Bariatric surgery can be an effective way of achieving weight loss for those withpolycystic ovarian syndrome (PCOS)living with obesity. For people with PCOS and obesity, significant weight loss is associated with the reversal of many of the PCOS-associated health problems, such as insulin resistance, irregular periods, infertility, and hyperandrogenism. However, more research is needed to fully understand the benefits and risks of this treatment in this population.
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Bariatric surgery has been around since the 1960s,and now most of the procedures are performedlaparoscopically, through a series of small incisions using a camera inside the body.
Choosing the Best Type of Weight Loss Procedure for You
The decision to have weight loss surgery, finding your surgeon, and ultimately determining what type of surgery to have requires a great deal of consideration. Several types of surgery are available, and your surgeon will likely have a recommendation as to which will be most effective for your PCOS.
It’s important to choose a surgeon who has experience working with PCOS. As with all surgeries, each procedure has its advantages and disadvantages.
Roux-en-Y
The surgery involves the following:
Roux-en-Y can be very effective at reversing insulin resistance in people who have diabetes.Insulin resistance is a significant problem for people with PCOS.
This procedure carries a higher risk of gastrointestinal malabsorption than some of the other types of weight loss surgery. Supplements are prescribed to prevent severe nutritional deficits. You will also need to have close monitoring and frequent follow-up appointments so your doctors can keep an eye on your nutritional status.
Other risks associated with this procedure include gallstones, intestinal blockage, leakage through sutures or staples, and dumping syndrome (a condition in which certain foods or drinks cause severe cramping and diarrhea).
Sleeve Gastrectomy
Medically referred to asLaparoscopic Sleeve Gastrectomy (LSG), this surgery has been performed as a standalone surgery for fewer than twenty years—and it has become a popular bariatric procedure in the United States.
This procedure involves:
Although the Roux-en-Y procedure is slightly more effective over the long term for weight loss, the newest research is showing that other benefits, such as improved insulin sensitivity and other metabolic benefits, are similar between Roux-en-Y procedures and LSG.
Lap Band
Laparoscopic Adjustable Gastric Banding (LAGB), referred to asLap Band,requires a shorter operative time (less than 2 hours) and reduced time in the hospital compared to those of the Roux-en-Y and LSG.
Thisprocedure involves:
Patients need several follow-up visits to adjust the size of the band opening. If it causes problems or is not helping you lose enough weight, your surgeon may remove it.
The impact on obesity-related diseases and long-term weight loss is less than with other procedures. Its use has therefore declined over the past decade.And a higher need for repeat surgery has been reported due to band slippage or port problems.
Best Options for PCOS
Roux-en-Y leads to a slightly higher loss of excess weight than LSG does, and both lead to more excess weight loss than LAGB.
It is important to have a discussion with your healthcare provider about your surgical options and to determine which procedure they believe would be best for you. Do your own research before your appointment so that you understand your options and goals for surgery—your PCOS symptoms and personal history are unique to you, even if your surgeon has experience treating people with PCOS.
Getting a second opinion can be a good idea before such a significant procedure.
7 Sources
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Lee R, Joy Mathew C, Jose MT, Elshaikh AO, Shah L, Cancarevic I.A review of the impact of bariatric surgery in women with polycystic ovary syndrome.Cureus. 2020 Oct 5;12(10):e10811. doi:10.7759/cureus.10811
Akst J.Deadly bariatrics.The Scientist,
American Society for Metabolic and Bariatric Surgery.Bariatric surgery procedures.
Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B.Bariatric surgery and long-term nutritional issues.World J Diabetes. 2017;8(11):464-474. doi:10.4239/wjd.v8.i11.464
Malik SM, Traub ML.Defining the role of bariatric surgery in polycystic ovarian syndrome patients.World J Diabetes. 2012;3(4):71-9. doi:10.4239/wjd.v3.i4.71
US National Library of Medicine.Weight loss surgery.
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