When it comes to addressing obesity, there are various surgical options available. The primary goal of bariatric surgery is to achieve significant weight loss, thereby reducing the risk of developing obesity related conditions, and in some instances, in treating certain already established diseases.
To be eligible for weight-loss surgery you must meet the following requirements:
– Have a body mass index (BMI) of 35kg/m2 or higher,
Or
– Have a BMI between 30kg/m2 and 35kg/m2 and an obesity related condition, such as heart disease, diabetes, high blood pressure or obstructive sleep apnoea.
In Australia, the most common types of bariatric surgeries performed include:
– Vertical Sleeve Gastrectomy
– Laparoscopic Adjustable Gastric Banding
– Roux-en-Y Gastric Bypass
– Omega Loop Mini (Single Loop) Gastric Bypass,
The Laparoscopic Sleeve Gastrectomy (LSG) is the most commonly performed primary bariatric surgery in Australia. The 2022 Annual Report published by the Bariatric Surgery Registry (BSR) showed that 80% of the 16,308 bariatric procedures registered in 2022 were LSG. A Sleeve Gastrectomy, also known as a ‘sleeve’ or ‘stomach stapling’ operation, is where about 2/3 of the stomach is removed from the body leaving a much smaller tube or ‘sleeve’ shaped stomach. Unlike with our gastric bypass operations, the small intestine is not adjusted in a LSG, only the stomach itself is operated on.
Weight loss results are very good for LSG. Average % total body weight loss at 1 year post procedure was 31%, which reduced slightly to 30% at the 3 year mark. Patients report reduction in their hunger drive and improved feeling of fullness following a LSG.
No procedure is without risk. The risks of LSG need to be explored thoroughly with your surgeon prior to your procedure. Reassuringly, the registry showed that complications reported within 90 days of the operation following a LSG was only 1.3% (return to theatre, unplanned ICU admission, readmission to hospital.) It is recommended you talk to your surgeon about specific risks and benefits of the procedure.
The Roux-En-Y Gastric Bypass (RYGB) is a metabolic bariatric procedure designed to treat obesity and also helps with gastric reflux disease. It is also used as a secondary bariatric procedure in some circumstances.
The RYGB promotes weight loss in two different ways. Firstly, it causes restriction. The Surgeon will take the large stomach and divide it using a surgical stapler device to create a new stomach which is very small and is known as a “pouch”. This pouch will form the new stomach and allows a person to feel full after a very small amount of food.
The Surgeon will reroute the small intestine, (the digestive portion of the bowel), and attach the pouch further down the small intestine to “bypass” some of the intestine which means that fewer calories are absorbed from the food. This is known as malabsorption.
The Surgeon then joins the loop of bowel connected to the detached “remnant” stomach further down the intestine so that the stomach and digestive juices can mix with the food again further down the digestive tract. It sounds complicated, but Surgeons have been performing these operations for decades and they are very safe primary bariatric procedures.
The One Anastamosis Gastric Bypass (OAGB) is also known as a Single Loop Gastric Bypass, an Omega Loop Gastric Bypass or a Mini Gastric Bypass. It is both a restrictive and malabsorptive procedure which results in significant weight loss. It differs slightly from the RYGB in that the gastric pouch of the OAGB is usually longer than the RYGB pouch and there is only one join (anastamosis) created as opposed to two.
Patients who have had a OAGB eat smaller volume meals and the food that enters the digestive tract ‘bypasses’ about 150cm length of small bowel, thereby resulting in decreased calorie absorption.
The OAGB is a relatively simple procedure to perform and, like the Roux-en-Y Gastric Bypass, is suitable for patients who suffer from obesity and gastro-oesophageal reflux disease in combination.
The OAGB is not without risks. Patients who have had any form of bypass surgery are at risk of nutrient deficiency and must adhere to taking a multivitamin lifelong. There are other complications that can occur, too, such as marginal ulcers and dumping syndrome. These risks can be reduced with comprehensive education and care provided by a specialised bariatric doctor, surgeon and dietitian.
The Laparoscopic Adjustable Gastric Band (LAGB) was a very popular and commonly performed surgical intervention for weight loss prior to the development of the Sleeve Gastrectomy technique. The LAGB was developed and fine tuned throughout the 1980’s and is a purely restrictive procedure. Patients and surgeons have generally moved away from the LAGB nowadays, and as of 2023, the most popular primary bariatric surgery performed in Australia is the Sleeve Gastrectomy. There are still many patients who have a LAGB in place, and certainly some patients who still opt to undergo LABG as their first intervention of choice.
The LAGB has its advantages. It is able to be placed laparoscopically (keyhole) and requires a short hospital stay. It is ‘adjustable’ in terms of the restriction applied to the stomach. It does not interrupt the anatomy of the bowel and overall has a low mortality rate. However, like any surgery, there are complications associated with the LAGB.
We see many patients who have had a LAGB who are having difficulties. If you are having concerns with your LAGB, such as pain, reflux, vomiting, weight regain or other symptoms, please contact us for an appointment to discuss your options. Your individual circumstances need to be reviewed before any specific medical advice can be provided. It is important to note that some patients with troublesome symptoms may require the LAGB to be removed and your GP, Bariatric Surgeon or MedSurg Weight Loss Doctor can help you to understand if you may benefit from a removal of the band.
Bariatric surgery is the strongest weight loss treatment available and is incredibly successful at facilitating significant weight loss. Further to this, there are so many more health benefits that can also be achieved, including:
There are many more examples of how weight loss associated with bariatric surgery can improve your metabolic and general health. If you’d like to know more about whether weight-loss surgery will be helpful for you, please make an appointment with your MedSurg Weight Loss doctor today.
MedSurg Weight Loss works alongside Surgeons Dr Kevin Chan, Dr David Mitchell and Dr Robert Finch to provide exceptional quality care to our shared Bariatric Surgery patients. Click below to learn more about our highly esteemed colleagues.
