Understanding Bariatric Operations: Types and Differences Explained

When we search the net for types of bariatric procedures all sorts of confusing terms are encountered. Is bariatric and weight loss surgery the same, or are metabolic surgery and surgery for diabetes similar, you will find many similar-sounding names that add up to confusion.

I will try to make it a bit simpler. Broadly speaking all bariatric and metabolic operations can be clubbed into two major types, a restrictive type operation, or a mal-absorptive type. However, there is no such thing as a purely restrictive or a purely mal absorptive operation. For example, sleeve gastrostomy has also some mal- absorptive components too.

Type of Bariatric Operations

The most common type of bariatric operation is Sleeve Gastrectomy; LSG and Gastric sleeve, are its other name. In common parlance it is also known as stomach stapling whereas, stapling is a technique of cutting and sealing tissue, it is employed in all bariatric and many GI surgeries.

Then there are types of bypass operations called Gastric bypass, one such operation is RYGB which is a standard and the longest-running operation for morbid obesity lasting more than 40 years. In fact its anti-diabetic effects were discovered accidentally, when it was done for other diseases, later on, it was modified to suit weight loss requirements.

Mini Gastric bypass, one anastomosis gastric bypass (OABG), and Billroth- 2 are the names of a variant of RYGB. There are minor technical differences with different outcomes and complications. A word of caution, however, it is a powerful operation, there is nothing mini about it.

In other types of bypass operations, a bypass is added to Sleeve Gastrectomy to potentiate its anti Diabetic effect, here the bypass joint is made at the level of duodenum the first part of the intestine. Depending upon how much intestine is bypassed, They are named, for example, DJB in which the first 2 meters of intestines are bypassed, and SADIS in which the majority of the small intestine is bypassed leaving only the last 3 meters to absorb nutrients.

Then there are metabolic surgeries for diabetes, that have a profound effect on glucose metabolism i.e. sugar control, but with minimal weight loss; Ileal-interposition is one such operation which is performed majorly in Brazil, and select centers, in India and abroad. Duodenojejunal Bypass (DJB) also comes under this category; its effect on Diabetes is similar to the Ileal- interposition.

So, it is enough to remember there are two major types of bariatric operations one with a bypass and the other without. The rest is all technical.