MBL's Ultimate Guide to Weight Loss Surgery!

Scroll to browse the whole guide or click the links on the right to be taken to your preferred section.
NOTE: This guide is just that, a guide and should not be considered medical advice. Consult with your physician to determine which weight loss surgery is right for you. 

What is weight loss surgery?

Weight loss surgery, or bariatric surgery, is surgery that involves making changes to the digestive system in order to promote weight loss. Weight loss surgery is often used when diet and exercise have not resulted in the desired weight loss, or the patient has other health conditions related to weight, such as type 2 diabetes or sleep apnea.

There are several different types of weight loss surgery. The right one for you will depend on several factors, such as your current weight, the amount of weight you need to lose, and whether you have any weight-related health conditions.

Scroll down or click on the links below to be taken to that specific weight loss surgery procedure section.

Are you curious about or considering weight loss surgery?

Do you need help losing weight? Has your doctor recommended a type of bariatric surgery to help with weight-related health conditions such as type 2 diabetes-related joint pain and deterioration or obstructive sleep apnea?

Weight loss procedures such as gastric bypass surgery have been helping people lose weight and improve weight-related health conditions for decades. Bariatric surgery can be very effective for patients who have tried other weight-loss surgery options without achieving long-term results. Now, new advances in weight-loss procedures and more clinical trials mean that patients have more options than ever before when it comes to both surgical and non-surgical interventions for weight loss.

Is weight loss surgery right for you?

If you think weight-loss surgery may be the right path for you, it’s important to weigh your options and understand what to expect from this part of your weight-loss journey. This Guide to Weight Loss Surgery answers many common questions about weight loss surgery. We’ll also take a closer look at 6 different bariatric procedures, including how each one works, the advantages and disadvantages of each type, and other considerations that will help you decide if any of these approaches is right for you.

A qualified bariatric surgeon can provide additional information about each procedure and help you develop a plan for meeting your weight-loss and wellness goals.

What are the benefits of weight loss surgery?

Weight loss surgery has helped many people reach and maintain their goal weight. Bariatric surgery typically results in more successful long-term weight loss than diet and exercise alone, especially for patients who are chronically obese and those who also suffer obesity-related disease, such as type 2 diabetes.

While people are often able to lose weight on their own through diet and exercise, keeping the weight off is another story. Cleveland Clinic reports that among people who lose 65 pounds or more, less than 5 percent of them keep the weight off for five years. Most of them gain the weight back within one year.

In addition to successful long-term weight loss, bariatric surgery has also been shown to lead to other benefits, including improved cardiovascular health, remission of type 2 diabetes, depression relief, joint pain relief, and improvements in other health conditions, such as sleep apnea, fertility problems, and more.

Estimate of Bariatric Surgery Numbers, 2011-2018

2011
2012
2013
2014
2015
2016
2017
2018
Total
158,000
173,000
179,000
193,000
196,000
216,000
228,000
252,000
Sleeve
17.8%
33.0%
42.1%
51.7%
53.6%
58.1%
59.4%
61.4%
RYGB
36.7%
37.5%
34.2%
26.8%
23.0%
18.7%
17.8%
17.0%
Band
35.4%
20.2%
14.0%
9.5%
5.7%
3.4%
2.7%
1.1%
BPD-DS
0.9%
1.0%
1.0%
0.4%
0.6%
0.6%
0.7%
0.8%
Revision
6.0%
6.0%
6.0%
11.5%
13.6%
14.0%
14.1%
15.4%
Other
3.2%
2.3%
2.7%
0.1%
3.2%
2.6%
2.5%
2.3%
Balloons
0.3%
2.6%
2.8%
2.0%

Originally published June 2018 The ASMBS total bariatric procedure numbers are based on the best estimation from available data (BOLD,ACS/MBSAQIP, National Inpatient Sample Data and outpatient estimations). *New methodology for estimating outpatient procedures done at non-accredited centers.

Educational Videos: Weight Loss Surgery

Video information + transcriptions below. Tap to open and read along with video.
Most people who need to lose 65 or more pounds have tried multiple times to lose the weight on their own. While they may have some success at first, less than five percent of people keep the weight off for five years or more. 
– Philip Schauer, MD, bariatric surgeon and Director of Cleveland Clinic’s Bariatric and Metabolic Institute

How dangerous is weight loss surgery?

All surgeries involve some risk. Specific risks related to weight loss surgery vary depending on the type of surgery performed. Some risks of bariatric surgery may include low blood sugar, malnutrition, nausea, vomiting, and the inability to eat certain foods. Talk to your doctor about the specific risks involved with the type of surgery you choose to have. Your bariatric surgeon and medical team will help you prepare for these risks and learn how to manage them.

How do you qualify for weight loss surgery?

Weight loss surgery is not for everyone. If you have only a small amount of weight to lose, or you haven’t tried to lose weight with diet and exercise first, weight loss surgery probably isn’t right for you. Bariatric surgery is typically recommended for people with a body weight index (BMI) of 40 or more, who have already tried to lose weight through other methods, and are able to commit to the lifestyle changes necessary for success with weight loss surgery (Lim et al., 2010).

Weight loss surgery may also be recommended for people with a BMI of 35 or higher and who have one or more health conditions that may be improved with sustained weight loss, such as type 2 diabetes, obstructive sleep apnea, hypertension, or heart disease (Lim et al., 2010).

Is weight loss surgery covered by insurance?

Weight loss surgery is sometimes covered by health insurance, but it’s important to understand exactly what your insurance plan requires. In order to have weight loss surgery covered by insurance, you may have to meet certain criteria and prerequisites. This may include undergoing psychological counseling and showing documented attempts to first lose weight through diet and exercise. Check with your insurance company to find out what they require, and make sure to follow their guidelines exactly to increase your chances of being approved for the procedure.

What are the different types of weight loss surgery?

Weight loss surgery is a continually growing field, and new procedures often become available after undergoing clinical trials and receiving FDA approval. However, some types of bariatric surgery have been used for years and continue to be popular due to their high success rates. Continue reading to learn more about six common types of weight loss surgery.

  1. Gastric bypass

  2. Gastric sleeve

  3. Gastric banding (Lap-Band)

  4. Gastric balloon

  5. AspireAssist

  6. Endoscopic sleeve gastroplasty Bypass procedure)

Gastric Bypass

(Laparoscopic Roux-En-Y Gastric Bypass Surgery)

What is gastric bypass surgery?

Gastric bypass is a type of bariatric surgery used to help people with severe obesity. Gastric bypass significantly reduces the size of the upper stomach and re-routes part of the small intestine so the food you eat “bypasses” the rest of the intestine, thereby limiting nutrient absorption.

The purpose of gastric bypass surgery is twofold: reduce the amount of food you can eat, and reduce the amount of fat and calories the body absorbs from food.

Gastric bypass surgery can be performed laparoscopically — a minimally invasive approach in which the surgeon makes small incisions and uses tiny surgical instruments rather than large incisions. Laparoscopic surgery reduces trauma on the body and makes recovery easier. It is associated with less risks than open procedures, such as infection at the surgical site.

Who is a candidate for gastric bypass surgery?

Gastric bypass surgery is usually recommended for people with a body mass index (BMI) of 40 or higher who have tried other weight-loss methods without long-term success.

People with a BMI between 35 and 40 and who also suffer from a related health condition such as heart disease, type 2 diabetes, sleep apnea, or high blood pressure may also be candidates for gastric bypass surgery (Neff & Roux, 2012).

Gastric bypass surgery is irreversible, but remains one of the safest and most effective weight-loss procedures for people who suffer from severe obesity.

How does Roux-en-Y gastric bypass work?

Gastric bypass surgery reduces the capacity of your stomach so you can feel full sooner and avoid overeating. After this procedure, foods will bypass part of the stomach and small intestine, which reduces the amount of fat and calories absorbed by the body (Hopkins Medicine).

Roux-en-Y gastric bypass surgery (RYGB) involves two main steps: reducing stomach size and re-routing the small intestine. First, your bariatric surgeon uses surgical staples to reduce your stomach pouch to the size of an egg. Then, the surgeon connects the new small stomach pouch to a section of the small intestine to form a “Y” shape. The re-routing of the intestine bypasses the lower section of the stomach and a portion of the small intestine, effectively reducing calorie absorption (University of Illinois Health, 2020).

