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Bariatric Surgeries in Combination

Bariatric surgery helps thousands each year lose weight and avoid many serious obesity-related conditions and health problems, like heart disease, type 2 diabetes and sleep apnea. It is recommended for those unable to lose weight through non-surgical means such as diet and exercise.

As you consider which type of bariatric surgery is right for you, your bariatric surgeon may recommend a combination of two surgical approaches, restrictive and malabsorptive surgeries. By combing the positive effects of both procedures, your surgeon will reduce the size of the stomach and the length of the small intestine during the same surgery.

Restrictive vs. Malabsorptive Surgeries, What’s the Difference?

The terms “restrictive” and “malabsorptive” to describe procedures are considered dated. As understanding of weight loss through bariatric surgery has evolved, we now understand weight loss is not induced by restriction alone.

However, restrictive bariatric surgery is a procedure that achieves weight loss by reducing the size of your stomach. This limits the amount of food you can eat but does not disrupt the normal digestive process like the malabsorptive procedures can. Lap-Band is currently the only restrictive procedure.

Lap-Band surgery is an adjustable and reversible weight loss treatment. The procedure involves the placement of a silicone band or ring around the top part of the stomach to limit how much food you can eat at any given time. Because the stomach size is decreased, you will be fuller faster and will not eat as much food.

Nowadays, Lap-Band surgery is not a recommended procedure. This is because it is less effective than other procedures and has been linked to several long-term complications that require additional surgeries or revisions.

Malabsorptive bariatric surgery limits the number of nutrients your body can absorb by rerouting a portion of the small intestine. This procedure restricts the amount of food you can eat but also reduces the number of nutrients and calories that are absorbed to enhance weight loss results.

Although malabsorption is one way that weight loss is started, it is not the only way that surgery works. Science has shown that most of our procedures work through a combination of mechanisms.

Combination surgeries

Because both malabsorptive and restrictive surgeries offer certain benefits, bariatric surgeries in combination are typically the safest and most effective strategy for weight loss.

In sleeve gastrectomy, about 80% of the stomach is removed, including the portion responsible for producing the hunger hormone ghrelin. The remaining part of the stomach is reduced to the size of a small pouch, or stomach sleeve, about the size and shape of a banana.

Your health care provider may recommend sleeve gastrectomy if you are severely obese with a body mass index (BMI) over 40. Your BMI is a measure of body fat based on height and weight. Your provider may also recommend it if you have a BMI between 30 and 40 and a health condition such as sleep apnea, high blood pressure, heart disease or type 2 diabetes.

Gastric bypass surgery is a combination of both restriction and malabsorption. Sometimes referred to as Roux-en-Y gastric bypass, it is one of the most effective procedures to help lose and maintain weight.

Like sleeve gastrectomy, gastric bypass surgery creates a smaller stomach but also bypasses areas of the gastrointestinal tract where most of the sugar and fat absorption occurs. This technique can lead to a long-term positive dietary change, but you typically need to take nutritional supplements after surgery since the normal amount is no longer absorbed by the small intestine.

Your health care provider may recommend gastric bypass if you are severely obese with a body mass index (BMI) over 40. Your BMI is a measure of body fat based on height and weight. Your provider may also recommend it if you have a BMI between 30 and 40 and a health condition such as sleep apnea, high blood pressure, heart disease or type 2 diabetes.

The biliopancreatic diversion with or without a duodenal switch is mainly a malabsorptive bariatric surgery. The duodenal switch is one of the most complex and least performed bariatric surgeries. However, it can help you lose more weight than sleeve gastrectomy or gastric bypass (Roux-en-Y gastric bypass) surgery.

The procedure removes a large part of the stomach, creating a tube-shaped pouch. Part of the small intestine is cut and connected to the duodenum, while the intestine is reconnected to itself.

The duodenal switch is recommended for people who are severely obese, those who have a BMI of 50 or greater or a BMI of 40 or greater with serious type 2 diabetes and other serious health problems.

Making the choice

It’s not always an easy choice regarding which bariatric surgery will be best for you or what you feel most comfortable following through with at the end of the day. What’s most important is that the solution is right for you and your body and that you and your surgeon both agree on a surgery that you believe will deliver the best outcome.

Whatever decision you make, be prepared to follow post-operative guidelines so you can reap the full benefits and ensure you lose the amount of weight you need to stay healthy and well.

Our Expert Bariatric Team

Bariatric surgery needs a multidisciplinary approach to obesity care. The Banner Health weight loss team offers compassionate, comprehensive and advanced care. Our team is dedicated to providing you with the safest, most successful bariatric patient experience possible.

Surgery is only one part of that care. Equally important is the education, lifelong follow up and support our team provides. Our team partners with you to achieve your weight loss goals and improve your quality of life.

Your team will involve a surgeon or surgeons, obesity medicine doctors, nurse practitioners, nurses, dietitians, behavioral health specialists, support staff, medical assistants and some specialists in cardiology, pulmonology and sleep medicine. We are all working together with you on your care.

Take the Next Step: Am I a Candidate? 

Bariatric Center of Excellence

Banner Health is accredited by the American Society of Metabolic and Bariatric Surgery for its high standards of care in weight loss surgery.

Ready to begin your weight loss journey?

Register to watch our free informational video to learn about the different weight loss surgery options we offer as well as eligibility requirements and what you can expect as a patient in the program.

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