When Diets Fail: Gastric Reduction Surgery

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This is week one of a three-week series on gastric surgery.

Here’s a hypothetical: You are obese, you have multiple medical problems and you have tried every diet under the sun, stars and moon without success. Is it time to look at what’s available in the surgical world?

The decision to have bariatric surgery should not be made lightly. But it’s something to consider if you are obese (with a body mass index—BMI—over 35) and you have diabetes.

Bariatric surgery is highly effective but it still carries significant risks. So before making your decision, it’s important to know a bit about the options available to you

There are two general types of procedures: reduction (limiting the size of the stomach which forces you to eat less), and reduction/malabsorptive (nutrients including calories are absorbed into the circulation all along the length of the intestine). Today, we’ll talk about reduction. Check back tomorrow to learn more about malabsorptive surgeries.

After surgery, there are changes in gastric motility, an increase in insulin production and an improvement in insulin sensitivity. These changes, more than the weight loss, are responsible for the high diabetes remission rates (>65%) in type 2 patients who undergo these procedures.


Reduction surgeries shrink the stomach in one way or another. Since the procedure doesn’t change the anatomy of the lower gastrointestinal tract, normal digestive processes are maintained and the surgery has fewer complications than bypass procedures.

Gastric Sleeve (gastric sleeve resection, sleeve gastrectomy, tube gastrectomy) surgery changes the shape of the stomach from its usual lima bean form into more of a tube. At the same time, it’s shrunk by approximately 85 percent. This surgery is done through a tiny incision in your stomach (a technique known as “laparoscopically”), so it avoids some of the complications of large, open-wound procedures.

Vertical banded gastroplasty divides the stomach into two separate sections, so it resembles a lima bean with a hole in the middle. A band is placed between the upper pouch and the stomach base, and a small section of the upper portion is stapled off from the rest of the stomach, forcing the food to drop straight down from the esophagus into the lower (and now smaller) part of the stomach.

The band, which is squeezing the newly created pathway, slows the entry of food into the small intestine (the duodenum), which makes you feel fuller faster while diminishing the rate of glucose entry into the blood stream.

Laparoscopic adjustable gastric banding (LAGB) also creates a small stomach pouch to help patients reduce the amount of food they consume at any one time. A band is placed around the upper most portion of the stomach, allowing a small bubble of stomach to protrude above. Food fills this little pouch, causing a feeling of fullness, then slowly moves into the rest of the stomach to be digested—the rate that this happens is determined by the tightness of the band, which can be adjusted as necessary according to amount of weight lost.

LAGBs have the benefit of minimal side effects compared to some of the more extensive surgeries, but usually don’t result in the same degree of weight loss.

Check back with us tomorrow for details on bypass surgery

2 Responses to When Diets Fail: Gastric Reduction Surgery

  1. Pingback: Operation or Modification?: Weight Loss and Diabetes | Joslin Diabetes Center Blog

  2. When considering bariatric surgery, I believe it is always essential to consult with an endocrinologist. Certain hormonal disorders such as Cushing’s syndrome cause both weight gain and elevated blood glucose. Cushing’s is challenging to diagnose, and primary care physicians sometimes miss it. It is troubling to think that some patients undergo major bariatric surgery when what was really needed was treatment for Cushing’s. Visit the Cushing’s Support and Research Foundation website at http://www.csrf.net for more information.

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