).
The pros of gastric bypass are that it has a high rate of success and a longer track record compared with the other options of gastric sleeve or gastric banding.
The cons are that even though it can often be done laparoscopically (using a few small incisions and a camera to guide the doctor's movements instead of opening up the abdomen), it still involves cutting the intestine — which makes it a more complex procedure than banding, and therefore has more potential for complications and a longer recovery time. The lack of intestinal absorption also tends to cause vitamin deficiencies and, unlike gastric banding, the procedure is not reversible.
Gastric sleeve (also called sleeve gastrectomy) is the second-most common weight loss procedure. With this operation, the surgeon removes part of the stomach and creates a tube or "sleeve" from the remaining portion. This new, banana-shaped stomach is much smaller than the original stomach.
After the operation, a person will eat less, feel full sooner, and be less hungry. Unlike gastric bypass, a gastric sleeve operation only changes the stomach. This kind of surgery doesn't divert food around part of the small intestine, so vitamin deficiencies are less likely.
Gastric sleeve surgery is less drastic and is easier to perform with fewer complications than gastric bypass. The gastric sleeve procedure is not reversible.
Gastric banding also works by decreasing the amount of food that can be comfortably eaten. An adjustable silicone ring is placed at the very top of the stomach to create a small pouch. Like gastric bypass and gastric sleeve, this band reduces the size of the stomach and makes people feel fuller sooner. Unlike bypass, though, banding does not interfere with food absorption in the small intestine.
The pros of gastric banding, which is done laparoscopically, are that it has a lower complication rate than the more invasive gastric bypass and gastric sleeve procedures, and vitamin deficiencies are less common because the intestine is not affected.
The band can be tightened or loosened to increase or decrease weight loss. Doctors adjust the band at periodic visits by inflating or deflating it through a port placed under the skin. The band may even be removed entirely if necessary, allowing the stomach to return to its normal size.
The cons are that it may not take off as much weight as the surgical bypass and sleeve options, and it may require replacement surgery later. Gastric band devices are not FDA-approved for people younger than 18. Though clinical trials are underway, most teens will not be able to get gastric band surgery.
Figuring out if a teen is a candidate for weight loss surgery is a big decision that requires a team approach, including the teen, his or her family, doctors, nutritionists, and psychologists.
Generally, a teen's body mass index (BMI) — the number calculated from a person's height and weight that estimates body fat — should be 40 or higher, which constitutes severe obesity.
A teen with a slightly lower BMI (35 or higher) also may be a candidate for surgery if there are health problems like diabetes or obstructive sleep apnea. He or she must also be physically mature, which generally means at least 13 for girls or 15 for boys.
The team will consider other things, too: Is the teen healthy enough for surgery? Have other weight loss options failed? Does he or she understand what's involved? Weight loss surgery is serious stuff — both physically and emotionally.
In fact, having the operation is only one step in losing weight. Teens need to build a new relationship with food — eating very small amounts, chewing thoroughly, and evenly spacing out food consumption throughout the day. For many, adjusting to this whole new way of eating and living in a "new" body can be overwhelming.
That's why doctors take a cautious approach when it comes to weight loss surgery for teens, and only recommend it for those who have what it takes to make it a success: the motivation to make lifelong changes and the support of their family to help them do so.
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