Modality of Weight Loss |
Restrictive and Malabsorptive
(stomach and intestines) |
Restrictive (stomach only) |
| Type of Operation |
Roux-en-Y Gastric Bypass Surgery |
Vertical Sleeve Gastrectomy |
Lap-Band Surgical Procedure |
| Anatomy |
Small 1 ounce pouch (20-30cc) connected to the small intestine. Food and digestive juices are separated for 3-5 feet. |
Long narrow vertical pouch measuring 2-3 oz (60-100cc). Identical to the duodenal switch pouch but smaller. No intestinal bypass performed. |
An adjustable silicone ring (band) is placed around the top part of the stomach creating a small 1-2 ounce (15-30cc) pouch. |
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| Mechanism |
Significantly restricts the volume of food that can be consumed.
Mild malabsorption
"Dumping Syndrome" when sugar or fats are eaten |
Significantly restricts the volume of food that can be consumed.
NO malabsorption
NO dumping |
Moderately restricts the volume and type of foods able to be eaten.
Only procedure that is adjustable
Delays emptying of pouch
Creates sensation of fullness |
Weight Loss
United States Average statistical loss at 10 years |
70% loss of excess weight
More failures (loss of <50% excess weight) than the DS |
60%-70% excess weight loss at 2 years
Long term results not available at this time. |
60% excess weight loss.
Requires the most effort of all procedures to be successful. |
Long Term Dietary Modification
(Excessive carbohydrate/high calorie intake will defeat all procedures) |
Patients must consume less than 800 calories per day in the first 12-18 months; 1000-1200 thereafter?3 small high protein meals per day
Must avoid sugar and fats to prevent "Dumping Syndrome"
Vitamin deficiency/protein deficiency usually preventable with supplements |
Must consume less than 600-800 calories per day for the first 24 months, 1000-1200 thereafter
No dumping, no diarrhea
Weight regain may be more likely than in other procedures if dietary modifications not adopted for life |
Must consume less than 800 calories per day for 18-36 months, 1000-1200 thereafter.
Certain foods can get "stuck" if eaten (rice, bread, dense meats, nuts, popcorn) causing pain and vomiting.
No drinking with meals |
| Nutritional Supplements Needed (Lifetime) |
Multivitamin
Vitamin B12
Calcium
Iron (menstruating women) |
Multivitamin
Calcium |
Multivitamin
Calcium |
| Potential Problems |
Dumping syndrome
Stricture
Ulcers
Bowel obstruction
Anemia
Vitamin/mineral deficiencies (Iron, Vitamin B12, folate)
Leak |
Nausea and vomiting
Heartburn
Inadequate weight loss
Weight regain
Additional procedure may be needed to obtain adequate weight loss
Leak |
Slow weight loss
Slippage
Erosion
Infection
Port problems
Device malfunction |
| Hospital Stay |
2-3 days |
1-2 days |
Overnight (<1 day) |
| Time off Work |
2-3 weeks |
1-2 weeks |
1 week |
| Operating Time |
2 hours |
1.5 hours |
1 hour |
| Recommendation |
Most effective for patients with a BMI of 35-55 kg/m2 and those with a "sweet-tooth". Virtually all insurance companies will authorize this procedure. |
Utilized for high risk or very heavy (BMI > 60 kg/m2) patients as a "first-stage" procedure. Very low complication rate due to quicker OR time and no intestinal bypass performed. Insurance companies will authorize this procedure in select patients. |
Best for patients who enjoy participating in an exercise program and are more disciplined in following dietary restrictions. Many insurance companies will NOT authorize this procedure. |
