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Weight Loss Surgery resource in Mexico

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BARIATRIC SURGERY

COMPARE BARIATRIC SURGERIES

Our patients frequently ask: how do I know which weight loss surgery is best for me? Choosing the right type of surgery is very important. It can prevent a lot of discomfort in the future, provide longer lasting results, as well as help resolve certain comorbidities more successfully.

Making the right choice will require a lot of thought, research on your part, and discussion with your doctor at home and our medical team. Please do not feel pressured to make a decision at the time of making your initial inquiry with our team. Our surgeons allow our patients to make their final decision even on the day of surgery.

Upon admission to the hospital, you will have the following options:

  • You may request a certain surgery type regardless of the recommendations provided by our medical team. For example, you may want to proceed with a gastric sleeve surgery due to a fear of a more invasive gastric bypass. Our surgical team will perform the surgery of your choice, unless there are serious health conditions that would make your preferred surgery option unacceptable and performing it unethical. We will discuss this matter further in the article dedicated to the significance of the pre-operatory endoscopy.
  • If you are still undecided on the day of surgery, you may entrust making this decision to our surgeons. Based on the pre-operative endoscopy results, our doctor will choose the type of surgery that will be the most beneficial for you. The importance of the endoscopy before surgery is explained HERE.

WHAT TYPES OF BARIATRIC PROCEDURES ARE THERE?

There are three basic types of bariatric surgery – restrictive surgeries, malabsorptive/restrictive surgeries, and purely malabsorptive surgeries. They help to lose weight in different ways.

An overweight woman smiling

Restrictive Surgeries

Restrictive surgeries are a type of bariatric surgery that induces weight loss by significantly reducing the size of the stomach. Naturally, a stomach can hold about 3 pints of food. After bariatric surgery, the stomach may at first hold as little as an ounce, although later, it could stretch to 3 or 4 ounces. The smaller the stomach, the less you eat. The less you eat, the more weight you lose. Examples of this type of surgery are gastric banding and gastric sleeve (regular or with a single incision). At Go Light Bariatrics we do not offer gastric banding (also called Lap Band) as this procedure is considered outdated, has multiple side effectsfollow-up, requires, follow up visits with a bariatric surgeon, and there are other more effective surgery options available nowadays.

An overweight woman laughing

Malabsorptive/Restrictive Surgeries

Malabsorptive/restrictive surgeries are a combination of physically restrictive and malabsorptive effects. In addition to restricting the size of the stomach, this type of weight loss surgery works by bypassing a portion of the small intestine. Almost all of the absorption of nutrients is performed in the small intestine. When bypassing a portion of the small intestine, food absorption becomes incomplete, and patients lose weight. Examples of this type of surgery are gastric bypass (RNY or Mini), SADI-S, and duodenal switch (DS). At Go Light Bariatrics, we consider SADI-S and Duodenal Switch options rarely, mainly in revisional cases.

An overweight woman in a blue shirt

Malabsorptive Surgeries

Malabsorptive surgeries. Purely malabsorptive procedures that bypass large sections of the intestine are no longer performed because they caused significant side effects including potentially dangerous nutritional deficiencies, dehydration, and electrolyte imbalances. These types of surgeries are now performed only in combination with restrictive procedures and patients undergoing this type of combination are carefully monitored for these side effects.

HOW DO I DECIDE WHICH OPTION IS BEST FOR ME PERSONALLY?

Before recommending a specific surgery type, our doctors will review your health history questionnaire and consider such crucial factors as:

•        Previous WLS (if any)
•        GERD (acid reflux)
•        Barrett`s Esophagus
•        Heartburn
•        IBS (irritable bowel syndrome)
•        Chron`s Disease
•        Diabetes (type 1 and 2)
•        High blood pressure
•        BMI
•        Age

There is no perfect choice, each surgery option has its own pros and cons. Below we provide opinions of our surgeons based on their vast experience, but ultimately, the success rate depends on adherence to the new lifestyle.

GASTRIC SLEEVE

(RESTRICTIVE SURGERY, ALSO KNOWN AS VERTICAL SLEEVE GASTRECTOMY OR VSG)

In general, gastric sleeve is recommended for patients who do not suffer from heartburn, GERD, and with lower BMI of 29-30 and up. Gastric sleeve can be used as the only bariatric surgery sufficient to reach goal weight. Or in case of high BMI patients, it can be used as the first step in weight loss process followed by a second bariatric surgery 2 + years later in order to achieve best results. Weight loss can be equally successful with the sleeve and with the bypass, and regain, partial or full, can take place after either procedure if the patient returns to their old eating habits. 

