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Guide to Types of Weight Loss Surgery
When it comes to weight loss surgery, there are more options than ever to consider. Listen as Dr. Kevin Huguet, Medical Director at the Metabolic and Bariatric Surgery Center at St. Anthony's Hospital discusses the different types of weight loss surgery available, so you can make a better-informed decision.
Featured Speaker:
Dr. Huguet earned his medical degree from the University of South Florida College of Medicine in 2001, where he graduated at the top of his class and received the prestigious membership to the Alpha Omega Alpha Honor Medical Society. His internship and residency in general surgery were completed at the Mayo Clinic in 2006. In addition, Dr. Huguet completed a post-graduate fellowship in minimally invasive and bariatric surgery at the Mayo Clinic in 2007 where he was granted the title of Assistant Professor of Surgery for his research efforts.
Dr. Huguet is committed to providing compassionate, high-quality care to all of his patients through minimally invasive techniques. He was voted by his peers as a Top Doctors List member for Tampa Magazine in 2019 and 2020 and awarded membership to Florida’s Top Docs in 2020. He has been awarded the Compassionate Doctor Award 2014-2018 and the Patient’s Choice Award in 2019 for his compassionate care.
Dr. Huguet has served as the Chairman of the Department of Surgery or General Surgery for over a decade at St. Anthony’s Hospital, which also happens to be the hospital in which he was born. He is a Fellow of the American College of Surgeons and a member of multiple medical societies including the Society of Gastrointestinal and Endoscopic Surgeons and the American Society of Metabolic and Bariatric Surgery.
Outside of his clinical interests, Dr. Huguet enjoys spending time with his children and his wife, who was his high-school sweetheart.
Learn more about Dr. Kevin Huguet
Kevin Huguet, MD, MPH, FACS
Dr. Huguet is an award-winning surgeon, practicing at the Minimally Invasive Institute of Surgery in St. Petersburg, FL. He was born and raised in St. Pete, and feels honored to be a leader in the medical community of his lifelong home.Dr. Huguet earned his medical degree from the University of South Florida College of Medicine in 2001, where he graduated at the top of his class and received the prestigious membership to the Alpha Omega Alpha Honor Medical Society. His internship and residency in general surgery were completed at the Mayo Clinic in 2006. In addition, Dr. Huguet completed a post-graduate fellowship in minimally invasive and bariatric surgery at the Mayo Clinic in 2007 where he was granted the title of Assistant Professor of Surgery for his research efforts.
Dr. Huguet is committed to providing compassionate, high-quality care to all of his patients through minimally invasive techniques. He was voted by his peers as a Top Doctors List member for Tampa Magazine in 2019 and 2020 and awarded membership to Florida’s Top Docs in 2020. He has been awarded the Compassionate Doctor Award 2014-2018 and the Patient’s Choice Award in 2019 for his compassionate care.
Dr. Huguet has served as the Chairman of the Department of Surgery or General Surgery for over a decade at St. Anthony’s Hospital, which also happens to be the hospital in which he was born. He is a Fellow of the American College of Surgeons and a member of multiple medical societies including the Society of Gastrointestinal and Endoscopic Surgeons and the American Society of Metabolic and Bariatric Surgery.
Outside of his clinical interests, Dr. Huguet enjoys spending time with his children and his wife, who was his high-school sweetheart.
Learn more about Dr. Kevin Huguet
Transcription:
Deborah Howell (Host): Welcome to BayCare HealthChat. I'm Deborah Howell. And when it comes to weight loss surgery, there are more options than ever to consider. Today, we'll guide you through the different types of weight loss surgery available, so you can make a better-informed decision. I'm joined today by Dr. Kevin Huguet, Medical Director at the Metabolic and Bariatric Surgery Center at St. Anthony's Hospital. Dr. Huguet, it's so nice to have you with us today.
Dr Kevin Huguet: Wonderful. Thank you. It's nice to be here.
Deborah Howell (Host): Our pleasure. Let's start off with the different types of weight loss surgery. And first up is laparoscopic sleeve gastrectomy. Can you tell us what that entails and how long it takes to recover?
Dr Kevin Huguet: Yes, absolutely. So the laparoscopic sleeve gastrectomy is a procedure where you go in with little incisions and all the surgeries we're going to be talking today are done laparoscopically, meaning through small incisions. And you basically remove part of the stomach by stapling off a portion of the stomach, which is typically about 70% of the stomach removed. The surgery itself is probably the simplest weight loss surgery that's done these days. And on average, it would probably take about 20 to 30 minutes to perform the operation and often patients can go home either the same day or the next day.
