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Modality of Weight Loss
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Restrictive and Malabsorptive
(stomach and intestines)
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Restrictive (stomach only)
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| Type of Operation |
Roux-en-Y Gastric Bypass Surgery |
Vertical Gastrectomy with Duodenal Switch |
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 vertical pouch measuring about 4-5 oz (120-150cc). The duodenum (first portion of the small intestine) is connected to the last 6 feet of small intestine. Food and digestive fluids are separated for more than 12 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
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Moderately Restricts the volume of food that can be consumed.
Moderate malabsorption of fat causing diarrhea and bloating
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Significantly restricts the volume of food that can be consumed.
NO malabsorption
NO dumping
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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
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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
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80% loss of excess weight
More patients lose too much weight or develop nutritional problems than the RNY
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60%-70% excess weight loss at 2 years
Long term results not available at this time.
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60% excess weight loss.
Requires the most effort of all procedures to be successful.
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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
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Must consume less than 1000 calories per day in the first 12-24 months, 1200-1500 thereafter
Consumption of fatty foods causes diarrhea and malodorous gas/stool
Failure to adhere to vitamin supplement regimen and consumption of high protein meals more likely to result in deficiency than RNY
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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
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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
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| Nutritional Supplements Needed (Lifetime) |
Multivitamin
Vitamin B12
Calcium
Iron (menstruating women)
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Multivitamin
ADEK vitamins
Calcium
Iron (menstruating women)
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Multivitamin
Calcium
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Multivitamin
Calcium
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| Potential Problems |
Dumping syndrome
Stricture
Ulcers
Bowel obstruction
Anemia
Vitamin/mineral deficiencies (Iron, Vitamin B12, folate)
Leak
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Nausea and vomiting
Heartburn
Severe diarrhea
Kidney stones
Stricture
Ulcers (less than RNY)
Bowel obstruction
Nutritional/Vitamin deficiencies (Vitamin A,D,E,K)?Loss of too much weight requiring reoperation
Leak
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Nausea and vomiting
Heartburn
Inadequate weight loss
Weight regain
Additional procedure may be needed to obtain adequate weight loss
Leak
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Slow weight loss
Slippage
Erosion
Infection
Port problems
Device malfunction
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| Hospital Stay |
2-3 days |
3-4 days |
1-2 days |
Overnight (<1 day) |
| Time off Work |
2-3 weeks |
2-3 weeks |
1-2 weeks |
1 week |
| Operating Time |
2 hours |
3 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. |
Best for patients with a BMI of > 50 kg/m2. Those with BMI of <45 kg/m2 may lose too much weight. Higher overall incidence of complications than other procedures. Most insurance companies will NOT 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. |
