Expert: John Pilcher, MD - 5/19/2009

Question
I'm a 48 y/o ER physician who is struggling with Metabolic Syndrome over 5 years. My diabetes is killing me! I have a BMI of 35. What type of surgery should I have???

Answer
Arturo,
Thanks for writing.  Given that you have been fighting this losing battle against weight and its complications for years, I can say clearly that it is appropriate for you to consider more extreme intervention in the form of bariatric surgery.

Of the types of bariatric surgery that are commonly performed, the only one I would not be able to support in your case is the BPD-DS, because of the dramatic weight loss (probably too much) and the nutritional complications.  Each of the others has advantages and disadvantages, but I think you can be fully successful with any of these:

Gastric Bypass - probably best in terms of the beneficial effect in re-balancing the abnormalities associated with metabolic syndrome.  Likely to create lots of weight loss, perhaps even too much.  Low maintenance.

Gastric Band - the "lightest" procedure that is well established.  Least downtime.  Less weight loss on average.  Higher maintenance.

Gastric Sleeve - more invasive than the Band, but with better weight loss and lower maintenance.  Has not been in use long enough to have confidence with long-term outcomes; there seems to be a reasonable chance of long term weight regain.

Best of luck!
Dr JP