What are the pros of gastric bypass surgery?

Gastric bypass surgery offers many benefits to those who are severely obese and who need help losing weight. This highly effective form of bariatric surgery can produce rapid, positive results that lower the risk of serious health problems and complications associated with severe obesity, such as stroke and cancer. 

Gastric bypass surgery can also help boost mental and emotional well-being, since losing weight can increase energy and lend to improved confidence and self-esteem.

Increased feelings of satiety and reduced hunger that occur following gastric bypass can often lead to improvements in insulin sensitivity, thereby improving blood glucose control and reducing the risk of type 2 diabetes. It has also been shown to lead to the remission of type 2 diabetes (Cleveland Clinic).

The following are additional benefits associated with gastric bypass surgery.

Gastric bypass surgery offers significant long-term weight-loss results. On average, people who undergo gastric bypass lose more than half of their excess weight following the surgery. Evidence shows that the majority of patients lose between 60 and 80 percent of their excess weight, and maintain a weight loss of more than 50 percent long-term.

Laparoscopic weight-loss procedures like gastric bypass are minimally invasive and offer a faster recovery time compared to open surgery. Many gastric bypass patients spend only two to four days recovering in the hospital following surgery. You may experience mild pain in your abdominal region for about one week following the surgery, which can be treated using over-the-counter pain relievers.

Imbalances in the gut can often impair metabolism and interfere with weight loss, but gastric bypass surgery helps facilitate positive hormonal changes in the gut. Improvements to gut hormones can help lower the risk of weight-related health conditions such as type 2 diabetes, reflux, sleep apnea, heartburn, and high blood pressure. Following Roux-en-Y gastric bypass, levels of the ghrelin hormone are decreased, which may lead to feeling less hungry longer (Korner et al., 2005).

 

What are the risks of gastric bypass surgery?

Gastric bypass surgery comes with its own risks just like any other surgery or medical treatment. One of the greatest risks associated with this surgery is weight regain. By the 10-year mark after surgery, many patients end up gaining back as much as 25 percent of the excess weight they initially lost (Cooper et al., 2015). Weight regain can be prevented by practicing healthy lifestyle behaviors including regular exercise and good nutrition.

Other risks associated with gastric bypass surgery include:

Complications that may stem from gastric bypass surgery include leakage at the sites where the stomach and small intestine were re-routed, shrinkage of openings into the intestine, and gallstones after rapid weight loss (Leyva-Alvizo et al, 2020). Distension of the unused part of the stomach may also occur, though this is rare.

Dumping syndrome is an umbrella term for a group of symptoms that occur when food enters the intestines too quickly before it’s been fully digested. Dumping syndrome is common among people who have had weight-loss surgery — especially for those who continue eating high amounts of sugary, high-fat foods following their procedures. Symptoms of dumping syndrome include nausea, vomiting, bloating, sweating, dizziness, and diarrhea.

The re-routing of the small intestine in Roux-en-Y gastric bypass surgery decreases the body’s absorption of vitamins, minerals, and other important nutrients that promote good overall health (Lewis et al., 2020). Eating a diet made up of foods like high-quality proteins, fruits, and vegetables is even more critical for maintaining good health after gastric bypass surgery. You may need to use nutritional supplements for life following surgery to avoid malnutrition that can stem from a reduced ability to absorb nutrients from food.

What happens during gastric bypass surgery?

Laparoscopic Roux-en-Y gastric bypass surgery takes between two and four hours to complete and is performed under general anesthesia. Your bariatric surgeon will insert a laparoscope — a tiny camera — into your belly in order to easily view and perform the procedure. This approach offers benefits such as smaller, less visible scarring, a shorter hospital stay, a faster recovery, and a reduced risk of infection (Elder & Wolf, 2007).

At the beginning of the surgery, the surgeon makes between four and six cuts in the abdominal region. The surgeon inserts the laparoscope and small surgical instruments into these cuts to perform the procedure, which reduces the level of trauma experienced by the body.

Next, the surgeon uses staples to create a smaller stomach pouch in the upper part of the stomach. This reduces the amount of food you can eat in one sitting. The lower part of the stomach that is no longer being used is known as the “blind” stomach.

The smaller upper stomach pouch is then attached directly to a part of the intestine to bypass the remaining portion of stomach and first part of the small intestine, known as the duodenum.

The narrow tunnel created between the stomach pouch and small intestine helps food stay in the pouch longer, which will help you feel full and satisfied for longer periods of time.

The stomach pouch will be roughly one ounce in volume and limits food intake to approximately one-half cup. Following surgery, you’ll start feeling full with much less food than before, and you will absorb far fewer fats and calories. Reducing your calorie consumption will lead to decreased weight and BMI.

Educational Videos: Gastric Bypass

Video information + transcriptions below. Tap to open and read along with video.
Gastric bypass dramatically reduces the size of the stomach. With a smaller stomach, the patient is physically unable to eat large amounts of food. With less food entering the body, fat stores begin to be used. The patient loses weight. 
– PreOp® Patient Education

How can I prepare for gastric bypass surgery?

Before surgery, your bariatric surgeon may recommend or require you to join a weight-loss or exercise education program so you can prepare for both the procedure and your new lifestyle following surgery. You may need to modify your diet before undergoing surgery to correct any nutritional deficiencies (Kushner et al., 2020). Nutritional counseling may be available to teach you about the healthy foods and supplements you’ll need following surgery and how to modify your diet to exclude foods that are high in calories. A balanced diet of protein, carbohydrates, and fats is important for your health and weight loss. You may also receive a psychological evaluation, along with education that stresses the importance of regular exercise and an active lifestyle for long-term weight-loss results.

If you smoke, stop smoking several weeks before your surgery. Smoking increases the risk of complications during and after surgery, including pneumonia and infection, and slows down your body’s repair and recovery processes (Haskins et al., 2014). Your surgeon may advise you to stop taking certain medications and over-the-counter medicines that increase the risk of blood clots and other complications, such as aspirin, acetaminophen, ibuprofen, warfarin, and vitamin E. Some patients may be asked to lose as much weight as possible through dietary adjustments before gastric bypass surgery to reduce the size of the liver and promote a safer surgery.

Your bariatric surgeon will provide you with a list of detailed pre-op instructions so you can arrive at your appointment fully prepared and ready to experience a safe and successful surgery. Prepare your home for your recovery period by throwing away unhealthy foods high in sugar and fat, and stock up on plenty of approved healthy foods and liquids. Create a comfortable resting place in your bedroom or living room where you can relax and recover from your gastric bypass surgery.

What happens after gastric bypass surgery?

Many gastric bypass patients go home within three to five days after surgery. Your hospital stay may last this long so you can be closely monitored during recovery and treated for any complications that may arise. Your surgeon will allow you to go home when you can freely move around without experiencing severe pain and are able to keep down liquids without vomiting.

Your surgeon will provide you with post-op instructions so you can experience a safe, full recovery from your gastric bypass surgery. For the first few weeks, you’ll be limited to liquids as your stomach adjusts to its smaller size and recovers from surgery. After the liquids phase, you can transition to soft, pureed foods for one or two weeks before moving on to solid foods.

To make the most of your gastric bypass surgery, you must exercise regularly and eat healthy foods to promote weight loss and maintain a healthy weight. Being sedentary and inactive or resuming poor nutrition habits can compromise your procedure and lead to weight regain. Your weight-loss surgeon will work with you to develop an individualized nutrition and fitness plan that works best for you. Your micronutrient levels may be monitored to make sure you have no deficiencies.

Is gastric bypass surgery right for me?

Gastric bypass surgery is generally recommended for those who are severely obese and who have a BMI of 40 of higher, patients with a BMI greater than 40 who have been unsuccessful with nonsurgical approaches, or who have a BMI of at least 35 and also suffer from a weight-related health condition like hypertension or type 2 diabetes (Elder & Wolfe, 2007). If you meet these qualifiers and have tried other weight-loss methods without experiencing long-term results, you may be an ideal candidate for laparoscopic Roux-en-Y gastric bypass surgery.

Use our directory to find a bariatric surgeon in your area ready to guide you safely through your weight-loss journey using laparoscopic Roux-en-Y gastric bypass surgery.

