Which operation is best for me?

When assessing patients for weight loss surgery, the surgeon is trying to find the safest operation that will achieve their goals.

Which operation you choose should be the safest operation that suits you.
None of these operations are perfect.

In a nutshell,

Bands are the safest,
Sleeves have the most natural eating style, &
Bypasses achieve the greatest weight loss.

They are all done laparoscopically (keyhole).

 

Gastric Bands

Gastric Bands are the safest operation and require the greatest effort to get them to work, are the most popular weight loss operation in Australia. Sweet-tooths and emotional eaters sometimes struggle. You need to follow the eating rules and get the band adjusted well. If you don’t, then the eating style might be difficult (eg vomiting) and weight loss modest. They are the only reversible and adjustable operation. There will be a silicone band around your stomach and a port under the skin permanently. Gastric Bands work by decreasing the speed of eating and hunger, which results in you eating less and therefore losing weight as long as you eat the right foods in the right way.

Sleeves

Sleeves are the latest operation and are rapidly becoming very popular in Australia, mainly because the eating style is almost normal. And because the effort required to lose weight is generally less than the other operations. Also the average weight loss is better than bands including for emotional eaters and sweet-tooths. Sleeve Gastrectomy is a higher risk operation then gastric band. The Sleeve is not reversible but is modifiable (eg if it is too big, it can be made smaller) and involves removing most of the stomach. The Sleeve works by not only decreasing the speed of eating and hunger, but also the volume of food you can eat, no matter what food you choose. This results in you eating less and therefore loosing weight as long as the foods are low enough in calories.

Gastric Bypass

Gastric Bypass is the operation for the greatest amount of weight loss and the first choice for revision surgery. It has the highest risk. To live well with a bypass you need to avoid meals high in fats and sugars as these will cause nausea, bloatedness, flatulence and diarrhoea. Malabsorption can occur though is rare. The Gastric Bypass works by decreasing the speed of eating, hunger, the volume of food you can eat, and also prevents you from eating high sugar meals and fatty meals by making you feel sick if you do, and also by not absorbing all the calories you eat. This results in you eating less fat and sugar and smaller meals and therefore loosing weight.

Part of deciding to have weight loss surgery is trying to choose the most appropriate operation for you. If you are not sure which operation is best for you, obviously you will need to give this some thought, but you may already feel you have made up your mind. At some stage before the surgery you will make a final decision.

Weight loss surgery is your second chance at having the life you want, one without a weight problem.

These operations are all tools for weight loss, not cures for obesity.

Also, choosing the right operation is very important because the best operation is the first operation. Redo surgery or revision surgery although usually possible has a number of limitations and increased risks.

 

So we need to try to make the right choice. Where to start?


There are no hard and fast rules in choosing. So we have to choose the weight loss operation that makes the most sense to you.

This is how we help people choose the right weight loss operation at Melbourne Bariatrics.

The right operation is the safest operation that is likely to remove the required amount of weight, and suits you.

 

Safety

The safest operation is gastric banding. Gastric Bands have a major complication rate of only 0.5%. Sleeves have a major complication rate of 2% and Bypass 5%.

What amount of risk do you think is acceptable to you to achieve this goal?

To put these numbers into perspective, Laparoscopic Cholecystectomy (removal of gallbladder) has a major complication rate of 2%.

All these operations are safer than remaining obese for the rest of your life.

Amount of Weight Loss

Obviously, we need the safest operation that is most likely to be effective for you. No point having the safest operation if it doesn’t work!


The average excess weight loss for bands is 55%, Sleeves 70% and Bypass 80%. Eg You are currently 120kg, your ideal weight is 70kg, with a Gastric Band you are likely (on average) to lose 27kg, with a Sleeve 35kg and a Bypass 40kg.

Some people will lose much more than this and some people lose much less. Failure to lose enough weight occurs more often with a Gastric Band than the two other operations.

What is an effective weight loss operation? How much is enough weight loss? In reality, an effective weight loss operation is the one that has you healthier, more able to do the things in life you were missing out on and has you feeling better about yourself and your appearance. It is not a number, a weight, a dress or trouser size. But the numbers can help you to imagine what will be enough weight loss.

What suits you?

Consider these
The operations features: reversible, adjustable,
Your current eating habits and lifestyle and whether they can change
Lessons learnt from previous weight loss attempts

So after safety and considering how much excess weight you need to lose, you need to think about which operation is going to suit you best. Which operation are you best able to live with already, and which could you easily adapt to?

Which one suits you? This can be the hardest. Unfortunately, medical research does not give a clear answer on this area, and there are people who have made the wrong choice, and so they might give their operation a bad reputation. Consider what suits you best, take advice from people who have had weight loss surgery, but think about how it applies to you. And don’t just take their word for it, ask someone else who has had weight loss surgery, and ask your surgeon.

