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Weight loss surgery breakdown: Which procedure is best for you?

Before and After BMI

December 19, 2018

Weight loss surgery breakdown: Which procedure is best for you?

Overweight woman in a library, smiling at camera while holding book.

If you’ve tirelessly tried diet and exercise but haven’t been able to lose weight and keep it off, weight loss surgery may be an option. Before considering any weight loss procedure, make sure you understand who each type of surgery is designed to help and what lifestyle changes need to be made after the procedure. Remember, rather than being a cure-all, weight loss surgery is a tool that, when combined with hard work, can help you lose weight and keep it off over time.

Several different types of procedures are available, and no single surgery fits everyone’s needs. Your doctor will explain your options to you, and your body mass index (BMI)—a measure of body fat that’s based on your height and weight—will play a large role in the type of procedure that you may qualify for. Having one or more obesity-related conditions can impact whether you qualify for one or more procedures.

The expert team at BMI of Texas in San Antonio offers the following guide to help you learn more about which weight loss procedure could be best for you:

Sleeve gastrectomy

Sleeve gastrectomy is usually performed laparoscopically, with your doctor using tiny instruments through small incisions. About 75 percent to 80 percent of your stomach is removed during this weight loss surgery, leaving a banana-shaped pouch. Due to your stomach’s smaller size, you can expect to eat less food than you did prior to the procedure. This surgery may also reduce the amount of the hunger-stimulating hormone ghrelin produced by your stomach, resulting in a reduced appetite.

This type of weight loss surgery is simpler than a gastric bypass, and you’ll still absorb the normal amount of nutrients from the food you eat. However, you may need supplements since you’ll be eating less.

Who is a good candidate for a sleeve gastrectomy procedure?

You may be a good candidate for sleeve gastrectomy if your BMI is 40 or higher, which is classified as extreme obesity. If you have a serious health condition that’s related to your weight—such as type 2 diabetes, sleep apnea, or high blood pressure—you may be able to have a lower BMI of 35 to 39.9. More than 75 percent of people who have laparoscopic gastric sleeve surgery experience an improvement or even a reversal of these diseases.


Gastric bypass

Gastric bypass, which is also sometimes referred to as the Roux-en-Y gastric bypass, is a more complicated procedure than the sleeve gastrectomy. The first stage of the surgery is like a gastric sleeve procedure and involves dividing the stomach, creating a small stomach pouch. The second stage involves working around the intestine—specifically, the first part of the small intestine is divided, and its bottom end is connected to your new, smaller stomach pouch. The divided small intestine’s top portion is then re-routed further down on the small intestine, which allows the first part of your small intestine to be bypassed so the stomach acids and enzymes will eventually mix with food lower down.

The procedure works by creating a small stomach pouch that holds far less food and it reduces the amount of ghrelin that your stomach produces. In addition, since a section of your small intestine is bypassed when you eat, you’ll absorb fewer calories and nutrients. You may be able to lose 60 percent of your excess weight—or more—in the two years after your surgery, and in general, gastric bypass patients tend to have a higher percentage of weight loss compared to those who undergo gastric sleeve surgery. As a result of this surgery, you may experience “dumping syndrome,” which occurs when your food is moved from your stomach pouch directly into your small intestine without being digested. If this happens, you may need to change your diet or take prescription medicine.

Who is a good candidate for gastric bypass?

Gastric bypass is usually performed in obese patients who have a BMI of more than 45. In some cases, you can qualify for the procedure with a lower BMI if you have an obesity-related condition that may be improved by gastric bypass surgery.

Duodenal switch

The duodenal switch procedure combines a sleeve gastrectomy procedure with an intestinal bypass. As with the sleeve gastrectomy, about 60 percent to 70 percent of your stomach is removed, leaving a banana-type pouch. The lower intestine is divided further down than with a gastric bypass procedure; most of the intestine is bypassed, and the first part of the intestine (the duodenum) is divided and attached to the intestine’s lower part (the ileum). The pylorus—the muscle that controls the emptying of the stomach—is preserved, so the dumping syndrome more often seen with a gastric bypass is unusual in a duodenal switch procedure.

Duodenal switch restricts the amount of food you can eat and the calories your body can absorb, and also eliminates the production of ghrelin. You may have more frequent, looser bowel movements after this type of surgery. Many patients are able to lose 60 percent to 80 percent of their excess weight over two years, and most are able to keep this weight off for over 10 years.

Who is a good candidate for a duodenal switch procedure?

This type of surgery is generally recommended for patients with a BMI of 50 or greater. It can result in greater weight loss and improvement of obesity-related conditions, but it also comes with a greater risk of complications and is a more technically difficult type of surgery to perform. In some cases, it can be performed in two separate stages, one to divide and remove part of the stomach and one to rearrange the intestines. These may be performed about a year apart if this better suits the patient’s medical needs.


BMI of Texas no longer offers LAP-BAND due to the challenges of this type of bariatric surgery. This procedure can result in multiple follow-up appointments as well as follow-up surgeries due to complications.

BMI of Texas is happy to help you manage or remove a LAP-BAND you already have. If necessary, a different surgery may be suggested to revise complications and weight loss issues.

Revision surgery and incisionless revision surgery

Revision surgery is a more difficult type of surgery that’s performed to help patients who have regained weight after a weight loss procedure or had significant complications afterward. It is usually performed as a minimally invasive surgery, often using the DaVinci Robot to navigate through scar tissue.

Some surgeries may be performed with an Overstitch device attached to a scope placed down a patient’s mouth. Sutures are then used to shrink a pouch or tighten a connection.

Who makes a good candidate for revision procedures?

You may be a good candidate for a revision procedure if you’ve had a previous procedure but regained weight or had complications.

Since revision surgeries are more complicated, your surgeons will have to run a number of tests before conducting the procedure. You’ll also be required to start the BMI of Texas medical weight loss program to increase the surgery’s chances of success.

To find out whether weight loss surgery might be right for you—and if so, which one—contact BMI of Texas today. We’re happy to help you evaluate your options, giving you the insight you need to make an informed decision that will give you the best chance of weight loss success.

You may be interested in: Do I Qualify for Weight Loss Surgery Quiz