Surgical Weight Loss Therapies

There are various options when it comes to weight loss surgeries. These options include gastric sleeve, gastric bypass, and adjustable gastric band. Based on your weight loss journey, your bariatric surgeon will determine the right procedure type.

Sleeve gastrectomy

Sleeve gastrectomy, now the most common weight loss operation in the United States, is a surgical procedure in which the stomach size is reduced to the shape of a banana or “sleeve,” restricting the amount of food you can eat.

How it is performed. The surgeon removes 60 to 75 percent of your stomach. Although originally devised as the first stage of a two-stage procedure for super-obese or high-risk patients, we now commonly use sleeve gastrectomy to achieve weight loss in people with a body mass index (BMI) over 35 and significant comorbid conditions.

Sleeve gastrectomy effectiveness. People undergoing this procedure usually lose 20 to 25 percent of their total body weight over a six-to-12-month period. When performed alone, sleeve gastrectomy also decreases the production of the hormone ghrelin, reducing feelings of hunger and resulting in weight loss comparable to gastric bypass.

Roux-en-Y gastric bypass surgery

Roux-en-Y gastric bypass, or gastric bypass, is the second-most common weight loss surgery in the United States.

How it is performed. Your surgeon creates a small pouch in the top of your stomach, forming a “new stomach,” which will limit the amount of food you can eat during a meal, helping you feel fuller sooner.

The surgeon then creates a small opening in the pouch and attaches that opening to a section of your small intestine. The reconnected intestine causes food to bypass part of the intestine, so some of the nutrients and fewer calories will not be absorbed.

The altered anatomy also changes your hormones, which also helps you feel full sooner.

Gastric bypass surgery effectiveness. Most people lose 30 to 35 percent of their total body weight within 12 to 18 months after surgery, with most of that loss sustained over the next ten years. Many obese people with diabetes find that with this surgery, their diabetes resolves rapidly — sometimes within days or weeks.

NewYork-Presbyterian surgeons have more than two decades of experience performing this procedure.

Biliopancreatic diversion with duodenal switch (BPD-DS)

Biliopancreatic diversion with duodenal switch (BPD-DS), also referred to as duodenal switch, is a complex procedure that promotes weight loss by combining two procedures: sleeve gastrectomy, to reduce food intake, and intestinal bypass, to limit absorption in the intestine.

It combines the hormonal changes of both operations and is very effective against diabetes.

How it is performed. With this procedure, the surgeon removes about 60 to 70 percent of your stomach so that it takes the shape of a banana (sleeve gastrectomy). The lower intestine is then divided much further downstream than with gastric bypass so that two-thirds or more of the intestine is bypassed, leaving only a few feet of the intestine where food and digestive enzymes meet; this is the intestinal bypass portion of the operation.

The name “duodenal switch” comes from the fact that in this operation, the intestinal bypass starts at the duodenum (the first part of the intestine), which is divided and attached to the lower portion of the small intestine (the ileum).

Duodenal switch effectiveness. Most people lose 35 to 40 percent of their total body weight over a two-year period, with 70 percent of the weight loss sustained beyond 10 years.

Single anastomosis duodenal switch (SADI/SIPS)

Similar to BPD-DS, the single anastomosis duodenal switch — also known as single anastomosis duodeno-ileal bypass (SADI), stomach intestinal pylorus-sparing surgery (SIPS), or loop duodenal switch — has the dual effect of restricting stomach size as well as inhibiting the absorption of some nutrients to help you achieve and maintain your weight loss goals.

In this procedure, however, the intestine is rerouted at a single point. The effective bypass in this procedure is slightly less than that of a traditional duodenal switch, yet still induces significant weight loss. SADI/SIPS is a simpler procedure than BPD-DS and is more effective than sleeve gastrectomy alone.

Laparoscopic gastric banding

Adjustable gastric banding (Lap-Band or Realize Band) is less invasive than other procedures because neither your stomach nor intestine is cut. Instead, a band is placed around your stomach that can be adjusted to restrict the amount of food you eat before feeling full.

How it is performed. Your surgeon places an adjustable band around the upper part of your stomach to create a small stomach pouch above the band. By adding fluid to the band after you recover from surgery, the surgeon adjusts the opening size between the smaller, upper pouch and the remaining lower portion of your stomach.

The tightness of the band opening controls the passage of food between the two parts of your stomach, giving you a feeling of fullness after eating that lasts significantly longer than it would without the band. Your surgeon works closely with you to tailor the band adjustment to your needs.

Gastric banding effectiveness. Losing weight after adjustable gastric band surgery is more gradual than with gastric bypass. You can expect to lose 15 to 20 percent of your total body weight within two years of surgery. The amount of weight lost depends on how you adapt and maintain new eating habits, regular exercise, and follow-up with your care team.

Short-term and especially long-term results are not as good as those achieved with other surgical weight loss operations but better than those associated with endoscopic treatments.