The adjustable gastric band is adjusted depending on the weight management plan and is tailor-made for patients. The band is positioned around the upper part of the stomach, forming a small pouch. It can help reduce the amount of food that a person wants to eat by inducing a sense of fullness after eating only a small amount of food. Although the weight reduction effect is less than that of gastric bypass or gastrectomy, it is relatively safe compared with other bariatric procedures. One of the drawbacks of this type of surgery is that the band will stay inside the body of the person permanently. Although this surgery helps reduce food intake, if the person continuous to consume energy-dense foods such as sugary drinks, ice cream, chocolate, etc., the expected amount of weight loss cannot be achieved.
"Sleeve gastrectomy" involves the removal of part of the stomach and leaving a small gastric tube. This leads to a decrease in the stomach size, an increase in the patient’s sensation of fullness, and eventually causing a decrease in appetite. Furthermore, the surgery removes the secretion site of appetite-stimulating hormones and therefore increases satiety. However, since the surgery involves removal of part of the stomach, there is a potential risk of leakage and bleeding. Gastric-reflux may occur after this surgery and long-term medications may be needed. Before deciding to receive this irreversible surgery, patients should have a thorough understanding of the procedures and potential risks.
In the gastric bypass surgery, the stomach is divided into a small upper pouch and a much larger, lower "remnant" pouch. The volume of small pouch is only 20-50ml. The small intestine is re-arranged to allow food to enter distal small bowel without passage of the remnant stomach, duodenum and proximal jejunum (150-200cm of small intestine in total). Since the size of the stomach is reduced, the eating portion becomes smaller and the absorption area in the small intestine is shortened; thus, rapid weight loss is expected. This is a complicated surgery which requires a long operation time, so there is a risk of leakage and bleeding. After the surgery, absorption of many essential nutrients and vitamins become limited and many people will require nutritional supplements on a daily basis. The advantages of this surgery include provision of a faster weight loss and a lower chance of weight regain. This surgery also effectively treats type 2 diabetes. Most of the people with diabetes have significant improvement after surgery, and some of them may be able to wean off their diabetes medication altogether.
This surgery includes sleeve gastrectomy and duodenojejunal bypass. The first part of this surgery is similar to the traditional sleeve gastrectomy. It involves removal of part of the stomach and leaving a small gastric tube. Meanwhile, rearrangement of the small intestine allows food to enter distal small bowel without passage of remnant stomach, duodenum and proximal jejunum (150-200cm of small intestine in total), which affects the absorption rate. This surgery applies mostly to people with type 2 diabetes. It helps reduce food intake and appetite of the patients. Also, the food bypasses the duodenum and part of the jejunum which stimulates intestinal hormonal secretion and improves insulin secretion. This eventually helps with glycaemic control and weight reduction. With the complexity of this surgery, there are risks of leakage and bleeding during or after the surgery. Complication such as anaemia and osteoporosis may occur due to chronic vitamin deficiency. Meanwhile, more evidence on the long term efficacy of this surgery is needed.
The intragastric balloon is inserted through the mouth and down the oesophagus into the stomach, giving a sensation of satiety. The intragastric balloon is not a permanent treatment with a maximal treatment period of 6 months. Stomach ulcers may occur if the balloon remains in the stomach for too long. Balloon deflation may lead to bowel obstruction. After 6 months, the balloon is removed in the same way that it was placed, via the oesophagus and mouth. After the balloon is inserted, the body weight is expected to drop by around 10kg on average. Upon removal of the balloon, weight regain occurs. Therefore, adherence to a healthier lifestyle such a balanced diet and regular exercise is necessary in order to avoid weight regain after this procedure.