Types of Weight Loss Surgery for Women With PCOS

Bariatric surgery can be an effective way of achieving weight loss for females with polycystic ovarian syndrome (PCOS) who are obese. For people with PCOS who are obese, 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.

Bariatric surgery has been around since the 1960s, and now most of the procedures are performed laparoscopically, 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

Laparoscopic Roux-en-Y Gastric Bypass is a widely performed procedure. This procedure causes food to bypass most of the gastrointestinal tract that absorbs nutrients and calories.

The surgery involves the following:

• Rearranging the gastrointestinal (GI) tract so that food bypasses a majority of the stomach and small intestine.
• Creating a small pouch at the top of the stomach.
• Making a second incision at the lower part of the small intestine, which is then connected to the pouch made at the top of the stomach.

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 as Laparoscopic 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:

• Removing a major portion of the stomach
• Closing the remaining portion of your stomach using surgical staples, creating a long, vertical "sleeve" or banana-sized stomach.

Complications such as nutrient deficiencies are less common with this procedure, and it does not include surgical bypass or device implantation.

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 as Lap 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.

This procedure involves:

• Placing an adjustable silicone band containing a circular balloon around the top part of the stomach.
• Adjusting the size of the opening from the pouch to the rest of your stomach by injecting or removing saline solution into the balloon through a small device (port) placed under your skin.

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.