Advantages:

  • Guaranteed restriction. Generally, gastric sleeve provides a stronger restriction effect compared to any bypass (although not always, some bypasses provide very strong restrictions depending on how your body heals and scars)

Disadvantages:

  • Gastric sleeve patients are at a high risk of developing acid reflux (GERD) no matter whether they had it before surgery or not. It can be mild and controlled by antacids that may be needed daily or on occasion for the rest of your life, or it can be severe and require a revision surgery from sleeve to RNY bypass.

GASTRIC SLEEVE SINGLE INCISION

(RESTRICTIVE SURGERY)

Patients with BMI under 35, without prior abdominal procedures, such as tummy tuck, may qualify for a gastric sleeve with only one abdominal incision made through the belly button (one additional tiny incision on the far-left side of the abdomen may still be required for the drain tube).

Advantages:

  • Less scars. This type of surgery is chosen mainly for aesthetic reasons, as it creates less scarring on the abdomen (patients who suffer from keloid scars may have particular interest in this option). But when it comes to the anatomy of the gastric sleeve itself, there is absolutely no difference between a gastric sleeve performed with multiple incisions and gastric sleeve performed with one incision.

Disadvantages:

  • Possibly more pain. The main incision made through the belly button is usually more painful and requires longer healing time compared to regular incisions. Since the surgeons can only use one incision for all the surgical instruments being inserted and removed, it causes more trauma to that incision (stretching and irritation) resulting in more pain during the healing process. This is caused also because a lot of nerve endings are concentrated around our belly button and the area is much more sensitive.
  • Extra cost. Because single incision gastric sleeve surgery requires more efforts on behalf of the surgical team and a longer time in the operation room, an extra cost applies. Also, if a patient has a hiatal hernia that needs to be repaired, or if gallbladder removal is required, single incision surgery is rarely possible.
  • Not suitable for patients who have had previous WLS such as lap band, plastic surgery such as tummy tuck; those with higher BMI over 35 or patients with extra-large liver.
  • Not an option when a patient requires a hiatal hernia repair or gallbladder removal (normally surgeon needs to make at least 1-2 additional incisions)
  • Nonreversible

MINI GASTRIC BYPASS

(MALABSORPTIVE/RESTRICTIVE SURGERY)

This procedure is slightly less invasive compared to full RNY bypass as it requires only one intestinal connection (anastomosis) whereas RNY bypass requires 2 intestinal connections. Less connections means less complication risk. Do not be misguided by the name of the procedure. “MINI” does not mean less malabsorption and less weight loss, rather it indicates less invasive surgery due to only one intestinal connection required.

Advantages:

  • Mini-Bypass is a great option for patients who do not report any heartburn or GERD, or only have mild heartburn with occasional use of antacids.
  • Due to malabsorption, it helps control diabetes (type 1 or 2) better than gastric sleeve.
  • Recommended for BMI 35 +
  • Dumping. Recommended for patients who are addicted to sweets (malabsorptive procedures are more likely to cause dumping syndrome as a consequence of eating large amounts of sugar. This unpleasant reaction prevents the patient from eating too much sugar again.)
  • Good option for patients who have had lap band or gastric sleeve surgery in the past and need to lose more weight via revision surgery.
  • Reversible

Disadvantages:

  • Not the best option to fix an already existing GERD
  • Risk of developing stomach ulcers or so-called marginal ulcers around the anastomosis
  • Due to a specific anatomy of Mini Bypass, it comes with the risk of developing bile reflux (which can be even more damaging to the stomach and esophagus than acid reflux).
  • Restriction varies among patients. Anastomosis (also called stoma, the connection between the stomach pouch and the small intestine) can stretch with time and restrictive effects will decrease.
  • Lifetime adherence to the vitamin regimen is required due to malabsorption; it also means a higher risk of metabolic disorders, diarrhea, vitamin or mineral deficiencies and protein deficiency.
  • Higher cost compared to gastric sleeve

RNY GASTRIC BYPASS

(MALABSORPTIVE/RESTRICTIVE SURGERY, ALSO KNOWN AS ROUX-EN-Y BYPASS OR FULL BYPASS)

This procedure is still called the golden standard in bariatric surgery and statistically has longer-lasting results compared to restrictive surgeries only. It is generally recommended for patients with higher BMI (BMI over 45-50 +), as gastric sleeve alone may not be sufficient for such patients to achieve their goal weight.

