The most important step in weight loss surgery is getting all of the information you need about the various bariatric surgery options. Ultimately your weight loss surgeon and other physicians are your best resource for information about the procedure they will recommend to you. When you ask a question, make sure you understand the answer. Do not hesitate to ask for a clearer explanation given in simpler language. The decision to have a weight loss surgery may take several office visits and consultation with more than one weight loss surgery specialist. You may choose to research weight loss surgery on your own via the Internet or through your local library. As with any search for medical information, be sure that your sources are responsible recognized experts in the field you are investigating. There are several valuable online resources for learning more about your weight loss surgery options including the American Society for Bariatric Surgery. 

Although the results of weight loss surgery can be drastic, there are potential risks and complications. Before making your decision, you should be well informed. These steps are necessary if you are to give what is called "informed consent" for the bariatric procedure. Informed consent is a legal term meaning that a weight loss surgery patient agrees that they have received and understood enough information about a procedure's benefits and risks to allow them to make a decision that is right for them. Your weight loss surgery specialist will require you to sign a consent form before performing your procedure. Before you sign a consent form, you should have a solid understanding of what is about to take place. You should know what you would need to do to live well after the bariatric procedure. And you should be aware of the signs or symptoms of complications to look for which may occur after your weight loss surgery treatment.

Important Considerations
Weight loss surgery should not be considered until you and your weight loss surgery specialist have evaluated all other weight loss treatments and options. The proper approach to bariatric surgery treatments requires discussion and careful consideration of the following with your doctor:

1. Laparoscopic weight loss surgery procedures are in no way to be considered cosmetic procedures.
2. Laparoscopic weight loss surgery does not involve the removal of adipose tissue (fat) by suction or excision.
3. A decision to elect surgical weight loss treatment requires an assessment of the risk and benefit to the patient and the meticulous performance of the appropriate surgical weight loss procedure.
4. These laparoscopic weight loss surgical procedures (approved in the United States) are reversible only under special circumstances.
5. The success of laparoscopic weight loss surgery is dependent upon long-term lifestyle changes in diet and exercise.
6. Problems may arise after laparoscopic weight loss surgery that may require re-operations.

The Success of any bariatric surgery treatment must begin with realistic goals and progress through the best possible use of well-designed and tested operations.

Weight Loss Surgery Options
The American Society for Bariatric Surgery describes two basic approaches that weight loss surgery takes to achieve change:

1. Restrictive surgical weight loss procedures that decrease food intake.
2. Malabsorptive surgical weight loss procedures that alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in the stool.

Adjustable Gastric Banding Surgery
Lap Band weight loss surgery is a purely restrictive procedure. The Lap Band surgery option restricts how much the stomach can hold by placing an adjustable band around the upper part of the stomach. The result is you take in less food. The LAP-BAND can be adjusted to suit your situation, and can be removed if necessary. The success of lap band surgery, however, also depends on how motivated you are and how committed you are to your goal of long lasting weight loss.

Advantages of Lap Band Weight Loss Surgery
The primary advantages of Lap Band weight loss surgery is that a reduced amount of well-chewed food enters and passes through the digestive tract in the usual order. This allows the nutrients and vitamins (as well as the calories) to be fully absorbed into the body.

Possible complications with Lap Band Weight Loss Surgery:

• Ulceration
• Gastritis (irritated stomach tissue)
• Heartburn
• Gas bloat
• Dysphagia (difficulty swallowing)
• Dehydration
• Constipation
• Weight gain
• Death
• Laparoscopic surgery possible complications
• Spleen or liver damage
• Damage to major blood vessels
• Lung problem
• Thrombosis (blood clots)
• Rupture of the wound
• Perforation of the stomach esophagus during surgery
• Readmission to the hospital may be required for fluid replacement or nutritional support if there is excessive vomiting and adequate food intake cannot be maintained

Gastric Bypass Roux-en-Y
In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. 

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages

• The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
• One year after surgery, weight loss can average 77% of excess body weight.
• Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
• A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

Risks

• Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
• Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
• A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
• A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
• In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.
• The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

Laparoscopic Weight Loss Surgery
When a laparoscopic weight loss surgery is performed, a small video camera is inserted into the abdomen. The bariatric surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures. 

The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery resulting in easier breathing and lung function and higher overall oxygen levels. Other realized benefits with laparoscopic weight loss procedures have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.

Laparoscopic weight loss surgery procedures employ the same principles as their "open" counterparts and produce similar excess weight loss. Not all weight loss surgery patients are candidates for this approach.