Deborah Howell (Host): Great news. And what about recovery?
Dr Kevin Huguet: Afterwards, patients have some discomfort at just one particular incision site, typically, for a few days up to a week. And most patients will go back to work at about a week. There are special dietary considerations afterwards and we do have our patients on. And we give them a manual and there's a lot of teaching involved. But afterwards, we start out with a liquid diet to kind of protect the staple line and there's a slow advancement to solid foods over about a six-week period or so.
Deborah Howell (Host): Let's move on to gastric bypass surgery. How is this surgery performed and, again, the recovery period, and also expected weight loss?
Dr Kevin Huguet: Absolutely. So the gastric bypass is also done laparoscopically. Gastric bypass is one of the original weight loss operations that has been done for quite some time, several decades. And basically, instead of the sleeve gastrectomy where you just staple off and remove part of the stomach, the gastric bypass, you don't remove anything, but you do staple off the majority of the stomach, and then you reroute the intestines to attach to the gastric stomach pouch. And so it works two ways, by not allowing you to absorb your nutrients, and also restricting how much you can eat. The gastric bypass operation is a more involved surgery. It does take longer to do the operation, and it is a longer hospital stay. You're in the hospital usually for a couple days after the gastric bypass operation.
Deborah Howell (Host): And how much should a patient expect on average to lose?
Dr Kevin Huguet: So the weight loss with the gastric bypass ranges approximately 60 to 70% of the excess body weight a patient has. And most patients reach their goal weight at about one year on average.
Deborah Howell (Host): Pretty amazing. All right. Let's move on to revisional bariatric surgery. And how does one prepare for that, what's the recovery time and, again, how much weight loss is expected?
Dr Kevin Huguet: So, a revisional bariatric operation is one that is on a patient that's already had some kind of a weight loss surgery and has regained weight or had some kind of problems related to the original weight loss operation.
Typically, what we're seeing most of right now are patients who've had what's called a laparoscopic adjustable gastric band or a Lap-Band that was placed in the past. And for the most part, that operation isn't done anymore. And for the most part, most patients are having them removed. And so that would be a revisional surgery where we would remove the Lap-Band. And then, usually several months down the road, after some of the scar tissue heals, we do the second step operation, which is usually something like a sleeve gastrectomy or a gastric bypass. I think most patients are electing to move with the sleeve gastrectomy these days though.
Deborah Howell (Host): Okay. And why would somebody want their Lap-Band removed?
Dr Kevin Huguet: Well, the Lap-Band itself has a lot of its own issues with failure of weight loss or people having a hard time swallowing or acid reflux. And often sometimes, people have discomfort after they eat as well. And so it was something that was pretty popular, I'd say, about maybe 10 years ago, seven to 10 years ago. And then, longer term studies have shown that it did require more revisional surgery and it had a lower weight loss over the long-term than other operations.
Deborah Howell (Host): We have better options now, right?
Dr Kevin Huguet: Yes. And I think what really happened is the certain group of patients who really maybe didn't want to have very extensive surgery, such as a gastric bypass, but they were willing to have like a Lap-Band, because it was such a simple operation. When the sleeve gastrectomy came around about seven to 10 years ago, it kind of took over and then the Lap-Band went by the wayside because they had a better alternative.
Deborah Howell (Host): Got it. Okay. Lastly, let's talk about something called duodenal switch.
Dr Kevin Huguet: So, the duodenal switch is one of the more uncommon operations that's done for weight loss surgery. And it's kind of a combination of the sleeve gastrectomy and the gastric bypass because you do a sleeve gastrectomy, like you would for just a sleeve gastrectomy. And then, in addition to that, you perform what's called a malabsorptive operation where you reroute the intestinal contents, just like you would do with a gastric bypass. So it's a much more complex operation. It works really well. It's just sometimes it works too well, and it can have its own set of issues and complications such as malabsorption issues. And one of the problems we run into with the duodenal switch is it's just not really covered by insurance because it's a less common operation.
Deborah Howell (Host): Understood. If everything goes well, how much weight can one expect to lose on average with a duodenal switch?
