Laparoscopic Bariatric Surgery in Toronto

In the operation the surgeon removes most of the stomach, leaving a narrow tube. Portions become much smaller and levels of ghrelin, the hunger hormone, fall, so the patient feels full far sooner and eats less.

Effectiveness: the method is appropriate for a BMI of 35 to 45. Average loss of excess weight is 60–70%.

Specifics: the result holds up less well than after bypass operations. If the diet is broken, particularly with high-calorie drinks and liquid food, weight may come back.

The surgeon shapes a small pouch, 50–70 ml, from the top of the stomach and routes it directly to the small intestine. Food intake drops and calorie absorption decreases as food covers a shorter distance in the gut.

Effectiveness: the operation counts as the “gold standard” for BMI above 45–50 with type 2 diabetes; 75–85% of excess weight is lost.

Specifics: the result is more durable than with other bariatric techniques. Diabetes, hypertension and similar related conditions often enter remission. The changed digestive anatomy means lifelong vitamin and mineral supplements.

An upgraded take on the classic bypass. In contrast to the standard method, only a single connection (anastomosis) is made between the small stomach and the small intestine. Being simpler, the technique is easier on the patient and shortens recovery.

Effectiveness: close to the classic Roux-en-Y bypass, with patients losing up to 75–80% of excess weight.

Specifics: surgery takes less time and recovery is faster. It can technically be reversed; the single anastomosis, though, poses a risk of bile reflux.

SADI-S is a modern combined technique that unites the benefits of sleeve gastrectomy and intestinal bypass. It is done in two stages: first the stomach is turned into a narrow tube, then the small intestine is rerouted so that most of it is excluded from active digestion.

Effectiveness: one of the most powerful options in bariatric surgery: excess weight loss of 80–90%, lasting a long time.

Specifics: appetite falls as the smaller stomach loses the zone that produces ghrelin, while food rerouted around part of the intestine yields fewer absorbed calories. Right for super obesity (BMI over 50), severe type 2 diabetes, or as a second stage after an ineffective sleeve.