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Bariatric Surgery


Weight Loss Surgery (Bariatric Surgery)




About Bariatric Surgery





Types of Surgery

Today, there are three main surgical techniques for weight loss: gastric bypass, gastric sleeve, and gastric banding.

Gastric Bypass

Gastric bypass (also called "Roux-en-Y" gastric bypass) is the most commonly performed weight loss surgery. It involves creating a small pouch, about the size of an egg, at the top of the stomach using surgical staples or a plastic band. This pouch, which will serve as the "new" stomach, is then connected directly to the middle part of the small intestine (the jejunum).

So not only will the pouch hold a lot less food — just 1 cup as opposed to the 4 cups or more that a normal-sized stomach can hold — but the food will also bypass the larger part of the stomach and the upper part of the small intestine (the duodenum).

The pros of gastric bypass are that it has a high rate of success and a longer track record compared with the other options of gastric sleeve or gastric banding.

The cons are that even though it can often be done laparoscopically (using a few small incisions and a camera to guide the doctor's movements instead of opening up the abdomen), it still involves cutting the intestine — which makes it a more complex procedure than banding, and therefore has more potential for complications and a longer recovery time. The lack of intestinal absorption also tends to cause vitamin deficiencies and, unlike gastric banding, the procedure is not reversible.


Gastric Sleeve

Gastric sleeve (also called sleeve gastrectomy) is the second-most common weight loss procedure. With this operation, the surgeon removes part of the stomach and creates a tube or "sleeve" from the remaining portion. This new, banana-shaped stomach is much smaller than the original stomach.

After the operation, a person will eat less, feel full sooner, and be less hungry. Unlike gastric bypass, a gastric sleeve operation only changes the stomach. This kind of surgery doesn't divert food around part of the small intestine, so vitamin deficiencies are less likely.

Gastric sleeve surgery is less drastic and is easier to perform with fewer complications than gastric bypass. The gastric sleeve procedure is not reversible.


Gastric Banding

Gastric banding also works by decreasing the amount of food that can be comfortably eaten. An adjustable silicone ring is placed at the very top of the stomach to create a small pouch. Like gastric bypass and gastric sleeve, this band reduces the size of the stomach and makes people feel fuller sooner. Unlike bypass, though, banding does not interfere with food absorption in the small intestine.

The pros of gastric banding, which is done laparoscopically, are that it has a lower complication rate than the more invasive gastric bypass and gastric sleeve procedures, and vitamin deficiencies are less common because the intestine is not affected.


The cons are that it may not take off as much weight as the surgical bypass and sleeve options, and it may require replacement surgery later. Gastric band devices are not FDA-approved for people younger than 18. Though clinical trials are underway, most teens will not be able to get gastric band surgery.


Who Is a Candidate?


Generally, a teen's body mass index (BMI) — the number calculated from a person's height and weight that estimates body fat — should be 40 or higher, which constitutes severe obesity.

A teen with a slightly lower BMI (35 or higher) also may be a candidate for surgery if there are health problems like diabetes or obstructive sleep apnea. He or she must also be physically mature, which generally means at least 13 for girls or 15 for boys.


In fact, having the operation is only one step in losing weight. Teens need to build a new relationship with food — eating very small amounts, chewing thoroughly, and evenly spacing out food consumption throughout the day. For many, adjusting to this whole new way of eating and living in a "new" body can be overwhelming.


Risks and Side Effects


  • bleeding
  • reaction to anesthesia
  • infection at the incision site
  • a blood clot in the legs or lungs
  • bowel obstruction

Other side effects are more common and not quite as serious, but still unpleasant nonetheless. For example, many people who've had weight loss surgery have pain, vomiting, diarrhea, and acid reflux (heartburn) after eating — especially if they eat too much or too quickly. This is why they have to change their approach to eating. If they don't, not only will they continue to feel sick, but in time they can regain weight.



Some teens may undergo an identity crisis of sorts and have trouble relating to others in their new, thinner body. And others have such high expectations — thinking that the surgery will boost their popularity or bring them more attention — that they're disappointed to find that old problems still exist even at a smaller size.


Reviewed by: Mary L. Gavin, MD
Date reviewed: September 26, 2016