Dr Kevin Huguet: So with the duodenal switch, you would end up losing more than like the gastric bypass. Instead of 60% to 70%, it's closer up to the higher near 70%, so high 60s excess weight loss. I think it's been shown to do the best at long-term weight loss. But, unfortunately with that, you get a lot of other risks that come with it.
Deborah Howell (Host): Understand. Now, thanks so much for that overview. And now, I would like to ask you about the risks associated with bariatric surgery. Can you please speak to that?
Dr Kevin Huguet: Absolutely. So, bariatric surgery has really evolved over, I'd say, the past 15 years or so. In decades past, it was something that was quite scary for patients because they may have had friends or family members who maybe had a really bad experience with weight loss surgery. And that was based on the techniques that were used so long ago. And I think with laparoscopy, in the past 15 to 20 years really evolving and our techniques evolving, we've really perfected a lot of the operations that make them much safer.
If we want to maybe rank these operations as least risk to most risk, the least risky by far would be like the sleeve gastrectomy. And I think that's why it's the most popular weight loss operation that we do in the US these days. It's because it's such a simple, straightforward operation. And really, there's two risks that I go over with patients that are isolated to the sleeve gastrectomy outside of the typical risk with any operation. And those two things would be, number one, the risk of heartburn. In my patient population, I see it in probably about five to 10% of patients. So that's just a side effect that patients have to be aware of before they decide if they want to do it. And then the other is a very small chance of a leak, and that would be a leak from the staple line. In my series of patients, I've done probably between 600 and 700 surgeries, it's about 0.005% or something like that, so very low number. So it's generally not a very risky operation at all for the sleeve gastrectomy.
And then, when you move down that ladder, the next would be the gastric bypass. Then, the most risky would be the duodenal switch. And so as you get to maybe more effective weight loss surgery, well, the trade-off with that is you do have more risks associated with that as well. And so those risks, sometimes if you're not following the right vitamin protocol, you can have vitamin deficiency issues. So you have to definitely follow up with your surgeon and stay on regular vitamins. And sometimes you have to have B12 injections or other routes of getting B12, so if you cannot absorb the B12 and that can cause problems with your blood counts and other things.
You definitely have to follow up after those other two operations because, without that, you'll get into trouble with vitamins and things like that. And besides that, there's other issues that can come up when you have these other operations where you can have hernias on the inside or blockages from the way that intestines are rerouted. And then, with the gastric bypass, one of the risks we worry about is ulcers can form at the connection and then that's a really difficult problem to treat as well.
Deborah Howell (Host): This is such good information. Is there anything else you'd like to add to someone considering weight loss surgery?
Dr Kevin Huguet: Oftentimes, I think patients think about it and they are a little bit intimidated by it and they fear something what they're considering so drastic, but we've got this operation now that I think is very safe, the sleeve gastrectomy. I think it's opened the doors for a lot of patients that maybe wouldn't have considered it in the past.
Patients also often feel like they're a failure if they have weight loss surgery. And every day in my office, we talk about this with my patients who are coming in new. And it's a whole different discussion, but it really is more they're fighting their own genetics in addition to some behavioral issues sometimes. And I think they need to not see it that way. And I think it really would help them understand what we're doing.
Deborah Howell (Host): Do you have aftercare and counselling?
Dr Kevin Huguet: We do. We have a huge support system. So we have our patient advocate who coaches the patient for all of their preoperative workup. And then postoperatively, we have a medical weight loss specialist who's a nurse practitioner, and her and myself coach the patients along. And once they have the operation, they're married to us forever. So we see them for the first year, probably about four to six times. And then after that, every year we see them for a checkup.
Deborah Howell (Host): Well, Dr. Huguet, this has been so enlightening. Thank you so much for all the good information you've given us today. We really appreciate it.
Dr Kevin Huguet: Absolutely. Thank you. It was very nice talking with you.
Deborah Howell (Host): And to learn more about weight loss surgery and all the services at BayCare, please visit BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together.
This is Deborah Howell. Have yourself a terrific day.
Deborah Howell (Host): Welcome to BayCare HealthChat. I'm Deborah Howell. And when it comes to weight loss surgery, there are more options than ever to consider. Today, we'll guide you through the different types of weight loss surgery available, so you can make a better-informed decision. I'm joined today by Dr. Kevin Huguet, Medical Director at the Metabolic and Bariatric Surgery Center at St. Anthony's Hospital. Dr. Huguet, it's so nice to have you with us today.
Dr Kevin Huguet: Wonderful. Thank you. It's nice to be here.
