People considering bariatric surgery have many questions about the procedure and what to expect before, during, and after. One common question is whether bariatric surgery is reversible. In most cases, the short answer is no. But of course, there is always a bit more to the story. And really, there are better questions to ask.
Understanding Bariatric Surgery
Bariatric surgery has evolved over at least 75 years, and the techniques have also improved during that time. The primary procedures that are performed today would include the sleeve gastrectomy, which is currently the world’s most widely performed weight-loss procedure. Next is the gastric bypass, currently the world’s number two, followed by the duodenal switch, and then lastly some folks having the gastric banding. There are a few other procedures that constitute a tiny fraction of the overall cases worldwide that are often some version of these four procedures. Now, in terms of reversibility, let’s think about these procedures one by one.
The sleeve procedure involves trimming off and removing the outer portion of the stomach tissue. That tissue is physically removed and goes off to the hospital specimen laboratory never to return. So, in the most meaningful and literal sense, it is not reversible. However, sometimes when people ask about reversibility, they are thinking through deeper concerns or meanings. For example, if I had a problem, would there be a way to correct it? And here, in nearly all cases, the answer is yes. There are cases in which some long-term problem arises that is correctable with further surgery or intervention. Weight regain, the most frequent problem outcome we try to avoid, is addressable with a revision surgery, which is usually quite successful. Other problems can be managed with endoscopy or occasionally further surgery.
Gastric bypass does not involve removing any significant tissue or organs, but it does involve rerouting the stomach and intestine. So, because all the parts have been rearranged, it is possible to go back to surgery and restore them or reverse the procedure. It is not done very often simply because it is not necessary or helpful in very many situations. But the procedure is technically reversible. And thinking of the question in another way — are there avenues to address any problems — the answer again is nearly always yes. Newer ways of revising gastric bypass can induce further weight loss if the problem has been one of weight regain. Other problems such as micronutrient malabsorption can also be addressed by reversing or revising the original surgery.
Duodenal switch or biliopancreatic diversion is in some way is a more complex bypass procedure. Like the gastric bypass, the rearrangement does not involve removing significant parts or tissues, so the procedure is technically and theoretically reversible. It is not very often that we do reverse the procedure, but in a rare case it becomes necessary due to nutritional deficiencies.
Gastric banding is considered the most reversible of the procedures. Unfortunately, this is really its best attribute because it is also the procedure with the lowest effectiveness, and thus it is no longer widely performed. But the band is a mechanical device placed around the upper stomach, and there is no additional cutting or operating on the organs. So, reversing it means simply going back and removing the band, something that is, in fact, done quite commonly. Today, many more people are having bands removed – due to adverse symptoms and poor weight loss – than implanted.
The Bottom Line
In many cases, the best question to ask is not about reversibility, but about safety and effectiveness, or about overall pros and cons. The sleeve has moved to the front of the line because most surgeons and individuals consider it to have the most pros and the fewest cons. It has a long-term record of delivering a high success rate in terms of weight lost, diabetes reversed, health improved, quality of life improved, and risks reduced. It has, in the eyes of most people, a lower rate of cons or complications than the procedures that came before it. And, if needed, it can be revised, converted to a bypass to deliver a more aggressive metabolic impact to reverse obesity and diabetes. Overall, the procedures have quite a few avenues or offramps if problems arise. In many cases, the best avenue is not a reversal of the procedure but is a revision of the procedure to achieve the best results in terms of health and quality of life.
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