Patients are often confused about which bariatric surgery they should undergo in order to reduce weight while having the least side effects. Bariatric surgery is a constantly evolving field with new procedures being developed and some of the older procedures being disregarded. With better understanding about obesity and developments in technology, the procedures are aimed to give long term weight loss without any negative impacts on lifestyle and health.
There is no “best” procedure and it is all about choosing the right procedure for the particular patient. The choice of procedure depends upon various factors like:-Young patients with moderate obesity and no associated diseases are often given the option of endoscopic procedures which are reversible and safe. These can be done in day care setting and patients can get back to their routine within a day or two.
Young adults with more severe obesity and higher BMI are offered a restrictive operation like sleeve gastrectomy which produces a good long term weight loss without the need for undue supplements and lower risk of nutritional deficiencies.
Older adults with long standing obesity and associated comorbidities are offered metabolic surgery like gastric bypass which helps in weight loss as well as comorbidity resolution. This is especially true of diabetic patients and sweet cravers for which bypass procedures are very effective.
While the gastric sleeve is avoided in patients having GERD (acid reflux), it is preferred for patients with compromised liver and cirrhosis.
Bypass procedures should be avoided in smokers, people with liver and intestinal diseases and those with strong family history of gastric cancer.
Vegetarians and people with poor protein intake and anaemia are offered a restrictive procedure only since metabolic surgeries can lead to long term nutritional deficiencies. This is also true of people who are foreign nationals and may not be able to comply with regular follow up and supplements.
Thus, the decision of choosing the correct bariatric procedure is a complex one is best made after careful discussion with the treating surgeon.