Deborah Howell (Host): Our pleasure. Let's start off with the different types of weight loss surgery. And first up is laparoscopic sleeve gastrectomy. Can you tell us what that entails and how long it takes to recover?
Dr Kevin Huguet: Yes, absolutely. So the laparoscopic sleeve gastrectomy is a procedure where you go in with little incisions and all the surgeries we're going to be talking today are done laparoscopically, meaning through small incisions. And you basically remove part of the stomach by stapling off a portion of the stomach, which is typically about 70% of the stomach removed. The surgery itself is probably the simplest weight loss surgery that's done these days. And on average, it would probably take about 20 to 30 minutes to perform the operation and often patients can go home either the same day or the next day.
Deborah Howell (Host): Great news. And what about recovery?
Dr Kevin Huguet: Afterwards, patients have some discomfort at just one particular incision site, typically, for a few days up to a week. And most patients will go back to work at about a week. There are special dietary considerations afterwards and we do have our patients on. And we give them a manual and there's a lot of teaching involved. But afterwards, we start out with a liquid diet to kind of protect the staple line and there's a slow advancement to solid foods over about a six-week period or so.
Deborah Howell (Host): Let's move on to gastric bypass surgery. How is this surgery performed and, again, the recovery period, and also expected weight loss?
Dr Kevin Huguet: Absolutely. So the gastric bypass is also done laparoscopically. Gastric bypass is one of the original weight loss operations that has been done for quite some time, several decades. And basically, instead of the sleeve gastrectomy where you just staple off and remove part of the stomach, the gastric bypass, you don't remove anything, but you do staple off the majority of the stomach, and then you reroute the intestines to attach to the gastric stomach pouch. And so it works two ways, by not allowing you to absorb your nutrients, and also restricting how much you can eat. The gastric bypass operation is a more involved surgery. It does take longer to do the operation, and it is a longer hospital stay. You're in the hospital usually for a couple days after the gastric bypass operation.
Deborah Howell (Host): And how much should a patient expect on average to lose?
Dr Kevin Huguet: So the weight loss with the gastric bypass ranges approximately 60 to 70% of the excess body weight a patient has. And most patients reach their goal weight at about one year on average.
Deborah Howell (Host): Pretty amazing. All right. Let's move on to revisional bariatric surgery. And how does one prepare for that, what's the recovery time and, again, how much weight loss is expected?
Dr Kevin Huguet: So, a revisional bariatric operation is one that is on a patient that's already had some kind of a weight loss surgery and has regained weight or had some kind of problems related to the original weight loss operation.
Typically, what we're seeing most of right now are patients who've had what's called a laparoscopic adjustable gastric band or a Lap-Band that was placed in the past. And for the most part, that operation isn't done anymore. And for the most part, most patients are having them removed. And so that would be a revisional surgery where we would remove the Lap-Band. And then, usually several months down the road, after some of the scar tissue heals, we do the second step operation, which is usually something like a sleeve gastrectomy or a gastric bypass. I think most patients are electing to move with the sleeve gastrectomy these days though.
Deborah Howell (Host): Okay. And why would somebody want their Lap-Band removed?
Dr Kevin Huguet: Well, the Lap-Band itself has a lot of its own issues with failure of weight loss or people having a hard time swallowing or acid reflux. And often sometimes, people have discomfort after they eat as well. And so it was something that was pretty popular, I'd say, about maybe 10 years ago, seven to 10 years ago. And then, longer term studies have shown that it did require more revisional surgery and it had a lower weight loss over the long-term than other operations.
Deborah Howell (Host): We have better options now, right?
Dr Kevin Huguet: Yes. And I think what really happened is the certain group of patients who really maybe didn't want to have very extensive surgery, such as a gastric bypass, but they were willing to have like a Lap-Band, because it was such a simple operation. When the sleeve gastrectomy came around about seven to 10 years ago, it kind of took over and then the Lap-Band went by the wayside because they had a better alternative.
Deborah Howell (Host): Got it. Okay. Lastly, let's talk about something called duodenal switch.
Dr Kevin Huguet: So, the duodenal switch is one of the more uncommon operations that's done for weight loss surgery. And it's kind of a combination of the sleeve gastrectomy and the gastric bypass because you do a sleeve gastrectomy, like you would for just a sleeve gastrectomy. And then, in addition to that, you perform what's called a malabsorptive operation where you reroute the intestinal contents, just like you would do with a gastric bypass. So it's a much more complex operation. It works really well. It's just sometimes it works too well, and it can have its own set of issues and complications such as malabsorption issues. And one of the problems we run into with the duodenal switch is it's just not really covered by insurance because it's a less common operation.
