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Choosing a Type of Weight Loss Surgery

Biliopancreatic Diversion

What is it? This is essentially a more drastic version of a gastric bypass, in which part of the stomach -- as much as 70% -- is removed, and even more of the small intestine is bypassed.

A somewhat less extreme version of this weight loss surgery is called biliopancreatic diversion with a duodenal switch or “the duodenal switch.” While still more involved than a gastric bypass, this procedure removes less of the stomach and bypasses less of the small intestine. It also reduces the risk of dumping syndrome, malnutrition, and ulcers, which are more common with a standard biliopancreatic diversion.

  • The Pros. Biliopancreatic diversion can result in even greater and faster weight loss than a gastric bypass. Studies show an average long-term loss of 70% to 80% of excess weight. Although much of the stomach is removed, the remainder is still larger than the pouches formed during gastric bypass or banding procedures. So you may actually be able to eat larger meals with this surgery than with others.
  • The Cons. Biliopancreatic diversion is less common than gastric bypass. One of the reasons is that the risk of nutritional deficiencies is much more serious. It also poses many of the same risks as gastric bypass, including dumping syndrome. However, the duodenal switch may lower some of these risks.
  • The Risks. This is one of the most complicated and high-risk weight loss surgeries. According to National Institutes of Health, the risk of death from the duodenal switch ranges between 2.5% and 5%. As with gastric bypass, this surgery poses a fairly high risk of hernia, which will need further surgery to correct. However, this risk is lower when the procedure is done laparoscopically.


Which Weight Loss Surgery Is Best?

The ideal weight loss surgery depends on your current health and body type. For instance, if you are very obese, or had abdominal surgery before, minimally invasive surgeries might not be possible. It really pays to talk with your doctor about the pros and cons of each procedure.

If possible, go to a medical center that specializes in weight loss surgery. Studies have shown that the risk of complications is lower when weight loss surgery is done by experts. No matter where you are, always make sure that your surgeon has had plenty of experience performing the procedure you need.

Is Weight Loss Surgery Right for Me?

Weight loss surgery is not for everyone. Doctors only recommend it for people who:

  • Have a body mass index (BMI) of 40 or more; this would be about 100 pounds overweight for men or 80 pounds for women.
  • Have a lower BMI (of 30 to 35) but also have a serious health problem related to obesity, such as heart disease, type 2 diabetes, severe sleep apnea, or high cholesterol
  • Have tried and failed to lose weight by other means
  • Fully understand the risks

In early 2011, the FDA approved the use of LAP-BAND surgery in those with a BMI of 30 or higher who have at least one obesity-related condition, such as diabetes.

Even if you meet these basic criteria, there's a lot more you have to consider. Perhaps most importantly, you need to be mentally ready. Weight loss surgery can be lifesaving, but it is not a cure. Instead, it's the first step in a lifelong commitment. For any surgery to help, you need to be dedicated to making dramatic and permanent changes to how you eat, exercise, and live.


WebMD Medical Reference

Reviewed by David T. Derrer, MD on May 29, 2014

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