 

Gastric Sleeve

(Laparoscopic Sleeve Gastrectomy Surgery)

What is gastric sleeve surgery?

Also known as gastric sleeve surgery, sleeve gastrectomy is a relatively new procedure that has quickly become one of the most common and popular bariatric surgery options. With this surgery, roughly 75 percent of the stomach is removed to leave behind a narrow gastric sleeve about the size and shape of a banana (Cleveland Clinic). There is no re-routing of the small intestine as with gastric bypass surgery — meaning you can lose weight and still absorb important vitamins and nutrients from the food you eat.

Laparoscopic sleeve gastrectomy surgery is a purely restrictive procedure and does not cause malabsorption. A smaller stomach limits food intake so you can eat less, consume fewer calories, and lose excess weight. This procedure may also help reduce food cravings and hunger, since the portion of the stomach that produces hunger hormones is removed during surgery.

Initially, sleeve gastrectomy was conducted as part of the duodenal switch procedure, where it was combined with gastric bypass surgery for weight loss. Today, sleeve gastrectomy is performed as a standalone weight-loss surgery that helps patients lose weight without causing malabsorption. In some instances with high-risk patients, sleeve gastrectomy is performed as a staging procedure before a duodenal switch.

What happens during laparoscopic sleeve gastrectomy surgery?

Laparoscopic sleeve gastrectomy surgery is performed under general anesthesia. This weight-loss surgery takes between 60 and 90 minutes to perform in most instances, but no longer than two hours (Columbia Surgery).

At the beginning of the sleeve gastrectomy surgery, your bariatric surgeon will make five to six cuts in your abdomen to allow for the insertion of the surgical tools and the laparoscope — a tiny camera that allows your doctor to see and perform the procedure more precisely. Your surgeon will then remove 75 percent of your stomach, leaving behind a smaller stomach pouch or sleeve that resembles a banana and that holds between 1.5 to 5 ounces of food and liquid. The stomach is closed using surgical staples, and you will awaken shortly following the procedure.

This minimally invasive weight-loss surgery results in a short hospital stay of between one and two days. You may experience mild pain and soreness in the abdominal region for a few days following the procedure, which can be treated using over-the-counter pain relievers.

What are the pros of laparoscopic sleeve gastrectomy?

Laparoscopic sleeve gastrectomy is a simple procedure associated with less downtime, quick recovery, less pain, and reduced scarring. A reduced stomach size restricts the amount of food you can eat in one sitting to help you achieve significant weight loss within a short period of time. Sleeve gastrectomy has been shown to help patients lose 40-50 percent of their excess weight within the first two years after surgery.

This is a good option for very obese patients with other diseases, such as cardiovascular disease) who are at risk of prolonged exposure to anesthesia and patients who have been unsuccessful with other approaches (Cleveland Clinic, 2020; Rosenthal et al., 2020).

Additional advantages of laparoscopic sleeve gastrectomy include:

During gastric sleeve surgery, your surgeon removes the portion of the stomach that produces ghrelin — a hormone that stimulates appetite. As a result, you may benefit from fewer hunger pangs and a reduced appetite, which facilitates weight loss. Additionally, the stomach is reduced in size by 75 percent to allow for lasting feelings of fullness with smaller food portions (Columbia Surgery).

Some surgical weight-loss procedures, such as gastric bypass, involve re-routing the small intestine to reduce the body’s absorption of fat and calories. However, this also reduces the body’s absorption of vitamins, minerals, and other important nutrients — increasing the risk of nutritional deficiencies. Gastric sleeve surgery only reduces stomach size to limit food portions, resulting in a lower risk of malnutrition.

Gastric sleeve surgery has been shown to be successful at helping people with a high body mass index (BMI) lose most of their excess weight. More than 75 percent of patients who receive sleeve gastrectomy surgery experience an improvement in weight-related health conditions including type 2 diabetes, obstructive sleep apnea, and high blood pressure. This type of bariatric surgery may also help improve certain food intolerances as your body becomes healthier due to excess weight loss.

Educational Videos: Gastric Sleeve

Video information + transcriptions below. Tap to open and read along with video.
You have about an 85 to 90 percent chance to be successful with gastric sleeve surgery. And, you have minimal chance of developing complications. 
– Yijun Chen, MD UCLA Bariatric Surgery

What are the risks associated with sleeve gastrectomy?

Laparoscopic sleeve gastrectomy surgery comes with its own risks and disadvantages just like any other surgery or medical procedure. Those who choose this weight-loss surgery must understand this procedure is permanent and irreversible.

Some risks and disadvantages associated with sleeve gastrectomy surgery include:

Potential Complications:

Sleeve gastrectomy can lead to possible complications including inflammation in the stomach lining, infection caused by the leaking of food contents from the staple site, injury to other organs, and bowel blockage caused by scarring in the stomach. Some individuals may experience vomiting from eating portions that are larger than the stomach pouch can hold, but this may be prevented by sticking to liquids and pureed foods during the initial weeks following surgery.

Weight Regain:

Gradually increasing your portion intake in the months and years following sleeve gastrectomy surgery can result in your stomach pouch becoming dilated. This behavior compromises your weight-loss surgery by expanding the stomach, which allows you to return to eating larger portions. Poor nutrition habits and lack of exercise may put you at risk for weight regain following gastric sleeve surgery. Working with your doctor and nutritionist will help keep you on track with your weight loss goals.

How should I prepare for sleeve gastrectomy surgery?

Before the date of your surgery, you may have several meetings with your bariatric surgeon to fully prepare for the procedure and for the lifestyle changes you’ll be required to make following surgery. Some bariatric surgeons require patients to receive education about how weight-loss surgery works and what to expect, along with education on the importance of good nutrition and regular exercise following surgery.

Other ways to prepare for laparoscopic sleeve gastrectomy surgery:

  • Inform your doctor of any medications, vitamins, herbs, supplements and other substances you may be using, since these may be dangerous to use before and after surgery
  • If you smoke, stop smoking as soon as possible, since smoking can delay healing and interfere with recovery
  • Start eating healthier foods to prepare your body for a lifetime of healthy eating after surgery
  • Remove all unhealthy foods from your home, such as junk foods and frozen TV dinners
  • Stock your kitchen with healthy foods and drinks, including approved liquids and pureed foods
  • Create a comfortable spot in your home where you can relax and recover following surgery
  • Join a support group, either online or in person, to keep you on track (Cleveland Clinic, 2020)
  • Work to maintain a positive attitude without turning to unhealthy food
  • Avoid drinking too much alcohol before and after surgery (Penn Medicine, 2015)

Your doctor will give you a list of pre-op instructions so you can arrive at your appointment prepared and ready to experience a safe and successful sleeve gastrectomy.

What happens after sleeve gastrectomy surgery?

Following surgery, your doctor will provide you with detailed post-op instructions on how to care for your incisions and what to eat once you get home. Eating the wrong types of foods or eating too quickly can interfere with the healing of your stomach and overall recovery. In most instances, your surgeon will advise consuming only liquids for the first week, followed by soft and pureed foods for two weeks, before moving onto small portions of solid foods.

Sleeve gastrectomy surgery reduces the size of the stomach — meaning you must adhere to a healthy nutrition plan since your portion sizes will be significantly smaller. A smaller stomach can help you achieve long-term weight loss, but only if you’re eating healthy foods like fruits, vegetables, and high-quality sources of lean protein. A diet made up of foods high in sugar and fat such as pastries, desserts, fried foods, and fast foods will not promote healthy weight loss even if you’ve had weight-loss surgery.

In addition to improving your nutrition, you must also make a series of healthy lifestyle and behavioral changes to get the most out of your surgical weight-loss procedure, such as:

  • Chewing food more slowly and thoroughly before swallowing
  • Greatly reducing food and drink portions
  • Consuming higher amounts of nutritious foods
  • Drinking more water and healthy fluids throughout the day
  • Consuming foods and drinks separately
  • Taking daily nutritional supplements to maintain optimal health
  • Exercising regularly to promote and sustain weight loss
  • Creating a support group to keep you on track

Weight gain and weight loss affect everyone differently. Results from sleeve gastrectomy surgery may vary for each individual, as patients are responsible for maintaining good nutrition and exercising regularly following the procedure. Some individuals may experience rapid weight loss after surgery, while others may lose weight at a slower, more gradual pace. Adhering to your surgeon’s instructions and recommendations can help you experience the best possible outcome following gastric sleeve surgery.

