Surgery – Sometimes The Only Option With Obese Cases


The high rate of obesity in the United States among adults has resulted in a crisis situation. It places pressure upon the entire health system and can have severe economic results. The medical profession has become increasingly aware of the potential threat. Over the past decades they have sought solutions in different approaches.

While many overweight individuals may address their health issues with a complete system of dieting and exercise, this may not be feasible for those who are morbidly obese. Reducing food intake and increasing the level of exercise may not prove to be effective. As a result, the only action possible to prevent increased risk of serious health problems and even possible death may lie in a more drastic bariatric surgery.

What is Bariatric Surgery?

Bariatric surgery is the branch of medicine that embraces the field of weight-loss. There are several surgical procedures that address or support weight loss. All the different types of bariatric surgery have specific goals in mind – to restrict the size of the stomach and, therefore, the intake of food or, by bypassing at least part of the small intestine, to prevent the absorption of as many nutrients or calories1.

What are the Major Types?

Bariatric surgery is available in several different forms. With the advances in surgery, specific methods have improved and altered, but, essentially, they remain classified according to their planned physiological effect as either restrictive or malabsorptive.

  • Restrictive: This medical procedure refers to the dramatic physical reduction of the size of the stomach in some fashion. Weight loss occurs as a result of the individual, and their stomach, being prevented from taking in large amounts of food. The most common methods used are laparoscopic adjustable gastric banding (LAGB) and vertical-banded gastroplasty (VBG). Other methods include the laparoscopic sleeve gastrectomy (LSG) and transoral gastroplasty (TOGA).
  • Malabsorptive: The term malabsorptive indicates the surgery is intended to prevent the body absorbing proteins and calories. As a result, this form of medical procedure involves the bypassing of the small intestine. The most common method of malabsorptive surgery is Roux-en-Y gastric bypass (RYGB). Other methods include biliopancreatic diversion (BD) and biliopancreatic diversion with duodenal switch (BDDS).
  • Liposuction: This is often considered cosmetic surgery. It can be used to help morbid obese individuals remove excess weight.

Currently, the most common or favored forms of bariatric surgery for obesity are RYGB and AGB.

Comparison of Restrictive and Malabsorptive Methods

Both restrictive and malabsorptive methods have their advantages and disadvantages – their own benefits and risks. The following chart will provide a simple means of comparing the various forms of bariatric surgery.

Procedure Type Method Follow-up Risks and Complications Safety and Effectiveness
Biliopancreatic Diversion Malabsorptive Removes part of the stomach Back to normal 3-5 weeks Nutrient deficienciesMalnutritionChronic ulcersBowel issues Safe consistently better than RYGB
Biliopancreatic Diversion with Duodenal Switch Malabsorptive A more complex operation. Removes a large portion of the stomach. Connects the duodenum to the jejunum Back to normal routine 3-5 weeks. Lifelong follow-up program Similar problems as with BD but less Safe with reservations
Gastric Sleeve (Laparoscopic sleeve gastrectomy) Restrictive Removes a large section of the stomach May be performed in as little as 1 hour. May be an outpatient but requires a 23 hour stayCrucial to have a regular follow-up Vitamin deficiency and mineral deficiencyhypoalbuminemia safe
Laparoscopic Adjustable Gastric Band Restrictive Least invasive of the operations. Retains the stomach by using an adjustable band/balloon combination Minimal stay. Fastest recovery30-40 minutes surgery40-50 minutes under anesthetic4-6 hour recovery Outpatient possible Limitations re: food intake, balloon may leakBand erosionDeep infection Safe and effectiveMinimal invasionAlso reversible
Liposuction Fat removal Small incision. Insertion of vacuum that suctions out the fat from the specific body region Day surgery in many cases Bruising, swelling, trauma Temporary weight loss only. Fat accumulates elsewhere
Roux-en-y Gastric Bypass Both restrictive and malabsorptive Creation of a small pouch without removal of the stomach. The stomach is bypassed by the creation of a long limb. Overnight stayMay have as an outpatient in certain cases Dumping syndrome after eating certain foods – usually sweetsUlcersNarrowing or blockage of the stomachVomiting More effective than LAGBConsidered one of the safest procedures
Transoral Gastroplasty2 Restrictive Formation using staples of a 4-inch pouch or tube in what is called the proximal stomach 94 minute operation Staples may come looseGastric ulcerAsthesiaDiarrheaNausea  Initial clinical studies indicate it is safe and effective since it avoids several cuts to the abdomen
Vertical Banded Gastroplasty Restrictive Compartmentalizes the stomach using vertical line of staples Difficult to digest many foodsAnemiaIron and vitamin B12deficiency Poor long-term weight lossLess effective means than LAGB and BPDDSNo longer commonly  performed in theUnited Statesdue to high risks and complications


Bariatric surgery comes in a variety of forms. This allows you and your medical professional to select the means best suited to your weight problem. While, in the past, there have been issues concerning the use of surgery to reduce weight, this has decreased in recent years3. Obesity and morbid obesity demands surgical measures.

While not all forms of bariatric surgery have proven consistently to be effective, they do offer a chance to reduce weight in order to ensure the implementation of other methods.  This is certainly true of liposuction. Other forms not only demand a long term commitment to discovering how to eat properly but also constant follow-ups by medical professionals.



1 McGowan, MP and Chopra, JM (2009). Gastric ByPass Surgery.New York: McGraw-Hill.

2 Devière, J; Ojeda Valdes, G; Herrera, CL; Closset, J; and Le Moine, O et al. (2008). Safety, Feasibility and Weight Loss after Transoral Gastroplasty: First Human Multicenter Study. Surgical Endoscopy 22 (3): 589-598.

3 Kelly, EB (2006). Obesity.New York:Greenwood Press.


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