What Type of Weight Loss Surgery Is Best for Women With PCOS?

The Difference Between the 3 Most Common Types of Weight Loss Surgeries

obese woman on scale
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Bariatric surgery can be an effective way of achieving weight loss for women with Polycystic ovarian syndrome (PCOS). But trying to figure out which type of weight loss surgery is best for you can be a difficult and confusing learning process.

Bariatric surgery has been around since the 1960's and now most of the procedures are performed laparoscopically, meaning through a series of small incisions using a camera inside the body.

Choosing the Best Type of Weight Loss Procedure For You

Making the decision to have weight loss surgery is a big one, as is finding your surgeon and ultimately, what type of surgery to have. There are many different types of surgery and your surgeon will likely have a preference or recommendation as to which will be most effective for your PCOS.

Your doctor will likely suggest the procedure with which she has most success with, an important reason for why you want a surgeon who has experience working with women with PCOS. There are multiple types of procedures and each has its advantages and disadvantages:

Roux-En-Y

Laparoscopic Roux-En-Y Gastric Bypass is the most widely performed procedure, and involves the following steps:

  • Rearranging the gastrointestinal (GI) tract so that food bypasses a majority of the stomach and small intestine.
  • A small pouch is created at the top of the stomach.
  • A second incision is made at the lower part of the small intestine, which is connected to the pouch made at the top of the stomach.
  • This allows food to bypass a majority of the part of the (GI) tract that absorbs nutrition and calories.

Roux-en-Y seems to be very effective at reversing insulin resistance, a significant problem for women with PCOS, even before the patient has lost weight. 

On the other hand, this procedure carries a higher risk of the malabsorption of many nutrients.

This is often corrected, and prevented, with supplements that may be necessary to prevent severe nutritional defects. You will also require close monitoring and frequent follow-up appointments to keep an eye on your nutritional status.

There are also other risks, including gallstones, blockage, leakage through the sutures or staples, and dumping syndrome (an unpleasant condition where certain foods or drinks cause severe cramping and diarrhea).

Lap Band

Lap Band, or Laparoscopic Adjustable Gastric Banding (LAGB) has a shorter operative time (under 2 hours) and less time spent in the hospital compared to the Roux-en-Y. This procedure involves:

  • Placing an adjustable silicone band around the top part of the stomach which can be progressively inflated and tightened to restrict food intake.
  • The tightening or inflation is done through a port of reservoir placed under the skin of the abdomen.  

Some studies show similar success rates as the Roux-en-Y, however, a greater need for repeat surgery was reported for band slippage or port problems.

 

Sleeve Gastrectomy

Medically referred to as Laparoscopic Sleeve Gastrectomy (LSG), this procedure involves:

  • Changing the shape of the stomach from a pouch shape into a slim sleeve.
  • A portion of the stomach is removed to accommodate the new shape, which results in a decreased stomach volume.

LSG is a newer procedure with fewer published studies. Complications are supposed to be lower with this procedure because it does not include any surgical bypass and avoids implantation of devices. 

While this procedure is effective, the research seems to show that the Roux-en-Y procedure is significantly better for weight loss and improving insulin sensitivity. However, higher weight loss was found with this procedure versus the Lap Band surgery based on a 2012 review published in the Journal of World Diabetes.

What Type of Weight Loss Surgery is Best for Women With PCOS?

An April 2012 article in the World Journal of Diabetes published that Roux-en-Y lead to a higher degree of excess weight loss than both the Lap Band Surgery and the Sleeve Gastrectomy. Patient satisfaction was also found to have been higher with the Roux-en-Y.

It is important to have an open discussion with your physician about your surgical options and which procedure she prefers for you (and why). Make sure to do your research before your appointment and understand your options and goals for the surgery, as your PCOS symptoms and personal history may be different than others that your surgeon has operated on.

Getting a second opinion is always a good idea, especially if you have any concerns about your planned procedure.

Sources:

American Physiological Society. (2007, May 8). Lap Band Gastric Bypass Surgery Improves Insulin Resistance.

JAMA and Archives Journals. (2011, February 22). Gastric bypass surgery associated with improved health outcomes.

Malik, S. M., & Traub, M. L. (2012). Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World Journal of Diabetes

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