Is laparoscopic sleeve gastrectomy surgery right for me?

Laparoscopic sleeve gastrectomy surgery may be ideal for you if you have a BMI greater than or equal to 40 without any associated comorbidities. This surgery is also effective when used as a staged procedure before another weight-loss surgery for patients who have a BMI of 50 or greater. If your BMI is between 35 and 40 and you have tried other weight-loss methods without experiencing long-term results, sleeve gastrectomy surgery may be ideal for you. Laparoscopic sleeve gastrectomy may also be a good option if you are obese and have other underlying medical conditions, such as type 2 diabetes or heart disease (Wolfe et al., 2017; Mechanick et al., 2013). 

Gastric sleeve surgery reduces the size of your stomach without changing the way your stomach and intestines function, and allows you to continue absorbing vital minerals and nutrients from the foods you eat. This procedure has been proven effective at treating high-risk patients who may suffer from Crohn’s disease or anemia in addition to obesity.

Use our search directory to find bariatric surgeons in your area who can help you achieve your weight-loss goals using laparoscopic sleeve gastrectomy surgery.

Adjustable Gastric Banding

(Laparoscopic Gastric Banding)

What is a gastric band?

Laparoscopic gastric banding surgery is a restrictive weight-loss procedure in which a band is placed around the upper portion of the stomach to help limit portion sizes. Gastric banding surgery helps you feel full with less food, so you can consume fewer calories and lose excess weight.

Commonly known under the popular brand names LAP-BAND and Realize Band, a adjustable gastric band is a soft, adjustable silicone band or ring that is placed around the upper portion of the stomach (Columbia Surgery). This separates the stomach into two different chambers: a small upper stomach and the remaining lower part of the stomach. The purpose of the adjustable gastric band is to limit food intake and slow the passing of food to the lower part of the stomach and digestive tract. This allows you to stay full for longer periods of time while consuming less food.

The adjustable gastric band has a small, narrow tube that connects to an access point just below your skin on the abdominal wall. Using this port, your bariatric surgeon can adjust the band at any time to increase or decrease the size of your stomach pouch, and to accommodate health conditions such as pregnancy. A fuller band creates a smaller stomach pouch that reduces food intake and slows the emptying of food into the lower part of the stomach. In the weeks, months, and years following gastric banding surgery, you may need to visit your doctor regularly to have the band adjusted as you gradually work toward achieving your weight-loss goals.

What happens during laparoscopic gastric banding surgery?

Laparoscopic gastric banding surgery is performed under general anesthesia, and takes between 30 minutes and one hour to complete.

Your bariatric surgeon begins by making five or six incisions on your abdomen to allow for the insertion of the laparoscope and other small surgical tools used to perform the procedure. The laparoscope is a tiny camera that helps your surgeon gain a better view of the inside of your stomach and perform a precise surgery. Your surgeon then places a small silicone gastric band around the upper part of your stomach to create a small stomach pouch, and attaches the gastric band to an access port on your abdominal wall.

The band will be deflated at the time of surgery, as your stomach will need time to heal before receiving the first fill. During future appointments with your surgeon, the band will be filled to reduce your stomach size as needed.

What are the advantages of gastric banding surgery?

Gastric banding surgery is an evidence-based weight-loss procedure designed to help you lose weight by reducing the amount of food you can eat at one time.

This procedure is less invasive than other bariatric procedures (Columbia Surgery). In many cases, you can go home the same day as the procedure and avoid a hospital stay.

Additional benefits of laparoscopic gastric banding include:

Weight Loss:

People who receive gastric banding surgery lose an average of  one-third to one-half of their excess weight. Weight loss with the gastric band usually happens more gradually than other surgical weight-loss procedures, as there is no removal of any portion of the stomach or re-routing of intestines to trigger rapid weight-loss results. On average, people who undergo gastric banding surgery continue losing weight for the following three years.

Less Invasive:

Laparoscopic gastric banding surgery is less invasive than many other weight-loss surgeries. Gastric banding is completely reversible and doesn’t involve removal or re-routing of any organs involved in the digestive process.

People who need the gastric band removed due to certain medical conditions or for personal reasons can do so without facing serious risks or complications. This bariatric procedure has been found to be a safe and effective method of weight loss at the 3-year follow-up.

Adjustable for Your Personal Weight-loss Needs:

A major benefit of gastric banding surgery is having the option to adjust the band based on your personal health and weight-loss needs. For instance, if you feel that your gastric band is no longer helping you stay full or lose weight, you can visit your bariatric surgeon to have the band filled with more saline fluid.

Women who have the gastric band and who become pregnant can have their bands deflated so they can eat more food and experience a healthier, more comfortable pregnancy.surgery

Educational Videos: Gastric Banding

Video information + transcriptions below. Tap to open and read along with video.
The Lap-Band System … is a much more natural, much safer way of losing weight. 
– John Dixon, MBBS, PhD Expert on obesity and bariatric surgery

What are the risks and disadvantages of gastric banding surgery?

Laparoscopic gastric banding surgery comes with its own risks, just like any other surgery or medical procedure. You can greatly reduce your risk of complications by following your doctor’s pre- and post-op instructions, such as quitting smoking and exercising regularly.

Short-term complications are not common with this surgery, but the long-term complications rate is higher (Columbia Surgery). Many patients have to undergo additional surgeries (Ellsmere et al.; Seeras et al., 2020).

Some of the risks and disadvantages associated with gastric banding surgery include:

Potential Complications:

Risks of anesthesia and any surgery include nausea, vomiting, infection, blood clots that may travel to lungs, heart attack, stroke, respiratory complications, neurologic complications, hypothermia, and pain and the site of operation (Thompson et al., 2011; Sun et al., 2015). Risks and potential complications specific to laparoscopic gastric banding surgery include slipping of the stomach through the band, gastritis, infection at the port site, and scarring in the belly, which can cause bowel blockage. You may experience vomiting if you eat portions of food larger than the stomach pouch can hold.

Weight Regain:

Risks of anesthesia and any surgery include infection, blood clots that may travel to lungs, heart attack, and stroke. Risks and potential complications specific to laparoscopic gastric banding surgery include slipping of the stomach through the band, gastritis, infection at the port site, and scarring in the belly, which can cause bowel blockage. You may experience vomiting if you eat portions of food larger than the stomach pouch can hold.

Major Lifestyle Changes:

Risks of anesthesia and any surgery include infection, blood clots that may travel to lungs, heart attack, and stroke. Risks and potential complications specific to laparoscopic gastric banding surgery include slipping of the stomach through the band, gastritis, infection at the port site, and scarring in the belly, which can cause bowel blockage. You may experience vomiting if you eat portions of food larger than the stomach pouch can hold.

Weight regain

Around 40-60 percent of weight loss has been reported for this bariatric procedure. The extent of weight loss is largely dependent on how well the patient follows their doctor’s recommendations (Columbia Surgery). Your doctor or nutritionist might suggest tracking your food intake. You may need to chew food more slowly to avoid vomiting.

Major Lifestyle Changes

You may need to make substantial changes to your diet. Eating sugary or high-calorie foods may lead to weight regain. You may need to start cooking or start buying healthy foods at the grocery store. You may not be able to drink soft drinks or eat the same quantity of food as before. In addition, you will need to maintain a healthy lifestyle—this may mean starting an exercise program or reducing time spent sitting.

How can I prepare for laparoscopic gastric banding surgery?

Weight-loss surgery requires you to make lifelong commitments and healthy changes surrounding your diet and exercise regimen. Nutrition counseling and education may be offered at your weight-loss clinic so you can learn how to lead a healthy lifestyle following laparoscopic gastric banding surgery. Your bariatric surgeon will give you detailed pre-op instructions, including information on when you can eat and drink before surgery.

