What Bariatric Surgery is Right for Me?

What You need to Know

Why Bariatric Surgery?

As we all know Morbid Obesity is a big problem in our country and around the world. Many have tried for years to lose weight. Others have lost a significant amount of weight but are struggling to keep the weight off.

Bariatric surgery has become a proven and realistic way to lose weight. Studies have also shown that weight loss surgery patients have a 75 percent chance of maintaining weight loss when compared to diet and exercise alone.

Free Online Bariatric Seminar

Do You Qualify for Bariatric Surgery?

We have explained this in more detail here.

https://drangelcabanmd.com/candidate

You can also watch the short video below explaining if you qualify for surgery base on your Body Mass Index (BMI) and comorbidities.

Can You Afford Weight Loss Surgery?

Most health insurances cover weight loss surgery in the United States. If you don’t have health insurance or you have no bariatric surgery coverage then you need to figure out how you can afford the surgery. Watch the video below were Dr. Caban goes over several options that you can use to pay for weight loss surgery.

Also, remember that you will need studies or other evaluations prior to surgery that you will need to self-pay or pay the copay.

Again, you can read more details about affording surgery here. You can also watch the video below.

If you have questions about your insurance coverage the best option is to call your insurance company and ask if you have weight loss surgery coverage and what are the requirements.

How to Choose the Surgery?

Weight loss surgery is a life long commitment. You cannot take this decision lightly. You need to gather as much information as possible in order to make the best-educated decision that you can.

One of the most common questions that Dr. Caban gets is; What surgery should I get?

That is a very personal decision and only you can make that decision. Our job is to educate you so you can make the best decision. If you see Dr. Caban in the office during a consultation he will sit with you and go over your weight loss needs and medical history. Most patients at that time will have a clear idea of what is the best surgery for them.

Below we will discuss the things you need to consider when trying to decide what type of surgery is best for you.

Surgeries Offered by Dr. Caban

The Lap Band or Laparoscopic Adjustable Gastric Band: This procedure restricts the amount of food that the patient can eat by placing a silicone band in the upper part of the stomach. Click here for more information.
The Sleeve Gastrectomy or Gastric Sleeve: This is also a restrictive procedure. The stomach is made smaller by cutting it in a banana shape. Approximately 75-80 percent of the stomach is removed. Click here for more information.
The Gastric Bypass or Roux en Y Gastric Bypass: Consider the gold standard of weight loss surgery. The bypass has a restrictive and malabsorption component. Not only it restricts the amount of food that you can eat but also it decreases the absorption of some calories and nutrients because of the bypass of 150 cm of the upper gastrointestinal tract. Need more information, no problem Click Here.
The Single Anastomosis Duodenal Switch or Loop DS: Also a restrictive and malabsorptive procedure. Imagine that the sleeve and the bypass got married and had a baby. This is a combination of those two surgeries. Click Here for more details.

Weight Loss Goals

The first thing you need to consider is how much weight you need to lose. Weight loss is different for each procedure. A good rule of thumb is the riskier or more complex the surgery the more weight loss.

We base the results on the excess body weight loss (EBWL). The EBW is the difference between your ideal body weight and your excess body weight.

Let’s say your ideal body weight base on your sex and height is 150 pounds. Currently, you weight 250 pounds. Your EBW is 100 pounds. 250-150=100 lbs.

The percent of body weight loss below is an average. Some people will do better and some people will do worse, but on average you should expect to be somewhere within this range.

Lap Band: 40-50% EBWL in 2-2.5 years.
Sleeve Gastrectomy: 60-70% EBWL in 1 -1.5 years.
Gastric Bypass: 70-80% EBWL in 1-1.5 years
Single Anastomosis Duodenal Switch: 80-90% EBWL in 1-1.5 years

As you can see the lap band is the simplest procedure and it offers the least amount of weight loss. It also takes the longest to accomplish the maximum average weight loss.

On the opposite end, the duodenal switch has the most weight loss because is the most aggressive surgery.

Ok so that is all good information but how that applies to you.

Let’s see a real example to help you figure this out.

Let’s evaluate the best option for a 65 y/o caucasian post-menopausal female that has diabetes, HTN and needs a knee replacement surgery due to severe knee pain. We will call her Debbie for simplicity. She has a 35 years old daughter that had a sleeve gastrectomy 2 years ago and did very well. Debbie now wants a sleeve because she also wants to lose 150 lbs as her daughter did.

