6 months after deployment.
Average Weight Loss With Gastric Balloon
The average weight loss is up to 30 pounds. However, the majority of patients regain their weight within one year. Patients typically have significant nausea and may experience dehydration within the first few weeks. Life threatening complications have been reported secondary to esophageal injury, stomach perforation, bowel obstruction and perforation.
As a result of the poor weight loss, likelihood of weight regain within the first year, and challenges in the first few weeks after balloon deployment, less than 5000 intra-gastric balloons were placed in 2019.
What Weight Loss Surgery Has The Lowest Risk?
The laparoscopic vertical sleeve gastrectomy is currently considered the lowest risk weight loss procedure in the US when considering several factors together such as initial operative risk, potential to develop nutritional deficiencies without adherence to supplementation after surgery, risk of reoperation and long-term weight loss.
Can Stress Affect Weight Loss?
Yes, stress can make it hard to lose weight. Below are a few reasons why:
- Increase in Cortisol – Our bodies naturally produce a hormone called cortisol. When we are stressed, cortisol levels are increased, which can lead to weight gain.
- Increase in Hunger – Stress can increase appetite, which may cause us to over eat.
- Food Cravings – We may crave sweet or salty foods when we are stressed. If you are having food cravings, try the following:
- Distract your attention for 10 or 15 minutes. The craving will likely pass.
- Snack on pickles. Pickles can be very low in calories and can be a good way to relieve a craving for something salty or crunchy. Be sure to check the label to make sure no sugar has been added. Cut up peppers or other non-starchy vegetables are also good options for something crunchy.
- Have a sugar free Popsicle. This can be a good way to relieve a craving for sweets.
- Brush your teeth or gargle some mouth wash. You may not want to snack after having a minty taste in your mouth.
- Treat yourself to hot tea or other sugar-free beverage.
- Not enough sleep – Not getting adequate sleep can affect our energy levels, and over time can contribute to unwanted weight gain.
Ways to Manage Stress:
- Take a walk or engage in other physical activity
- Reach out to a family member or friend for support in-person, online or over the phone
- Read a book
- Do online yoga or workout videos
- Take a warm bath
- Paint your nails
- Participate in a hobby
- Limit caffeine and alcohol
- Get adequate amounts of sleep (at least 7-8 hours per night)