How to prepare for laparoscopic gastric banding:

  • Inform your surgeon about any medications, herbs, vitamins, supplements, and other substances you may be using, since these can interfere with anesthesia and surgery.
  • Start eating healthier foods to prepare your body for surgery and for life after surgery.
  • Start chewing and eating your food more slowly, since this is required for your smaller post-surgery stomach.
  • If you smoke, quit smoking at least 30 days before your gastric banding surgery, as smoking increases the risk of surgery-related complications and delays the body’s healing processes.
  • Start exercising regularly to lose as much excess weight as possible before surgery, which helps lower the risk of complications during surgery.
  • Replace unhealthy foods in your kitchen with healthy counterparts and foods approved for post-surgery eating, such as chicken broth and vegetables that can be pureed.
  • Prepare your bedroom or living room for post-op recovery, and place essentials nearby so you can relax without having to move around excessively.
  • Make childcare or pet arrangements as necessary for the days you’ll be having and recovering from your laparoscopic gastric banding surgery.

Don’t hesitate to ask your bariatric surgeon any other questions you may have about preparing for surgery, since doing so can reduce your risk of complications and promote a smooth recovery.

What happens after laparoscopic gastric banding surgery?

A key advantage of laparoscopic gastric banding is the ability to visit your bariatric surgeon any time to have the band adjusted, or “filled.” Your first band fill will take place about six weeks following surgery, after your stomach has completely healed. Following the first fill, you can have your gastric band adjusted between four and six times per year. Regular appointments with your bariatric surgeon can promote weight loss, and can help ensure the band isn’t too tight to the point it causes discomfort or interferes with your ability to perform everyday tasks. A band that is too tight can lead to excessive vomiting (Kushner et al., 2019).

Following gastric banding surgery, you’ll need to eat small portions of healthy foods that promote weight loss and overall nutrition. Eggs, beans, and fish are just some foods that can be consumed in small portions and that can help you stay full and energetic. Your bariatric surgeon will also recommend that you exercise regularly to enhance the effects of the gastric band and to keep weight off long-term after reaching your goal weight.

Keep track of the foods and portions you eat and whether they cause discomfort so you can avoid certain foods that cause negative reactions. Chew and eat your food slowly and thoroughly to avoid overeating, since your stomach pouch will be much smaller than before. Don’t hesitate to contact your bariatric surgeon if at any time you feel something is wrong with the gastric band, or you experience discomfort when eating.

Is laparoscopic gastric banding surgery right for me?

Laparoscopic gastric banding surgery may be ideal for you if your body mass index (BMI) is 40 or higher, or 35 or higher with health conditions that can be improved with weight loss, including type 2 diabetes, high blood pressure, and sleep apnea. This type of bariatric surgery is also ideal if you’re severely obese, or have tried other weight-loss methods that haven’t led to long-term results.

Use our search directory to find a bariatric surgeon near you who can help you lose weight using laparoscopic gastric banding surgery. A bariatric surgeon can determine whether you’re an ideal candidate for this procedure, or recommend other weight-loss solutions that work best for you.

Lap-Band’s drastic decline in popularity

Why you may want to consider gastric sleeve surgery instead of the Lap-Band — or even have your Lap-Band removed

Lap-Band surgery, or gastric banding, has been one of the most popular forms of weight-loss surgery since it was introduced in 2001. In recent years, however, popularity of gastric banding procedures has been sharply declining.

As more information has emerged from long-term studies, gastric banding has been revealed to be associated with serious complications that make it inferior to procedures such as gastric sleeve (O’Brien & Dixon, 2004). Many people who have had Lap-Bands placed in the past are now choosing to have them removed.

What does the new data show about Lap-Band surgery, and is it still recommended for weight loss? If you already have a Lap-Band, should you consider having it removed?

History of the Lap-Band

The Lap-Band was approved by the FDA for weight-loss surgery in 2001. Much of the appeal of the Lap-Band stemmed from 2 key features: it’s adjustable, and unlike other forms of bariatric surgery, it’s reversible.

Gastric banding is also considered a minimally invasive procedure that can be performed laparoscopically. Unlike gastric bypass or gastric sleeve, it doesn’t involve cutting into the stomach or rerouting the intestines. Micronutrient deficiencies are not common after this procedure (Kushner et al., 2020)

The ease of the procedure and claims of relative safety drew many people to gastric banding. It appeared to be a simple solution to the often-frustrating process of weight loss.

As recently as 2011, the number of Lap-Band surgeries performed was on par with gastric bypass. But recent, longer-term research has revealed that gastric banding can lead to significant complications, and that other forms of weight-loss surgery lead to better success rates and fewer complications.

The Lap-Band’s popularity has been in steady decline since 2011, and in 2018 it accounted for only 1% of weight-loss surgeries (ASMBS).

Gastric sleeve surgery is now the most popular, accounting for close to 61% of surgeries, while gastric bypass — the “gold standard” of weight-loss surgery — accounts for roughly 17%.

How weight-loss surgeries work

There are 3 primary categories of weight-loss surgery:

  1. Restrictive procedures, which restrict how much food you can eat
  2. Malabsorptive procedures, which change the way your body absorbs calories
  3. Combination procedures, which have elements of both

How the Lap-Band works

Gastric banding is a restrictive procedure. The Lap-Band involves inserting a silicone band around the upper portion of the stomach to help create a feeling of fullness. The band can be “filled” or “unfilled” to help control the amount of restriction it delivers. Saline is inserted or removed through a port on the side of the abdomen to adjust the fit of the band.

How gastric sleeve works

Sleeve gastrectomy, or gastric sleeve, is also a restrictive procedure. With gastric sleeve surgery, roughly 75 percent of the stomach is removed, creating a narrow sleeve roughly the size and shape of a banana. This smaller stomach limits the amount of food that can be eaten, so patients eat less and consume fewer calories. Gastric sleeve also helps reduce food cravings and hunger, as the surgeon removes the portion of the stomach that produces ghrelin — a hormone that stimulates appetite.

How gastric bypass works

Gastric bypass is both physically restrictive and malabsorptive. The purpose of gastric bypass surgery is twofold: reduce the amount of food the patient can eat, and reduce the amount of fat and calories the body absorbs from food (Yehoshua et al., 2008; Korner & Liebel, 2003; Ionut et al., 2013).

In a gastric bypass surgery, the stomach size is reduced, and the small intestine is rerouted to bypass the lower section of the stomach and a portion of the small intestine, effectively reducing calorie absorption.

Other forms of bariatric surgery include biliopancreatic diversion and gastric balloon surgery.

The darker side of the Lap-Band

All forms of weight-loss surgery pose certain risks, but the presence of the band around the upper portion of the stomach can lead to certain risks and complications that are unique to gastric banding.

Potential side effects of the Lap-Band include:

  • Abdominal pain or pain when eating
  • Band slippage, which occurs when the band slips out of the correct place.
  • Band slippage can lead to complications such as vomiting, gastric perforation, and acid reflux.
  • Infection at the port or band site, which may require removal of the device. A new device can then be implanted to replace it.
  • Band intolerance, which can lead to excessive scar tissue formation and prolapse of part of the stomach, as well as nausea, vomiting, and reflux (Png et al., 2013; Gagner et al., 2013)
  • Band erosion, which occurs when the band erodes through the outer stomach wall.

Lap-Band patients may also require heartburn medication, which can have an effect on bone density, and they may be at risk of long-term effects of malnutrition caused by a limited diet.

Lap-Band and disordered eating

The makers of the Lap-Band claim that it encourages healthier eating habits, but does it?

Perhaps not surprisingly, the Lap-Band can contribute to disordered eating. To relieve the pressure caused by the band, some Lap-Band patients deliberately vomit after eating. Many others will continue to primarily eat high-glycemic foods such as crackers and bowls of cereal, because fiber-rich foods like raw vegetables or greens are painful to digest.

Some people will purposely keep the band overfilled to make it harder to eat, despite the pain it causes. In these cases, rather than promoting healthier habits, the device becomes a crutch that will quit working if it ever needs to be removed.

The Lap-Band and hunger

Another drawback of the Lap-Band is that it does not produce any physiological or hormonal changes that help reduce hunger. Patients still feel the same level of hunger as before, but are unable to eat as much.

People often find ways to compensate, such as drinking more calories. Lap-Band patients often learn which high-calorie foods can easily slip through the narrow stomach opening. They may respond to hunger and cravings with foods such as high-calorie milk shakes and mashed potatoes, ultimately impeding their weight-loss efforts.

