What are the side effects of weight loss surgery?

Question

Hello Doctor,

I have been struggling with my weight for over 15 years now, and nothing seems to work long-term. Currently, I weigh 286 pounds and am five feet four inches tall, giving me a body mass index (BMI) of 49.1. I have type 2 diabetes, obstructive sleep apnea, and hypertension.

My hemoglobin A1C is 8.7 % despite taking Metformin 1000 mg twice daily (Biguanide class) and Glipizide 10 mg (Sulfonylurea class). I use continuous positive airway pressure (CPAP) therapy every night, but I still wake up exhausted. My blood pressure averages 162/94 mmHg, even though I am taking Lisinopril 40 mg and Amlodipine 10 mg (Calcium Channel Blocker).

I have tried Weight Watchers, the ketogenic diet, intermittent fasting, and even Tirzepatide (brand name: Mounjaro – GLP-1 and GIP Receptor Agonist), but the side effects were so severe that I had to discontinue it after two months.

The excess weight has severely affected my knees. I underwent right knee replacement last year, and my orthopedic surgeon has advised that the left knee also requires replacement. However, he has requested that I lose weight first. My cardiologist is also concerned because my latest echocardiogram showed left ventricular hypertrophy.

Due to chronic joint pain, the only exercise I can currently manage is water aerobics twice weekly. My primary care physician has finally referred me to a bariatric surgeon, but I am terrified about possible complications.

Would laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) be a better choice given my medical conditions? How much diabetes medication would I still need after surgery?

My biggest fear is undergoing major surgery and still not losing enough weight to improve my health issues. Additionally, my best friend underwent Roux-en-Y gastric bypass three years ago and has regained half of the weight, which makes me question whether the risks are worth it.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Both laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) can be effective for someone with your medical conditions. However, they offer different risk and benefit profiles.

Gastric sleeve surgery involves removing a portion of the stomach, which leads to a reduction in appetite and food intake. This can result in significant weight loss and improvements in conditions such as type 2 diabetes, obstructive sleep apnea, and hypertension.

Gastric bypass surgery reroutes part of the digestive tract and alters how your body absorbs nutrients. It is known to result in even greater weight loss and superior blood sugar and cholesterol control. However, it carries a higher risk of micronutrient deficiencies, including deficiencies in iron, calcium, vitamin B12, and folate, which require lifelong supplementation.

The amount of antidiabetic medication required after surgery varies from patient to patient. Many individuals experience significant reductions in dosage or complete remission of type 2 diabetes following surgery, especially with Roux-en-Y gastric bypass.

Please note that long-term success with either procedure greatly depends on your adherence to dietary guidelines, nutritional supplementation, physical activity, and regular medical follow-up.

It is important to have a thorough discussion with your bariatric surgeon to explore which procedure aligns better with your health status and goals. You may also benefit from hearing real-life experiences from other patients who have undergone these surgeries.

I hope this helps.

Thank you.