Metabolic and Bariatric Surgery

Metabolic and bariatric surgery is more effective than diet and exercise alone for severe obesity (80-100 pounds over ideal body weight) and disease remission. Research shows weight loss surgery is associated with lower mortality rates and longer life expectancy.

With technological and research advances, most procedures are minimally invasive with easier recovery and less side effects. Our team will work with you to determine what type of procedure will be the safest and most effective for you.

Understanding Surgical Weight Loss Procedures

Weight loss procedures fall into two categories—restrictive or malabsorptive. Restrictive procedures, such as gastric sleeve, reduce the number of calories that you can take in by limiting the size of the stomach pouch. Malabsorptive procedures block the absorption of calories through the intestinal wall into the bloodstream, by rerouting or bypassing part of the intestinal track. Some procedures, like the gastric bypass, combine both restrictive and malabsorptive techniques.

Sleeve Gastrectomy

Considered a restrictive procedure, a small sleeve is created using a stapling device, removing approximately 80% of the stomach. The stomach is permanently reduced, limiting food consumption.

• Laparoscopic Sleeve Gastrectomy is the most common bariatric surgery. Also known as sleeve or vertical sleeve gastrectomy (VSG).
• It is a technically simple procedure preferred for patients with high-risk medical conditions. Sleeve surgery is used as part of the TRIMS program for organ transplant patients.
• Sleeve surgery may be used as a bridge to gastric bypass or SADI-S procedures, and as a first step for patients with very high BMIs.

Roux-en-Y Gastric Bypass

Both restrictive and malabsorptive, the stomach is divided with a portion bypassed no longer storing food. The small intestine is also divided and connected to the new stomach to allow food to pass. The newly created stomach is smaller and able to hold less food. The change of the food course decreases hunger, making patients feel fuller.

• One of the most common bariatric procedures and improved as a laparoscopic approach.
• May be the best option for patients with gastroesophageal reflux disease or GERD.
• Proven procedure with reliable, long-lasting weight loss.
  Effective remission of obesity-associated conditions.
• Requires life-long vitamins/supplements after surgery.

SADI-S/Loop DS – Single Anastomosis, Duodeno-Ileal Bypass with Sleeve Gastrectomy

Both restrictive and malabsorptive, the operation starts the same way as the sleeve gastrectomy by removing a portion of the stomach. Part of the small intestine is divided and connected to the stomach.
Food goes through the pouch and directly into the latter portion of the small intestine allowing vitamin and mineral absorption. Also known as Loop Duodenal Switch or Loop DS.

• Superior weight loss and metabolic effect.
• Requires life-long vitamins/supplements after surgery.
• Improves or resolves obesity related diseases at a high rate over the long-term including type 2 diabetes, hypertension, obstructive sleep apnea, and more.

BPD/DS – Biliopancreatic Diversion with Duodenal Switch

Both restrictive and malabsorptive, the operation includes a sleeve pouch and bypasses 75% of the small intestine.
The DS affects intestinal hormones to reduce hunger and increase fullness.

• Somewhat combines sleeve gastrectomy and gastric bypass procedures utilizing a sleeve pouch and bypassing a portion of the small intestine.
• Requires life-long vitamins/supplements after surgery.
• Most effective procedure for treatment of type 2 diabetes. Best for weight loss compared to other procedures.
• More complex procedure than SADI-S

Bariatric Surgery Revisions

UC Health bariatric surgeons perform revisional procedures related to complications, side effects, and weight regain or inadequate weight loss with a primary surgery. Each revisional case is evaluated individually and may require repeating some or all program and insurance requirements.

Revision surgery evaluations require diagnostic testing that is reviewed by the surgeon to determine what procedure is best for you. Most bariatric surgeries can be revised to address side effects and weight gain. Most revisions are still considered minimally invasive using laparoscopic techniques, however with cases where an open procedure was done previously an open approach may be necessary.

We also offer an endoscopic procedure specifically to revise gastric bypass procedures called Overstitch or TORe Transoral Outlet Reduction. Overstitch sutures tighten the opening between the stomach and small intestines to slow food movement to stay full longer, eating less.

TRIMS (Transplant-Related Interdisciplinary Metabolic Surgery)

A multi-disciplinary weight loss program specifically for transplant patients.
Patients who are waiting for an organ transplant often need to lose weight before being considered or approved for surgical transplantation. The TRIMS program addresses the needs of these patients, with our bariatric surgeons working closely with the UC Health Transplant department pre and post-operatively.

Learn more about TRIMS.