Revisional surgery is common after Lap-Band

Emerging studies have shown that a number of Lap-Band patients have required additional surgeries after having their band inserted.

These additional surgeries may involve removing the band, replacing it, correcting band erosion, or a revisional surgery, which involves following the initial procedures with another type of weight-loss surgery, such as gastric bypass.

In a 2017 study that demonstrates just how problematic gastric banding can be, researchers looked at 16 years of data from 25,000 patients to determine how common additional surgeries were after the initial Lap-Band operation. They found that 20% of the Lap-Band patients required an additional operation.

That’s far higher than re-operation rates for gastric bypass and gastric sleeve, which fall between 3 and 9 percent.

Many patients had more than one follow-up surgery. In fact, the average number of surgeries per patient was 3.8 (Ibrahim et al., 2017).

Inferior weight loss compared to other surgeries

Long-term success rates with the Lap-Band are also inferior to other forms of weight-loss surgery. A 2016 study found that Lap-Band patients lost significantly less weight than those who underwent gastric sleeve or gastric bypass.

After 4 years, gastric bypass patients had lost 28 percent of their original body weight and gastric sleeve patients lost 18 percent. But Lap-Band patients lost only 10 percent.

Those numbers make it hard to justify the risks involved with gastric banding, and explain why many doctors no longer recommend gastric banding to their patients. Fewer patients are asking for the device, and fewer doctors are recommending it.

Be aware of the risks

If you’re considering Lap-Band surgery, it’s important to do your research and be aware of the potential risks and complications.

Also be aware that having the band removed could come with a hefty price tag that insurance may not cover unless it’s medically necessary.

Talk to a bariatric surgeon to determine the best approach for your unique situation. A bariatric surgeon will be able to provide you with options for safe, evidence-based weight-loss procedures designed to help you reach and maintain your goal weight.

Gastric Balloon

(Intragastric balloon weight-loss procedure)

What is a gastric balloon?

The gastric balloon is a non-surgical weight-loss procedure that reduces the size of your stomach so you can feel full while eating smaller portions and consuming fewer calories. The gastric balloon itself is a medical device inserted into the stomach via the mouth and esophagus, and then inflated to take up room in the stomach. This helps patients experience a lasting feeling of fullness after eating smaller food portions.

Many people who use the gastric balloon lose between 20 and 30 percent of their excess weight during the first six months. After the six-month mark, many gastric balloon patients go on to lose up to 51 percent of their excess weight. The gastric balloon may be right for you if you’ve tried other weight-loss programs without experiencing long-term success, and if you want an effective, proven non-surgical solution for weight loss.

Several brands are available for gastric balloons, but the brands most commonly used are the Orbera Intragastric Balloon, the ReShape Duo, the Obalon Gastric Balloon, the Spatz balloon, and the Elipse balloon (Kim et al., 2016). If you’re not sure which gastric balloon is right for you, your doctor and medical team can offer professional recommendations and help you choose a device.

What happens during the gastric balloon procedure?

Before your doctor inserts the gastric balloon into your stomach, you will be mildly sedated to reduce any related discomfort. After you are sedated, your doctor will use a thin, flexible tube called an endoscope to insert a deflated silicone balloon into your stomach via the esophagus. The endoscope has a light and camera on the end, which allows your doctor to see inside your stomach and perform the procedure safely and precisely.

After the balloon is inserted into your stomach, your doctor fills the balloon with air or a safe, sterile saline solution to inflate the balloon to roughly the size of a grapefruit. This reduces the amount of room in your stomach available for food. Some doctors use a gastric balloon pill capsule that has a fine, thin tube attached. Patients swallow the capsule, and the doctor inflates the balloon using the tube, which is then safely pulled out of the stomach via the esophagus. No sedation is necessary for the insertion of the gastric balloon in capsule pill form.

The gastric balloon procedure is performed as an outpatient service and usually takes only between 15 and 30 minutes to complete. There is no surgery involved, and no need for incisions for the placement of the balloon. Two hours after your  endoscopic procedure, you can return to the comfort of your home to experience a speedy recovery.

Some balloons are also removed after a period of time. For example, the Orbera balloon is kept in place for 6 months, at which point it is removed via endoscope (Kim et al., 2016).

What are the advantages of gastric balloons?

One of the main advantages of the gastric balloon is that this procedure is non-surgical, meaning you can enjoy the benefits of having a smaller stomach without having to care for incisions, developing scars, or worrying about serious complications. This procedure can effectively complement healthy eating and regular exercise to help you achieve weight loss.

Other advantages of the gastric balloon procedure include: 

The gastric balloon is a non-invasive medical procedure that does not involve incisions, the removal of tissue, or the rerouting of the digestive tract. People who have the gastric balloon procedure can reduce the size of their stomachs without anesthesia or downtime, and without facing the side effects and complications associated with surgical weight loss. Patients can return home the same day of the procedure without hospitalization.

Weight-loss surgery options like gastric bypass and sleeve gastrectomy involve the permanent removal of stomach tissue. The gastric balloon is a temporary weight-loss device that can be removed after six months or at any time per your discretion.

The gastric balloon has been shown to help people lose patients lost 6 percent of total body weight one month after balloon placement (Armijo et al., 2019). Patients ultimately lose approximately 10 percent of excess body weight (Courcoulas et al., 2017). This medical device contributes to relatively fast weight loss so you can start losing weight much sooner than with many other weight-loss methods.

The gastric balloon has been shown to be more effective than conventional surgical procedures and offers fewer risks. Most people who choose this weight-loss option do not experience complications. Weight-loss surgery, on the other hand, comes with risks that include infection, malnutrition, and obstruction of the bowel or stomach.

In addition to helping you shed excess weight, the gastric balloon may help improve weight-related health conditions including heart disease, hypertension, type 2 diabetes, and obstructive sleep apnea. These conditions will gradually improve as you continue losing weight with the gastric balloon.

The gastric balloon does not require you to undergo surgery, anesthesia, or hospitalization, and is less costly compared to many other weight-loss procedures. The cost of the gastric balloon ranges between $6,000 and $9,000, while many bariatric surgeries range between $15,000 and $25,000, or higher (NIH & NIDDK). Many weight-loss practices offer financing options to help people who want the gastric balloon and can’t pay the full cost upfront.

Educational Videos: Gastric Balloon

Video information + transcriptions below. Tap to open and read along with video.
There’s no surgical incision and there’s no recovery period involved with the gastric balloon. So there’s no pain. The patient can return to work or regular activities the following day. 
– Dr. Keith Wright South Texas Surgeons

What are risks associated with the gastric balloon?

As with any other medical procedure, the gastric balloon comes with its own risks and disadvantages. Take these factors into consideration when choosing the gastric balloon.

You may experience mild pain and discomfort during the insertion and removal of the gastric balloon, though sedation may help reduce these feelings. Some people experience discomfort for the first few days after the procedure, accompanied by nausea and vomiting. However, these symptoms will go away on their own as your body and stomach adjust to the presence of the gastric balloon.

 

During the insertion and removal of the gastric balloon, there is a risk of perforation or bleeding in the esophagus and/or stomach. Other complications associated with the gastric balloon include abdominal or back pain, reflux, a heavy feeling in the abdomen, and indigestion. In rare instances, the gastric balloon may leak or deflate on its own. This may also happen to those who do not have their gastric balloons removed or replaced every six months.

 

The gastric balloon can be used as a weight-loss tool, but cannot trigger significant weight loss on its own without your help, commitment, and dedication to living a healthier lifestyle. Additionally, this weight-loss procedure isn’t permanent — meaning at some point the balloon will be removed, and you’ll have to rely on optimal nutrition and physical activity to keep off the excess weight you initially lose with the gastric balloon.

How can I prepare for my gastric balloon procedure?

Prior to your gastric balloon procedure, your doctor will work with you to develop a healthy nutrition plan you must follow in order to safely facilitate weight loss using this medical device. Before your procedure, clean out your kitchen pantry and refrigerator, and stock up on healthy foods and liquids approved by your doctor.

Ask your doctor when you should stop consuming foods and liquids before the procedure, since your stomach should be completely empty for the insertion of gastric balloon. You may also want to make childcare arrangements if necessary, and arrange to be driven to and from the procedure since mild sedation and discomfort may interfere with your ability to drive safely. Your doctor will give you a detailed list of ways to prepare beforehand so you can experience a safe procedure and fast recovery.

