Obesity is a global health epidemic, and consequences for an individual’s well-being and life expectancy are significant. It stems from our genetics combined with some serious changes in the environment and food supply that hijack our metabolism. While lifestyle changes, including diet and exercise, remain essential for weight management, surgical interventions are valuable tools in the battle against obesity. Over the past 50+ years, metabolic surgery, also known as bariatric surgery, has gained prominence as an effective and safe method for substantial weight loss and the resolution of obesity-related health problems or comorbidities. Because obesity plays out in slow motion, few people recognize that leaving it untreated is far riskier than today’s very safe surgery to treat it. But what’s the safest weight-loss surgery? Here’s what to know.
A Quick Look at Metabolic Surgery
Metabolic surgery comprises a range of surgical procedures that alter the gastrointestinal tract’s anatomy and physiology to promote weight loss and improve metabolic health. The primary goal is to modulate hormonal signaling, which contributes to weight loss, lower long-term blood sugar, and reduced circulating triglycerides (think of it as reducing the bad fats). Here are the most common metabolic surgical procedures:
- Sleeve gastrectomy. In this procedure, the outer 75-80% of the stomach is removed, leaving a more slender banana-like stomach. The main mechanism stems from changing the metabolic hormones that come from this stomach tissue, while it also reduces the stomach’s capacity and results in early satiety. It has become the most widely performed procedure and has demonstrated impressive outcomes in safety, weight loss, diabetes reversal, and resolving comorbidities.
- Roux-en-Y gastric bypass (RYGB). RYGB involves the creation of a small stomach pouch and rerouting a portion of the small intestine. This procedure shifts the metabolic hormones favorably, restricts food intake and may affect some nutrient absorption. It has been widely practiced for decades and has proven effective in achieving weight loss, diabetes reversal, and improving metabolic health.
- Biliopancreatic diversion with duodenal switch (BPD/DS). BPD/DS combines a sleeve gastrectomy with a type of bypass starting at the duodenum. It significantly shifts the hormone profile quite favorably, leading to substantial weight loss and perhaps the most effective diabetes reversal profile. However, it is a somewhat more complex procedure and may carry somewhat higher risks.
- Adjustable gastric banding. Not often performed today, the banding procedure was displaced by the sleeve procedure which many people believe is quite similar in terms of safety and simplicity, while offering a higher success rate. A silicone band is placed around the upper part of the stomach, creating a small upper pouch. The band is adjustable, allowing for control of food intake. While this procedure is less invasive than bypass-type procedures (at least in the short term), it has not been as effective as other options in achieving substantial and sustained weight loss.
Understanding the Safety of Metabolic Surgery
Metabolic surgery overall has become perhaps the safest category of widely performed procedures in the world today. That’s important context. It’s safer than most of the procedures one might think of, including hernia repair, hysterectomy, gallbladder removal, knee replacement among many others. When we talk about the safety of metabolic surgery, it’s a term that encompasses not only the risk of surgical complications but also the long-term improved heart, lung, and kidney safety or health.
Several factors contribute to the overall safety of metabolic surgery:
- Short-term complications. All surgical procedures carry inherent risks, such as infection, bleeding, or leakage. Laparoscopic techniques, improved training, centers of excellence, and decades of improvement have reduced these risks significantly. Today, sleeve gastrectomy ranks as the safest procedure with the fewest short-term complications, owing in part to the relative simplicity of the 30–40-minute procedure.
- Long-term complications. Some surgical procedures may have long-term complications such as nutritional deficiencies, malabsorption, ulcers, hypoglycemia, or gastrointestinal symptoms. These risks are more significant in procedures like RYGB and BPD/DS that involve rerouting of the intestines.
- Weight loss and metabolic outcomes. The long-term safety of a procedure is closely tied to its effectiveness in achieving significant and sustained weight loss and the resolution of obesity-related comorbidities. All the procedures, especially sleeve gastrectomy, RYGB and BPD/DS have shown consistent reduction in a person’s chance of serious illness and death compared to non-surgically treated controls. A few key studies have given an edge to the sleeve procedure because of fewer complications.
- Patient satisfaction. Patient satisfaction and quality of life are vital safety considerations. Patients who undergo metabolic surgery should experience an improvement in their overall well-being, both physically and psychologically.
Which Weight-Loss Surgery is Safest?
When determining the safest weight loss surgery, it’s important to consider the needs and risk profile of the individual patient. However, based on current research and clinical practices, sleeve gastrectomy is often considered one of the safest options for a broad range of patients. This procedure is less invasive than RYGB or BPD/DS, reducing the risk of surgical complications. It provides substantial and sustained weight loss, leading to an improvement in metabolic health and comorbidity resolution. The simplicity of the procedure also enhances patient satisfaction and minimizes long-term complications compared to more complex surgeries. For the small percentage of sleeve patients who later need a more aggressive procedure, they can still have it revised to one of the bypass-type procedures safely.
The Bottom Line
Metabolic surgery has emerged as an effective and safe solution for addressing obesity and its associated health issues. While the safety of any surgery depends on various factors, sleeve gastrectomy stands out as a safe and effective choice for many patients. It is crucial for individuals considering metabolic surgery to consult with experienced bariatric surgical professionals to determine the most suitable procedure based on their unique circumstances, ensuring the best possible outcomes and long-term safety.
If you’d like to learn more about weight-loss surgery and whether you might be a candidate, contact the Nevada Surgical team today.
