Quite a while ago now my dietician asked me if…
How do I choose which weight loss surgery to have?
There are a few things I see asked in weight loss surgery groups time and time again and one of those is how do you choose which bariatric surgery to have? The choices you are presented with are largely dependent on whether you go public or private and which surgeon you are working with. You may have up to three options to choose from which can be really overwhelming. In this post I’m going to talk briefly about the common options in New Zealand and how you can weigh them up to make the best choice for you.
The field of bariatric surgery is quite specialised and within that specialisation most surgeons will perform one or two types of the possible surgeries. The bariatric procedures most common in New Zealand are Sleeve Gastrectomy, RNY Gastric Bypass and Duodenal Switch. I have linked those names to some information about those procedures. Gastric Banding has seemed to fall out of favour with surgeons in New Zealand. From what I have read the success rates varied wildly and there was ongoing maintenance (in the form of surgery a lot of the time) to keep them working how they should.
RNY Gastric Bypass
This procedure takes away a very large percentage of the stomach capacity leaving a very small stomach pouch. The intestine is also modified so the top metre or so is bypassed and what’s left is joined back up to the stomach further down than previously. In some Gastric Bypass operations a siliastic ring is also placed just above the stomach which is very effective in helping to maintain weight loss long-term and reduce the risk of stretching the stomach out. The bits you aren’t using anymore are left inside you and are not removed and gone forever. Read more and see a picture to illustrate what happens here.
Sleeve Gastrectomy
This procedure lops off about 75% of the stomach capacity by chopping the big side bit off and leaving a stomach pouch about the size and shape of a banana. The intestine is left alone and this is the least invasive and you could say, most straightforward procedure of them all. Read more and see a picture to illustrate what happens here.
Duodenal Switch
This procedure is the most physically modifying of them all and I have to admit I still have to look it up to see how it works. About 70% of the stomach is removed as a first step, the small intestine is then divvied up and ends up having three pathways. From there the food gets put into the large intestine where the small intestine has had a limited period of time to absorb nutrients. As you can see it’s hard to explain so check out this link to get a better explanation of it.
There are advantages and disadvantages of each surgery and I have listed some of them below:
** Please note: This is a very non-scientific, I googled and found some stuff interesting kind of list. Don’t make any decisions based solely on this list. If you are serious about surgery research as much as you can to enable you to make a fully informed decision.
| Procedure | Advantages | Disadvantages |
| RNY Gastric Bypass | Great results for diabetics and other obesity co-morbidities such as high blood pressure and high cholesterol
Higher percentage of excess weight tends to be lost
Dumping Syndrome (good if you’re a sugar fiend)
Greater success rates long-term
|
Malabsorption requiring daily vitamins for the rest of your life
Possible complications such as leaks along staple lines
Could have weight regain 2-5 years out from surgery
|
| Sleeve Gastrectomy | Permanent and not reversible
Less malabsorption risk
Can be converted to another bariatric surgery in future if not effective enough
Not as much surgery enforced dietary restriction
|
Possible complications such as leaks along staple lines
Initial weight loss expectation is not as high as other surgeries, tends to be done on patients with not as much weight to lose
|
| Duodenal Switch | Rapid and greater initial weight loss
Weight maintenance long-term
Great results for other co-morbidities such as diabetes, obstructive sleep apnoea, high cholesterol
|
Harder to maintain protein levels long-term and may result in a deficiency
Gas and diarrhea if too much of the wrong foods are eaten
Malabsorption, the daily vitamin requirements are much higher than what’s required for other types of surgery.
|
In making such a huge decision for yourself you have to weigh up the advantages and disadvantages against your life, your priorities and what you can come to terms with and live with long-term. You need to research and find as much information as you think you need to make the decision. No one else can tell you what the best surgery is for you. Your surgical team may be able to tell you which one they think is most appropriate for you but you need to feel comfortable with this. I had researched like crazy and decided I wanted a RNY Gastric Bypass. My surgical team were leaning towards a Sleeve Gastrectomy until I pointed out my issues with reflux which then made them change tact completely and made the bypass route the best choice for my circumstances.
Weigh up the pros and cons. Inform yourself as much as you feel you need to whether that’s just knowing the basics of each procedure or going to the extreme of watching YouTube videos of the surgeries being performed (I never went quite this far but I know a few who have). Think about your life, what will work and fit in and what won’t. Have a think about and rank your priorities to see what you should be letting guide your decision. Ask people who have had surgery about their experiences and if they have any advice for you. After all of this you will most probably have a gut feeling about which one you think is right for you.
Good luck on your journey! Writing this has made me consider if I need to offer mini coaching packages when I launch myself as a coach to help people make this decision if they feel really lost. Would this be something you are/were interested in? Comment below and let me know how you decided what the best surgery was for you.
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Hi Melissa
The mini coaching package sounds like a great idea. I’m still struggling to decide which surgery is right for me and I need to decide sooner rather than later!
Hi Susie, it’s a tough choice isn’t it. What are your choices?
Good overview! Here in Ontario (Canada) we have a public health system (thankfully)- like New Zealand and Australia and most other enlightened countries (I feel so bad for Americans). The process is a lengthy one – 8 months to a year on average once you qualify for the program. I also think it an excellent one. The reality is that none of these procedures is a magic bullet. They are simply another tool which sort of (in my opinion) gives you a “quick start” – but long-term, it’s up to the individual and over the course of the program, you see nutritionists, social workers, nurse practioners and psychologists as well as taking a 2 hour nutrition course, filling out various (required) “tests” on what will be happening etc.. The surgeon is the one who chooses the option. Unless there are other issues wherein a gastric sleeve is done, the RNY is considered the “gold standard” and the most likely surgery used.
I am scheduled for my RNY on June 11 (2019) and am REALLY ready for it. I have almost completed the process (nutrition course refresher and one phone call follow-up and of course pre-op with doctor 2 weeks before), and this is the second time I have gone through it. I simply wasn’t ready to commit to what is inarguably a pretty radical change to my body the first time my surgery date was assigned and opted out. Things change and the more I researched, the LESS I was able to lose weight on my own and most pertinantely, I developed Type 2 diabetes and am having major issues with medications (terrible reactions to several of them to date)- it became inevitable.
This time around I’m committed, passionate and looking forward to changing my future; at this juncture (pre-surgery) it is pretty bleak – I’m uncomfortable, diabetic and unable to pursue goals I always dreamed of (travelling, I LOVE exercising but that is difficult at this weight, exploring etc) – so onward and “downward” one can hope!
It sounds like you have a great system there in Canada. The time it takes in the lead up is an advantage I think, lets you figure some stuff out and be mentally prepared for it. Good luck with your upcoming surgery. I really hope it changes everything for you and reverses your diabetes.