What happens after my gastric balloon procedure?

After the insertion of the gastric balloon, you will start feeling full sooner after eating smaller amounts of food.

Following the procedure, you’ll be required to practice healthy eating habits and exercise regularly. For the first two weeks, you’ll be limited to liquids only as your stomach adjusts to the presence of the device. After two weeks, you can start eating soft, moist, pureed foods such as applesauce and ground meats. Beginning at week five and beyond, your diet should consist of a healthy balance of proteins, fruits, vegetables, and other nutritious foods that help promote weight loss.

Six months after the insertion of the gastric balloon, you must have the balloon removed to prevent the device from deflating or deteriorating while in your stomach. Prior to removal, the gastric balloon is deflated, then removed from your stomach using the same tiny endoscopic tube your doctor used for the insertion of the balloon. You may either decide to have the balloon replaced, or continue on your weight-loss journey without the balloon. Keep in mind that your stomach will return to its normal shape and size following the removal of the gastric balloon.

Am I an ideal candidate for the gastric balloon?

The gastric balloon is primarily used to help people achieve modest weight reduction, and is most ideal for people who have a body mass index (BMI) higher than 35. People who have a BMI of at least 30 may also qualify for the gastric balloon if they suffer one or more weight-related health conditions, including high blood pressure, type 2 diabetes, and sleep apnea. You may be an ideal candidate for the gastric balloon if you have a qualifying BMI, and if you have tried other weight-loss methods without experiencing long-term results.

Use our search directory to find a doctor near you who offers the gastric balloon for weight loss. A bariatric surgeon can evaluate your overall health and determine whether you can benefit from the gastric balloon or another safe, proven weight-loss procedure.

AspireAssist

What is an AspireAssist?

AspireAssist is a minimally invasive, non-permanent weight-loss procedure that reduces calorie absorption, allowing patients to lose weight and improve weight-related health conditions.

This reversible procedure is ideal for those who want to experience moderate to significant weight loss without removal of any part of the stomach or re-routing of the intestine.

Evidence shows that AspireAssist can help patients lose up to three times more weight than they can just with diet and exercise alone.

How does AspireAssist work?

AspireAssist is a system that allows you to remove 30 percent of your stomach contents after every meal to reduce the body’s calorie absorption. A small incision is made in the abdomen for the insertion of a tube and small disk-shaped valve. The tube connects the stomach to the valve, which is connected to an access port on the outside of the abdomen.

Twenty minutes after a meal, the patient connects a device to the access port and empties a portion of the stomach contents into a toilet, while the remaining food is digested normally.

This reduction in the amount of food digested can help patients lose weight at a steady, consistent pace when combined with good nutrition and regular exercise. For the AspireAssist to work optimally, you must chew your food slowly, thoroughly, and mindfully to prevent overeating, and to allow for proper digestion. Chewing food thoroughly also helps contents pass more easily into the tube for removal after you are finished eating.

This rendering provided by Aspire Bariatrics, Inc. demonstrates the use of the AspireAssist weight loss device, approved by the Food and Drug Administration on Tuesday, June 14, 2016. The AspireAssist system consists of a thin tube implanted in the stomach, connecting to an outside port on the skin of the belly, which itself is connected to an external device, which helps remove nearly a third of the food stored in the stomach before calories are absorbed into the body, causing weight loss. (Aspire Bariatrics, Inc. via AP)

What are the benefits of AspireAssist?

AspireAssist is an FDA-approved medical device for use in weight-loss treatment for patients who are 22 and older and obese. The AspireAssist offers several advantages to help you achieve your weight-loss goals.

People using AspireAssist have been shown to lose more than 12 percent of their original body weight within the first year of using the device, which is more favorable than the average 3.6 percent of body weight lost with just weight counseling on its own. Those who are severely obese may lose over 100 pounds with the AspireAssist. Results will vary based on your food choices, portion sizes, and physical activity level.

This weight-loss procedure is completely reversible and does not reroute the intestines or remove a portion of the stomach. This minimally invasive surgery requires your surgeon to make one tiny cut on your abdomen for the insertion of the tube and valve. If you decide later on that you want the AspireAssist removed, your doctor can remove the tube and valve and facilitate proper healing of your stomach and abdomen.

 

Nutrition will be more important than ever with the AspireAssist, as your body will be absorbing fewer calories. The food choices you make must be highly nutrient-dense so you can benefit from a higher level of vitamins and minerals that sustain your energy and help prevent nutrient deficiencies. The AspireAssist can help you ease into improved nutrition and food choices as you benefit from weight loss.

Educational Videos: AspireAssist

Video information + transcriptions below. Tap to open and read along with video.
The most unique thing about this procedure is, it takes away the element of deprivation. Patients who use the AspireAssist device tell us that they’re able to enjoy food the way they have always eaten. Little by little, they improve their eating habits without feeling deprived. 
– Dr. Vafa Shayani Bariatric Institute Greater Chicago

What are the risks and drawbacks of AspireAssist?

Every weight-loss system comes with its own risks and drawbacks — especially since there is no one-size-fits-all solution that works for everyone when it comes to losing weight.

The potential risks and disadvantages associated with the AspireAssist include:

The most common side effects of the AspireAssist are skin irritation around the button site and abdominal discomfort following the procedure. Potential complications include herniation, infection, and ulceration, which may be treated using medications or by removing or replacing the tube. Though the AspireAssist is minimally invasive, this procedure may cause side effects and complications just like any other weight-loss surgery.

The AspireAssist requires you to chew food into small pieces that can be aspirated in five to 10 minutes without clogging the tube. Approximately 30 percent of your stomach contents can be emptied into a toilet. People who use this weight-loss method are urged to aspirate three times per day every day, approximately 20 to 30 minutes after completing their meal, to achieve the best weight-loss results. You’ll also be required to meet with your doctor regularly for monitoring and checkups, and to discuss your weight-loss progress.

After your AspireAssist procedure, you must chew your food slowly and carefully before swallowing to control your portion intake. You will also work with a nutrition counselor to develop a healthy meal plan that delivers an adequate amount of vitamins, minerals, and other important nutrients. Because the AspireAssist limits calorie absorption, you will need to use nutritional supplements to reduce the risk of nutritional deficiencies. You may need to modify the aspiration time depending on the type of food you consume. 

As you lose weight with the AspireAssist, you must visit your doctor as often as needed to have the tube shortened, which may be inconvenient for some people. Additionally, the medical device will lock up and stop working after 115 aspiration sessions, which is normally between five and six weeks if you aspirate three times per day. This requires you to visit your doctor regularly for replacement parts. The regular maintenance involved with the AspireAssist may not work for those who have extremely busy lifestyles.

What happens during the AspireAssist procedure?

Patients are given mild anesthesia so they can be sedated for the entirety of the procedure, which takes roughly 15 minutes to complete in an outpatient setting. After you are sedated, your doctor makes a tiny incision on your abdomen for the insertion of the tube and valve that make up the AspireAssist weight-loss system. Many patients are able to return home within one to two hours following the procedure, and require very little downtime from work and other activities.

What happens after I have the AspireAssist procedure?

Chewing your food slowly and thoroughly is critical to making the AspireAssist work, since food particles must be small enough to pass through the tubing during aspiration. You must aspirate 20 to 30 minutes after every meal, three times per day, to experience the best possible weight-loss results.

The AspireAssist is combined with lifestyle counseling to help you adjust to a healthier lifestyle that involves improved nutrition, smaller portion sizes, and regular exercise. You’ll be meeting with your lifestyle counselor and doctor regularly to discuss your weight-loss goals and progress, and to make changes to your nutrition and fitness regimens as needed to promote further weight loss.

The lifestyle counseling that is paired with the AspireAssist weight-loss system can provide you with the education, support, and motivation you need to continue losing weight long after you stop using the system. Lifestyle counseling may also help you overcome certain emotional and situational triggers that can lead to overeating, such as stress and spending time around family members who demonstrate poor nutrition. Identifying and learning how to manage these triggers can help you avoid situations that lead to unhealthy food choices and overeating.

How can I make the most out of my AspireAssist procedure?