Deborah Howell (Host): Understood. If everything goes well, how much weight can one expect to lose on average with a duodenal switch?
Dr Kevin Huguet: So with the duodenal switch, you would end up losing more than like the gastric bypass. Instead of 60% to 70%, it's closer up to the higher near 70%, so high 60s excess weight loss. I think it's been shown to do the best at long-term weight loss. But, unfortunately with that, you get a lot of other risks that come with it.
Deborah Howell (Host): Understand. Now, thanks so much for that overview. And now, I would like to ask you about the risks associated with bariatric surgery. Can you please speak to that?
Dr Kevin Huguet: Absolutely. So, bariatric surgery has really evolved over, I'd say, the past 15 years or so. In decades past, it was something that was quite scary for patients because they may have had friends or family members who maybe had a really bad experience with weight loss surgery. And that was based on the techniques that were used so long ago. And I think with laparoscopy, in the past 15 to 20 years really evolving and our techniques evolving, we've really perfected a lot of the operations that make them much safer.
If we want to maybe rank these operations as least risk to most risk, the least risky by far would be like the sleeve gastrectomy. And I think that's why it's the most popular weight loss operation that we do in the US these days. It's because it's such a simple, straightforward operation. And really, there's two risks that I go over with patients that are isolated to the sleeve gastrectomy outside of the typical risk with any operation. And those two things would be, number one, the risk of heartburn. In my patient population, I see it in probably about five to 10% of patients. So that's just a side effect that patients have to be aware of before they decide if they want to do it. And then the other is a very small chance of a leak, and that would be a leak from the staple line. In my series of patients, I've done probably between 600 and 700 surgeries, it's about 0.005% or something like that, so very low number. So it's generally not a very risky operation at all for the sleeve gastrectomy.
And then, when you move down that ladder, the next would be the gastric bypass. Then, the most risky would be the duodenal switch. And so as you get to maybe more effective weight loss surgery, well, the trade-off with that is you do have more risks associated with that as well. And so those risks, sometimes if you're not following the right vitamin protocol, you can have vitamin deficiency issues. So you have to definitely follow up with your surgeon and stay on regular vitamins. And sometimes you have to have B12 injections or other routes of getting B12, so if you cannot absorb the B12 and that can cause problems with your blood counts and other things.
You definitely have to follow up after those other two operations because, without that, you'll get into trouble with vitamins and things like that. And besides that, there's other issues that can come up when you have these other operations where you can have hernias on the inside or blockages from the way that intestines are rerouted. And then, with the gastric bypass, one of the risks we worry about is ulcers can form at the connection and then that's a really difficult problem to treat as well.
Deborah Howell (Host): This is such good information. Is there anything else you'd like to add to someone considering weight loss surgery?
Dr Kevin Huguet: Oftentimes, I think patients think about it and they are a little bit intimidated by it and they fear something what they're considering so drastic, but we've got this operation now that I think is very safe, the sleeve gastrectomy. I think it's opened the doors for a lot of patients that maybe wouldn't have considered it in the past.
Patients also often feel like they're a failure if they have weight loss surgery. And every day in my office, we talk about this with my patients who are coming in new. And it's a whole different discussion, but it really is more they're fighting their own genetics in addition to some behavioral issues sometimes. And I think they need to not see it that way. And I think it really would help them understand what we're doing.
Deborah Howell (Host): Do you have aftercare and counselling?
Dr Kevin Huguet: We do. We have a huge support system. So we have our patient advocate who coaches the patient for all of their preoperative workup. And then postoperatively, we have a medical weight loss specialist who's a nurse practitioner, and her and myself coach the patients along. And once they have the operation, they're married to us forever. So we see them for the first year, probably about four to six times. And then after that, every year we see them for a checkup.
Deborah Howell (Host): Well, Dr. Huguet, this has been so enlightening. Thank you so much for all the good information you've given us today. We really appreciate it.
Dr Kevin Huguet: Absolutely. Thank you. It was very nice talking with you.
Deborah Howell (Host): And to learn more about weight loss surgery and all the services at BayCare, please visit BayCare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together.
This is Deborah Howell. Have yourself a terrific day.