Advantages:

  • Great option for everyone who already suffers from strong heartburn or GERD and/or diabetes (type 1 or 2). For the vast majority of bypass patients, GERD resolves completely or at least decreases significantly. Although a small percentage (about 5%) continue suffering from GERD even after RNY bypass.
  • Due to double weight loss effect (restriction + malabsorption), RNY bypass promotes better weight loss.
  • Due to malabsorption, better diabetes control (type 1 or 2) .
  • Recommended as a primary surgery for BMI 45 + without acid reflux, or BMI 32 + with acid reflux.
  • Dumping. The intestines are much more sensitive than the stomach and this can cause unpleasant reactions to certain types of food. Usually high-calorie foods, such as concentrated sugars and fats, are the type that cause problems. Dumping can include nausea, diarrhea, cramping and low blood sugar. These unpleasant side effects help you stay away from junk food.
  • Recommended as a revision surgery for patients who suffer from severe GERD (acid reflux), in such special cases lower BMI is acceptable 25 + (with smaller portion of the small intestine being bypassed)
  • Good option for patients who had lap band or gastric sleeve surgery in the past and need to lose more weight via revision surgery.
  • Reversible

Disadvantages:

  • The vast majority of patients develop strong restrictive effects, but some do not. It depends on the healing process (scarring of the anastomosis) and on every individual`s stomach tissue (elasticity)
  • Risk of developing stomach ulcers or so-called marginal ulcers around the anastomosis.
  • Risk of intestinal obstruction.
  • Lifetime adherence to a vitamin regimen is very important for all bariatric procedures but especially those that involve malabsorption (RNY, Mini bypass, SADI-S, DS).
  • Risk of developing diarrhea (especially when larger portion of the small intestine needs to be bypassed in case of an extra high BMI or RNY to RNY revisions)
  • Higher cost compared to gastric sleeve
  • Slightly longer recovery time compared to less invasive gastric sleeve.

SADI-S

(MALABSORPTIVE/RESTRICTIVE SURGERY, ALSO KNOWN AS SINGLE
ANASTOMOSIS DUODENAL-ILEAL BYPASSWITH SLEEVE OR LOOP DS OR LOOP DUODENAL SWITCH)

Yet another option that has become available recently. This procedure is a type of a duodenal switch, is considered more invasive than RNY bypass but less invasive than regular Duodenal Switch (DS) due to only one intestinal anastomosis. If your BMI is over 50 and/or you have type II diabetes, you don’t suffer from bowel issues or reflux, and you can commit to a lifetime of vitamin and protein supplements, then the SADI-S can be an extremely powerful weight loss tool for you.

Advantages:

  • Safer option for medical tourism patients compared to classic DS due to the fact that only one intestinal bypass is made, rather than two, resulting in less time in surgery and reduced risk of intestinal leakage.
  • Guaranteed restriction. SADI-S preserves the lower stomach sphincter just like in gastric sleeve (thus providing guaranteed restrictive effect)
  • Stronger malabsorptive effect than a regular bypass
  • Research shows better weight loss results compared to RNY bypass or sleeve by about 10%. This is achieved by a biliopancreatic diversion.
  • Recommended for higher BMI 50 +
  • Good option for those who do not suffer from heartburn or reflux and who worry about not losing enough weight with a sleeve alone
  • Recommended as a primary procedure or as a revision surgery after gastric sleeve or lap band
  • Good option for those who have diabetes (malabsorption helps fight this issue).
  • Dumping due to malabsorption (helps to stay away from junk foods high in fat and sugar)
  • Does not have the ulcer risk of a Gastric Bypass

 Disadvantages:

  • Not suitable for patients with GERD (acid reflux) or strong heartburn, or irritable bowel syndrome (IBS) .
  • Higher risk of malnutrition and vitamin deficiency compared to regular bypass
  • Risk of developing diarrhea
  • Risk of intestinal obstruction
  • Irreversible
  • Longer recovery time compared to sleeve or bypass
  • Higher cost

At Go Light Bariatrics we will help you make the right choice. Our bariatric surgeons will thoroughly evaluate your health status based on the information you provide in our detailed medical history form as well as during the pre-operative consultations that are mandatory in order to be approved for surgery