The first thing that Debbie needs to understand is that her daughter has a completely different metabolic rate than she does. The daughter is younger, “healthier” and more active. She also lacks the severe joint pain that Debbie has. For that reason, the daughter can go to the gym and do more aggressive exercise. Plus she has a higher metabolism due to muscle mass and hormones.

The likelihood that Debbie is going to lose 150 lbs with a sleeve gastrectomy is very low. She will probably lose 40-50 lbs at best. A gastric bypass is probably a better option. She most likely will lose between 80-100 lbs. Not exactly the total 150 lbs but definitely better than a sleeve gastrectomy.

This is the type of thought process that you will go through with Dr. Caban in order to pick the best surgery for you.

Activity Levels

We talked about activity levels with Debbie in the previous scenario and how that can affect the results of the surgery. But let’s look at this a little bit further.

If you are wheelchair-bound or you have significant physical limitations that will limit your ability to exercise then you need to be looking into more aggressive metabolic surgeries like the Roux en Y gastric bypass or the single anastomosis duodenal switch.

This is particularly true the older you are. With age, you lose muscle mass and your metabolism decreases making the sleeve gastrectomy and the lap band less effective.

Younger and more active patients that can do more vigorous exercise can consider a lap band or a sleeve gastrectomy.

Success after bariatric surgery takes effort and time. Exercise is part of that effort.

If you think that the weight is just going to melt away after surgery you are wrong. In life, nothing comes easy and that also applies to weight loss surgery. If you want to do well after bariatric surgery you need to put all your effort into it otherwise you will be disappointed at the end of your journey.

Eating Habits

We will go back to our patient, Debbie. She is the typical overweight female that frequently skips breakfast and lunch. Routinely eats dinner, and eats a snack before bed but overall is not a big eater.

Because she is not a big eater she cannot explain how she keeps gaining weight year after year and her diabetes is always hard to control.

This scenario is very common, and Dr. Caban sees this weekly in his office.

A patient with these eating habits is probably more suited for a gastric bypass or a duodenal switch.

The lap band or the sleeve gastrectomy are mainly restrictive procedures. They tend to work better in patients that eat large amounts of food.

Risk Tolerance

Bariatric surgery is like investing in the stock market. The riskier stocks can generate higher returns but also have the highest risk of losing all your money.

The surgeries that offer the highest weight loss also have the highest risk of complications. If you want more information about the complications click here.

Now let’s be clear because we don’t want you to get scared.

If you look at Dr. Caban outcomes in the 10 years that he has been in practice you will see that the complication rate is very low.

His overall complication rate for bariatric surgery is less than 5 percent. That is including bariatric surgery revisions. His mortality rate is an outstanding 0% and the most common complication is a urinary tract infection.

In order to truly evaluate your risk, you need to consider several factors. Age, other medical conditions, weight, previous surgeries, and physical activity levels.

Again, if you need more detail information about Bariatric Surgery Complications click here.

Commitment and Reliability

We will start with the follow-up. A big part of the commitment is following up with your bariatric program. Bariatric Centers of Excellences are required to have adequate follow up of the patients in order to keep the accreditation. If you failed to follow up with them you are actually hurting their program. S0 please stick to your follow up.

Dr. Angel M. Caban follows sleeve, bypass and duodenal switch patients two weeks after surgery and every three months for the first year. After the first year, you will follow up every six to twelve months thereafter.

Lap Band patients have different follow-up. You will be seen at two weeks after surgery and then every six weeks for band adjustments until you reach adequate restriction.

If you are thinking about a Lap band then you need to consider the frequent follow-up and the cost associated with these follow-ups. Insurance companies usually have a limit in the follow-ups that they will cover for band fills.

Another big thing to consider is your reliability in terms of taking supplements. This is particularly important if you go for the bypass or the duodenal switch. You will need to take vitamin and nutritional supplements for Life… Yes for life. Also, you need to take supplements specially designed for bariatric patients.

Yes, you guessed it. They are usually more expensive than a centrum or a Flinstone multivitamin.

For example, this Bariatric Advantage Multivitamins without iron are 56 dollars on Amazon.

Also, it is very important that you know what type of surgery you had done for future reference. Let’s say that ten years after your duodenal switch you developed colon cancer and you need surgery for that. You go and see a surgeon in a new area that you recently moved in. On the surgical history, you mention “stomach stapling”. The surgeon has no idea what that means but he assumes it is a sleeve gastrectomy.

