Dr. Ahmed
Which Weight Loss Surgery is the Safest? What is the safest form of weight loss surgery? Which weight loss surgery suits your health condition? Which weight loss surgery has the least complications?
These are common questions that we’ll try to answer here.
Introduction
Morbid obesity is a metabolic disorder that is currently rising at an alarming rate. It has multiple systemic complications ranging from simple GERD to life-threatening malignancies.
That is why many clinical trials are underway for the proper treatment and prevention of obesity.
Currently, among the different medical and surgical interventions, the most tremendous weight loss has been associated with weight loss surgeries.
Wegovy vs Sleeve Gastrectomy: Weight Loss Medicine Vs Surgery
However, compared to medical treatments like Wegovy, Saxenda, Contrave, Qsymia, and Xenical, weight loss surgeries are associated with more complications.
This is the reason why one should choose the safest form of weight loss surgery before embarking on any surgical intervention.
The safety profile of each bariatric surgical procedure differs.
Which Weight Loss Surgery is the Safest in terms of Mortality rates?
Mortality or death rate associated with weight loss surgery is probably the number 1 factor one should base the safety profile of a weight loss surgery on. The higher the weight loss surgery-associated deaths, the less safe is the procedure.
On the other hand, the safest weight loss surgery is the one that is associated with the least number of deaths and long-term disability or morbidity.
The overall death rate, 30-day death rate, 90-day death rate, and peri-operative death rates have been studied with the different currently practiced weight loss surgeries.
A meta-analysis studied the death rates associated with the different weight loss surgeries. The proportion of patients dying from each procedure is listed here in ascending order i.e from the least to the highest number of deaths associated with the procedure [Ref]:
Types of Weight Loss Surgery |
Mortality Rates |
| Gastric band | 0.03% |
| Sleeve Gastrectomy | 0.05% |
| Gastric bypass one anastomosis | 0.09% |
| Roux-en-Y Gastric Bypass | 0.09% |
| Duodenal switch | 0.41% |
As seen in the table above, the risk of a person dying from weight loss surgery is very small. The gastric band is the safest followed by Gastric Sleeve, Gastric Bypass, and Duodenal switch.
The risk of death from Duodenal switch is 14 times greater than Gastric banding, 8 times greater than Sleeve Gastrectomy, and 5 times greater than Gastric bypass surgery.
Which Weight Loss Surgery is the Safest and Least Invasive?
The least invasive surgery is considered the safest weight loss surgery. Invasive surgery is the one that involves the most incisions, dissections, resections, and anastomosis.
Surgical options are categorized here from the least invasive to the most invasive weight loss surgery.
Least invasive to most invasive weight loss surgery:
Type of Bariatric Surgery |
How Invasive |
| Intragastric Balloon | Least Invasive 😊 |
| Laparoscopic Adjustable Gastric banding | Less Invasive 🙂 |
| Laparoscopic Sleeve Gastrectomy | Invasive 😐 |
| Laparoscopic Roux-en-Y Gastric Bypass | Very Invasive 😣 |
| Laparoscopic Duodenal switch | Very very Invasive 😥 |
| Laparoscopic Biliopancreatic Bypass | The Most Invasive 😡 |
The safest weight loss surgery is based on the degree of manipulation of the gut and the natural anatomy.
The intragastric balloon is the safest procedure, followed by Gastric banding, Sleeve gastrectomy, Roux-en-Y Gastric Bypass, Duodenal switch, and Biliopanreatic Bypass.
Intragastric balloon system:
This is minimally invasive because it does not involve any kind of resection and is done through an endoscope. It is rather not a surgery. Intragastric balloons are currently of three major types. Two require the placement of balloons via an endoscope while one type is swallowed by the patient.
So, intragastric balloons are the safest of all, and the least invasive, but has their own stomach-related side effects.
Laparoscopic adjustable gastric banding:
Requires minimal dissection and one securing of the band with the stomach wall. It is probably the second least invasive surgery. It does not require any surgical dissections or resection of any part of the stomach.
Laparoscopic sleeve gastrectomy:
It involves the resection of the stomach only. Not much dissection is required in the rest of the gut. It does not cause significant malabsorption but has gastrointestinal side effects.
Gastric Sleeve Vs Gastric Bypass Surgery: Which is Safer & Effective?
Laparoscopic roux en y gastric bypass:
This is a more extensive procedure because it involves the resection of the stomach wall. Along with it requires resection and anastomosis of the small gut. This puts the patient at risk of developing anastomotic leaks and other complications.
Laparoscopic duodenal switch:
This is an extensive procedure because it requires resection and anastomosis at multiple levels. Thus there is a risk of complications arising from the anastomosis as well as the risk of obstruction because adhesive band formation increases at a later stage.
Laparoscopic bilo pancreatic bypass procedure:
This is the most invasive and extensive procedure of all bariatric surgeries currently in practice. Like a duodenal switch, it requires multiple anastomoses but its complication rates are high.
Even some patients had to undergo a reversal of this procedure. which itself is a very high-risk procedure.
The various complications associated with each of the above procedures are discussed in the next article: Complications of bariatric surgery.
