What is Restrictive Surgery for Weight Loss?

If you and your doctor have decided that weight loss surgery is right for you, you have several options. In a restrictive surgery, a surgeon uses one of a variety of techniques to reduce the size of the stomach. After restrictive surgery, you’ll feel full faster, eat less, and lose weight.

The full names for the three types of restrictive surgery for weight loss are:

• Laparoscopic adjustable gastric banding
• Vertical banded gastroplasty
• Sleeve gastrectomy

What Is Gastric Banding Surgery?

The surgeon uses laparoscopy (which involves small cuts in the belly) to place an adjustable silicone band around the upper part of the stomach. Squeezed by the silicone band, the stomach becomes a pouch with about an inch-wide outlet. After banding, the stomach can hold only about an ounce of food.

A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. Injecting saline fills the band and makes it tighter. In this way, the band can be tightened or loosened as needed to reduce side effects and improve weight loss.

What Are the Results of Gastric Banding?

Gastric banding surgery is no longer commonly performed because of its high failure rate. This procedure usually leads to a loss of about 35% to 45% of excess weight. For example, someone who is 100 pounds overweight might expect to lose about 35 to 45 pounds after gastric banding. However, results vary widely. The procedure can be reversed if necessary, and in time, the stomach generally returns to its normal size.

What Are the Side Effects?

People tend to have few problems as a result of gastric banding surgery. The risk of death due to gastric banding surgery is less than one in 3,000. The most common problems after gastric banding surgery include:

• Nausea and vomiting. These can often be reduced by adjusting the tightness of the band.
• Minor surgical complications. These include problems with the adjustment device, wound infections, or minor bleeding, and they occur less than 10% of the time.

Unlike gastric bypass surgery, gastric banding does not interfere with food absorption. For this reason, vitamin deficiencies are rare after gastric banding.

What is Sleeve Gastrectomy?

In a sleeve gastrectomy, more than half of your stomach is removed, leaving behind a thin vertical sleeve about the size of a banana. Because part of your stomach is removed, this surgery is not reversible.

Gastric sleeve surgery is becoming the most popular method of restrictive operations both because of its success rate and the lower incidence of complications. Those who have had this surgery report losing 40% to 50% of their overall weight.

The procedure is performed either through a large incision in the abdomen (an open procedure) or laparoscopically (several small incisions using small instruments and a camera as a guide). Physical recovery takes 4 to 6 weeks.

What Is Vertical Banded Gastroplasty?

Vertical banded gastroplasty (VBG) also involves a plastic band placed around the stomach. In addition, the surgeon staples the stomach above the band into a small pouch.

Vertical banded gastroplasty results in less weight loss, compared with other surgeries. It also has a higher complication rate. For these reasons, vertical banded gastroplasty is less common today. Only 5% of bariatric surgeons still perform this surgery.

What Is a Mixed Surgery? (Restrictive and Malabsorptive)

Restrictive surgery is an important part of nearly all weight loss surgeries. During a gastric bypass, a common weight loss surgery, restrictive surgery is done first. This "stomach stapling" creates a small stomach pouch. Then, the new stomach pouch is reconnected to a part of the small intestine farther down. This leads to less food eaten (restrictive) and less food absorbed (malabsorptive).

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