The AspireAssist may help you reach your weight-loss goals, but is not to be viewed as a cure for weight loss. To get the most out of the AspireAssist, you must stay active, exercise regularly, and make healthy food choices that drive weight loss. As you lose weight, you can reduce the number of times you aspirate per day and eventually have the device removed completely.

Use the tips provided by your doctor and lifestyle counselor to seamlessly incorporate the AspireAssist into your day-to-day routine. Having a solid routine that works great for you can make you feel more confident about using the AspireAssist for weight loss. Making regular appointments with your doctor and lifestyle counselor can help you stay motivated to maintain long-term weight loss (AspireAssist, 2016).

Am I an ideal candidate for AspireAssist?

The AspireAssist weight-loss procedure is ideal for those who are aged 22 years or older and have a body mass index (BMI) of at least 35. This weight-loss system is intended for long-term use combined with lifestyle counseling and ongoing medical monitoring, which means ideal candidates must be willing to attend regular appointments for the maintenance of the AspireAssist and to receive continuous medical care and support.

The AspireAssist may not be right for you if you have medical conditions such as anemia, blood clotting disorders, disorders that interfere with swallowing and digestion, or an eating disorder like bulimia or binge eating disorder.

Use our search directory to find a bariatric surgeon near you who can help you lose weight using the AspireAssist. A doctor can help you determine whether you’re an ideal candidate for AspireAssist or another evidence-based weight-loss procedure that can help you achieve your weight-loss goals.

Endoscopic Sleeve Gastroplasty

What is endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty is a non-surgical alternative to vertical sleeve gastrectomy. This minimally invasive weight-loss procedure reduces your stomach to the size and shape of a banana just like sleeve gastrectomy, but uses staples to reduce the size of the stomach instead of relying on tissue removal.

Endoscopic sleeve gastroplasty is ideal for those who have a BMI between 30 and 35 and who want to experience significant weight loss without surgery.

Endoscopic sleeve gastroplasty is performed as an outpatient procedure, which means you can go home the same day you have surgery. General anesthesia is used so you can remain unconscious during the procedure without feeling any pain. This weight-loss procedure usually takes roughly 45 minutes to perform, after which you will wake up in a recovery room where medical staff will check your vitals and monitor you for complications.

Your bariatric surgeon begins by inserting an endoscope into your stomach via the esophagus. The endoscope is a long, thin, flexible tube with a camera and suturing device attached. The doctor will use the endoscope to see the inside of your stomach, and to make approximately 12 sutures inside the stomach. Because the procedure is performed with an endoscope, your surgeon will not need to make incisions on your abdomen.

After your doctor has sutured your stomach, the stitches will be pulled tight to constrict the stomach and turn it into a smaller pouch roughly 30 percent of its normal size.

Endoscopic sleeve gastroplasty can help you achieve weight-loss results similar to those produced by sleeve gastrectomy, but is far less invasive in that it doesn’t involve the permanent removal of stomach tissue. This significantly reduces the risk of complications associated with bariatric surgery and shortens recovery time.

What are the advantages of endoscopic sleeve gastroplasty?

Endoscopic sleeve gastroplasty is a safe, effective alternative to permanent, non-reversible weight-loss surgeries such as vertical sleeve gastrectomy and gastric bypass surgery. Patients who have had endoscopic sleeve gastroplasty report that the procedure has allowed them to benefit from improved quality of life and long-term weight loss.

Advantages associated with endoscopic sleeve gastroplasty include:

This gastric bypass surgery is minimally invasive and eliminates the need for incisions — meaning there will be no visible scarring. Endoscopic sleeve gastroplasty is ideal for those who want to undergo an effective weight-loss procedure that offers minimal pain and downtime, and that can be reversed at any time later down the road.

 

The smaller stomach pouch that results from endoscopic sleeve gastroplasty allows you to consume smaller portion sizes at each sitting. Lower caloric intake can help you lose weight — especially when you’re also eating healthy foods and staying physically active. This relatively new weight-loss procedure has been shown to help people lose more than 18 percent of their total body weight after one year after the gastric bypass surgery.

 

Unlike surgical weight-loss procedures that come with potential risks of infection and blood clots, data on endoscopic sleeve gastroplasty show high patient survival rates and low rates of adverse events. Endoscopic sleeve gastroplasty is safer than many conventional bariatric surgeries, yet equally as effective, with weight-loss results comparable to many surgical solutions and the gastric balloon (Dayyeh et al., 2013).

 

Obesity can increase your risk of serious medical conditions including gallbladder disease, cancer, heart disease, and stroke. Endoscopic sleeve gastroplasty can help you lose weight and lower your risk of these and other obesity-related health problems — including common comorbidities such as reflux, sleep apnea, and type 2 diabetes.

Endoscopic sleeve gastroplasty is less costly than most other surgical weight-loss options at around $12,000 (Milton S. Hershey Medical Center). This surgery is ideal for those who don’t want to spend a high amount of money on more complex, involved procedures that require longer hospitalization, such as gastric bypass surgery, which tend to cost more than $25,000.

Educational Videos: Endoscopic Sleeve Gastroplasty Section

Video information + transcriptions below. Tap to open and read along with video.
We have converted a very complex procedure that used to be done surgically to an outpatient procedure that can be done in a few hours, with the patient going back home the same day. 
– Michel Kahaleh, MD, AGAF, FACG, FASGE

What can I expect after having endoscopic sleeve gastroplasty?

Eating will be off-limits for the first eight hours following your procedure. After that, you’ll be restricted to a liquid diet to prevent nausea and vomiting, and to allow your body to adjust to its new stomach size. The liquid food phase may last one to two weeks. After the liquid phase, you can move on to eating soft, pureed foods such as mashed vegetables and applesauce. When you’ve fully recovered from endoscopic sleeve gastroplasty, you can eat solid foods just like you did prior to your procedure.

The amount of food you’ll be able to consume in one sitting will be significantly reduced after having endoscopic sleeve gastroplasty. This will lead to the absorption of fewer calories, along with weight loss.

People who undergo endoscopic sleeve gastroplasty are shown to experience an average weight loss of 18.7 percent of body weight one year following the procedure. Evidence also shows that people who have this procedure and who have a starting body mass index (BMI) of 38 can experience an average weight loss of 39 pounds after six months, and 42 pounds after 12 months. For those with a BMI of 45, weight loss is roughly 73 pounds during a six-month period.

Am I an ideal candidate for an endoscopic sleeve gastroplasty?

This stomach reduction procedure is most ideal for people who want to lose excess weight and who have a BMI greater than 30, but cannot or do not want to have weight-loss surgery. If you have a BMI of 30 or higher, are at least 18 years of age, and haven’t experienced weight-loss success with diet and exercise, then endoscopic sleeve gastroplasty may be right for you.

Having endoscopic sleeve gastroplasty requires you to participate in a medically supervised weight-loss program. This program comes with nutrition education and planning, along with a personalized weight-loss and fitness plan. You must be willing to attend regular appointments to stay on track with weight loss after having this procedure.

Endoscopic sleeve gastroplasty is not ideal for those who have a hiatal hernia that is larger than three centimeters, those who have already had stomach surgery, or those who have gastrointestinal bleeding. If you are not an ideal candidate for this procedure, talk to your doctor about alternate weight-loss options that won’t pose serious risks for your health conditions.

 

Use our directory to find an experienced bariatric surgeon in your area who is qualified to perform endoscopic sleeve gastroplasty. A bariatric surgeon will discuss your available options for safe, evidence-based weight-loss procedures designed to help you reach and maintain your goal weight.

vertical sleeve gastrectomy and gastric bypass surgery. Patients who have had endoscopic sleeve gastroplasty report that the procedure has allowed them to benefit from improved quality of life and long-term weight loss.

Contributing Authors

Karen Eisenbraun

Certified Holistic Nutrition Consultant

Karen Eisenbraun is a certified holistic nutrition consultant and writer with a background in digital marketing. She has written extensively on the topics of nutrition and holistic health for many leading websites.

Karen received her nutrition certification from the American College of Healthcare Sciences in 2012. She follows a ketogenic diet and practices intermittent fasting. Karen advocates a whole foods approach to nutrition and believes in empowering yourself with information that allows you to make smarter decisions about your health.

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