Well, he is up for a big surprise when he goes in your belly and sees a completely different anatomy. That small detail can completely change your outcome of that surgery.

You are responsible for your own health. If you can’t commit to that then a big surgery like the duodenal switch is not for you.

Many general surgeons that don’t have bariatric training or experience taking care of complex gastrointestinal surgery will decline care of patients that had a gastric bypass or a duodenal switch. That will limit your options at the time of emergent or elective surgeries.

Medical History

Bariatric surgery is very safe nowadays but it still has risk. This is particularly true for older patients with multiple comorbidities. A very important thing to consider is the overall medical condition of the patient. A patient that is waiting for a heart transplant has a completely different risk profile than a 25-year-old otherwise healthy patient.

For a patient that is on the transplant list for a new heart usually the surgery of choice is a sleeve gastrectomy. Why, because it is a low-risk simple surgery that offers good weight loss. For this type of patient less is more. The least amount of anesthesia and operative time the better.

Another case scenario is the older uncontrolled overweight diabetic. A patient that takes two pills and over 100 units of insulin a day and his blood sugar still out of control most likely won’t benefit as much from the sleeve gastrectomy. A gastric bypass or a duodenal switch might be a better option.

Those are just two examples of indefinite options but it shows you how your medical conditions can stir you and your surgeon towards a particular operation vs another.

Surgical History

Just like medical history, surgical history could be a limiting factor in the type of surgery that you can have. A patient with no previous abdominal surgery has no issues but a patient that had a car accident and required five large abdominal surgeries to fix all the injuries has limited options for bariatric surgery.

A patient with multiple open abdominal surgeries usually is a candidate for a laparoscopic sleeve gastrectomy or a lap band.

Another scenario is the patient that had three C-sections, total hysterectomy, open gallbladder surgery, and the appendix removed. This patient had multiple abdominal surgeries but none of these surgeries significantly interfere with the above mentioned bariatric procedures.

It is very important that you list all the previous abdominal surgeries that you had in the past so you and your surgeon can decide the feasibility of the bariatric surgery you are considering.

Again, there is a lot of variability in this area. Including the surgeon’s experience in dealing with complex abdominal surgeries. If you have a complex surgical history and your surgeon tells you that XYZ surgery is not possible you can also consider a second opinion.

Dr. Caban has operated in many patients that were declined by other surgeons due to prior surgeries or medical conditions. Do your homework, shop around and get different opinions.

Current Weight and Body Composition

Your current weight and body composition can also affect the type of surgery that you can have. Not every person is built the same way. Some patients carry the weight around the abdomen (central obesity). Others carry most of their weight in the arms, butt, and legs (peripheral obesity).

There are good things and bad things about both body types. People with central obesity are harder to operate on because most of the fat is around the abdominal organs. That can limit the type of surgery you could have.

For example; A 550 pounds female with a BMI of 70 that has most of her weight in the midsection is probably not a feasible candidate for a laparoscopic gastric bypass. She is probably better suited for a two-stage surgery, first a sleeve gastrectomy followed by a conversion to a gastric bypass or duodenal switch in 1-2 years after some weight loss.

Another patient with similar weight and BMI that has more peripheral obesity than central obesity could still be a candidate for a laparoscopic gastric bypass or duodenal switch.

One more thing to know about central versus peripheral obesity is the ease of weight loss. Central obesity is usually easier to lose versus the weight in the legs and butts. That weight distribution is usually harder to lose.

Reversible vs Permanent

Weight loss surgery should be considered a one time deal. In many ways this is true but unfortunately, some patients do require some type of surgery in the future. This surgery could be a revision, conversion or a re-do.

Some bariatric procedures are irreversible, the sleeve gastrectomy and the duodenal switch are a couple of examples. Once a portion of the stomach is removed it cannot be replaced.

The gastric bypass and the lap band can be completely reversed if needed.

Some of these procedures could be revised or redone. If you are interested in more information about revisions please see these links.

Conclusion

We hope this post helps you with your decision regarding what bariatric surgery is right for you.

Unfortunately, nobody can make this decision for you. this is a very personal decision. You are the one that is gonna live with the new changes.

Our recommendation is that you make the best-educated decision that you can by reading and learning about the different options. Also, meet with a well qualified bariatric surgeon that can help you with this life-changing decision.

Also, support groups can be very helpful. Be careful with online support groups. Like anything else that you can find online you need to consider the source of the information.