So, based on the limited research in this area and our extensive experience, we would recommend that the Gastric bands are effective for anybody who is able to follow the eating rules and guidelines. The trouble is for some people it is hard to follow these rules. Bands are therefore sometimes less effective with certain eating habits (sweet tooths, emotional eating, frequent snacking) and certain lifestyles (eg can’t attend follow up).

The Sleeve is best suited to those who feel they are unlikely to change their habits much. The Sleeve is very popular with people who cannot attend many follow up appointments, who don’t like the idea of having to change what, when and how they eat in order to lose weight (but accept they need to eat less calories). The Sleeve is not popular for people who don’t like the idea of most of their stomach being removed, and those who would like a potentially reversible operation.

(Reversibility is only very rarely needed. Reversing weight loss surgery invariably means returning to the original weight, and most people do not want that at all! Reversing a band for failure to lose weight or a complication of the band in Australia is around 10 to 15 %, and 2% at Melbourne Bariatrics. But reversal because the patient (or “Bander”) doesn’t want the Gastric Band anymore, believing they can control their weight by themselves is very rare.)

The Bypass is for best suited to people who want the operation that will force them to change the way they eat and lose the greatest amount of weight. At Melbourne Bariatrics we find that bypass surgery tends to be the first choice for people having revision surgery and when they have a BMI greater than 55, but this is different to other clinics.

(In the situation of patients who require revision surgery all three operations are considered. However, the issues to consider are complex and are best done with your surgeon. The main issue is to work out what is actually, technically possible and what option is the safest. In general, the safest operation in most situations is bypass, but there are plenty of exceptions.)

It becomes a personal choice. A choice that largely revolves around getting an understanding of your eating habits and the major eating issues that are contributing to your weight problem. Are you a sweet tooth, an emotional eater, grazer, big meal eater or high calorie eater? Or perhaps most of your calories are consumed when you are out and about enjoying yourself. Whatever the pattern, there are operations which may suit you better than others.

So for people who just need a gentle reminder to eat more slowly and want to feel full to make their meals smaller, the band is a good choice often.

If, on the other hand, food for you is largely about pleasure, or dealing with emotions, and often involves eating “bad foods”, high calorie foods, eating at odd times of day or all evening, perhaps a gentle reminder to stop eating will be enough, perhaps not.

The Sleeve controls the volume of food you can eat. So if you tend to eat a lot after the kids go to bed or out on a Friday night, and you think these are the biggest sources of excess calories, then perhaps you will tend to want to keep eating that way, you will eventually find your way around a band and resume eating the way you are now. So if you have a band, this will make you want the band tighter to help you more, and eventually the band will be too tight for you to eat healthy foods anymore. A sleeve is a better choice if you think this sounds like you. However, a lot of people with bands do adapt their eating and find themselves perfectly able to lose large amounts of weight despite eating in this way.

You also need to consider things like whether you have time to attend several medical appointments or just a few. The average number of appointments for the first year after the surgery is greatest for the band: around 8, Sleeve and Bypass around 3. After the first year the bands continue to need more follow up: average 3 per year for the first 2 years then 1 per year, Sleeve and Bypass 1 per year after the first year.

Where do you live? (eg do you live hours away from your surgeon and can't be making trips to see them too often)

What have you learnt about yourself from past attempts to lose weight? Did you fail in the end because your new lifestyle became too hard to maintain and the weight loss slowed down and so you naturally gave up.

Or did you find yourself eating high calorie treats when the weight loss looked good, just as a little reward for your efforts, or did it fall over because something stressful happened. These kinds of reasons might suggest you currently have a tendency to sabotaging yourself. Sabotage is potentially still going to be a problem after surgery and needs to be addressed. When being sabotaged like this, the Gastric Band is more likely to fail to help you lose weight compared with the Sleeve and Bypass. Our psychologist will help you sort these kinds of things out to help you know you are making the right choice.
Perhaps the comparison table might make it easier to think through some of the issues that are important to you.

Your surgeon will consider the most appropriate operation to be the one that is the safest operation that is most likely to achieve the desired amount of weight loss that also meets your personal needs. Our psychologist will help you choose the operation that fits you best.
Deciding on the most suitable operation is sometimes simple and other times difficult. Take the time to discuss it with your family, friends and surgeon until you are happy you are making the right choice.

So, think about how much weight you want to lose, which operations sound ok and which do not, how much of your eating habits and lifestyle already match the various operations, and how much you are able to change these habits.

Good Luck!

 

 

Please Contact Melbourne Bariatrics on  03  9770  7189  for more information or to make an appointment
Royal Australasian College of SurgeonsAMA - Australian Medical AssociationFRACS - Fellow of the Royal Australasian College of Surgeonsmattu - Minimal Access Therapy Training Unit GuildfordIFSO - International Federation for the Surgery of Obesity and Metabolic DisordersMonash University
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