Like in many other surgical procedures, there is element of risk from the surgery for weight loss, so everyone should not make this important choice unconscientiously. Additionally, surgery never is a panacea. A successful operation is mainly based on the patient’s motivation as well as on his/her best ability to change his own eating habits and lifestyle. Surgery must be taken into consideration only after the failure of the integrated programme based on no surgical treatments (such as diet, physical activity, behaviour therapy). There are many different procedures for surgical treatment of obesity:

•Restrictive procedure – it reduces the amount of food the stomach can contain but it does not obstruct the normal assimilation of food and nourishment

• Malabsorption surgery – it acts on the digestive process by reducing the assimilation of food

• Mixed surgery sets a limit to the patient’s food intake but it can also decrease the assimilation of nutrients.

Adjustable Gastric Banding

Adjustable Gastric BandingThis is one of the most widely used procedures for weight loss in Europe. It is a quite simple and completely reversible operation. By applying the laparoscope technique, an adjustable band of silicone (ring shaped) is placed around the upper portion of the stomach. The band is connected to the port through a small canal which has been placed beneath the skin during the operation. After the procedure, the surgeon can vary the stoma’s dimensions by injecting or inhaling a physiological solution through the port in the band. Basically, in the stomach what is formed is essentially a new small stomach ‘pouch’ that has to restrict the amount of food to ingest. This restricted bypass increases the time of emptying out by means of the banding. In conclusion, the consequent reduction of food results in slimming.

Early complications:

• The most recurrent problem these patients have to overcome is vomiting that can be avoided by masticating slowly and by limiting to drink liquids during mealtime.

Main long-term complications

During the following months or some years after the operation complications are likely to result in:
• The expansion of the gastric ‘pouch’
• Sliding upwards of the gastric wall through the band
• Erosion of the stomach wall of the band which could result in the stomach insertion of the band into the stomach
• Infection of the tank placed beneath the skin
• Fracture of the small canal which connects the band to the tank
• Reflux of food intake resulting in esophagitis.

Sleeve gastrectomy

sleeve gastrectomyThe sleeve gastrectomy is a restrictive procedure. With this procedure the patient can have a feeling of a lasting satiety and fullness which makes him consume a small amount of food. As a result the patient loses weight. Moreover, his stomach is divided into two parts vertically. The left side is removed because it would be left out by the digestive process. The remaining side of the stomach that is the gastric canal will have the same natural functions just as before the operation. The sleeve gastrectomy is a medical methodology which can be associated with a second procedure that is bariatic surgery, thus the former operation can be considered the “first phase” for quite overweight people (BMI>50). The weight loss mostly occurs in the early 18 months after the surgery. Additionally, many patients may solve their obesity problem by reaching the overweight stage again and very rarely by getting a normal weight. On the other hand digestion normally occurs as natural as before the procedure.

Gastric bypass

Gastric bypassGastric bypass is a mixed procedure which combines restrictive and malabsorption methods. This procedure involves the creation of a “small gastric pouch” to which an intestinal loop is anostomesed (topped up). As a result the gastric pouch that is as big as a coffee-cup can receive only a small amount of food. Then food finds a new way by ‘skipping’ the stomach, the duodenum, and the first part of the small intestine. No parts of the stomach or of the intestine have to be removed. The weight loss is the main consequence of a small amount of food that can be consumed and of an early feeling of satiety and fullness though the restriction of food intake. Another effect is the decreasing of the appetite caused by some changing of hormones. Although the standard technique does not result in a “malabsorpotion” there could be some mineral and vitamin deficiencies. So individuals undergoing this surgery require lifelong multivitamin supplementation every day, calcium and iron as well.


• Initial rapid weight loss

• Procedure mininvasive

• Weight loss is much greater than with the adjustable gastric banding

• Resolution of the type II diabetes in 84% of patients, of the arterial hypertension and of the syndrome of sleep apnea in 95% of patients.


• Procedural complications occurring more than with gastric banding

• A portion of the digestive section has been excluded by reducing the absorption of the essential nutritional substances, so alimentary integrators should be taken regularly

• Patients might develop the “syndrome of a rapid gastric emptying” resulting in nausea or in a feeling of being unwell and diarrhea

• A hard reversibility

• The stomach partly becomes inaccessible to the endoscopic examination

• Death rate is greater than with gastric banding

Late complications:

• Intestinal obstruction

• Stenosis of anastomosis

• Anaemia because of iron and vitamin B12 and/or folic acid deficiencies

• Calcium deficiencies may lead to osteoporosis

• Ulcer

The treatment of these complications does not usually require any surgical procedure but it might be necessary at times.

Biliopancreatic Diversion

Biliopancreatic DiversionBiliopancreatic diversion is a malabsorption surgery. The stomach will be removed of about ¾ of its size and the new gastric ‘pouch’ will be connected to the final section of the small intestine. By making food go through this bypass, the nutritional substances can be kept distinct from the bile and from those pancreatic enzymes which would allow the absorption. As a consequence, diversion decreases digestion considerably resulting in the absorption of food and its caloric component. After the diversion procedure the staple diet is essentially with no restrictions except simple sugars (contained in fruits, sweets, milk, drinks and alcohol) since their absorption has not been altered. Biliopancreatic diversion is the most efficient procedure concerning the weight loss and the treatment of metabolic diseases which are often related to obesity. As a consequence, obese individuals with an high body mass index (BMI>50 for quite overweight people) with type II diabetes and/or hypercholesterolemy are more likely to undergo this procedure. The staple diet with no restrictions solve many of the problems that generally affect obese individuals.


• The malabsorption initially allows a great weight loss
• It allows the patient to consume a large amount of food because of the larger size of the gastric ‘pouch’
• the total average of the weight loss is greater than with gastric bypass and gastric banding procedures
• 98% of patients with type II diabetes and 100% with hypercholesterolemy have normal values of glicemy and cholesterol just after a few months from the time of the surgery.


• Much more complications than with gastric banding procedure
• A portion of the digestive part has been diverted decreasing the absorption of some nutritional substances and making indispensable for the patient the regular integration of vitamins, minerals and proteins
• Life-endangering of intestinal irritation and ulcers
• A very hard reversibility
• Death rate might be higher than with other procedures
• Probable weight regain for those individuals who overeat food, drinks or sweets again.

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