|
Modality of Weight Loss |
Restrictive and Malabsorptive
(stomach and intestines) |
Restrictive
(stomach only) |
| 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. |
| |
|
|
|
|
| Mechanism |
Significantly restricts the
volume of food that can be consumed.
Mild malabsorption
"Dumping Syndrome" when sugar or fats are eaten
|
Moderately restricts the volume
of food that can be consumed.
Moderate malabsorption of fat causing diarrhoea and bloating
|
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
|
70% loss of excess weight
More failures (loss of <50% excess weight) than the DS
|
80% loss of excess weight
More patients lose too much weight or develop nutritional
problems than the RNY |
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 1000
calories per day in the first 12-24 months, 1200-1500 thereafter
Consumption of fatty foods causes diarrhoea 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 |
Must consume less than 600-800
calories per day for the first 24 months, 1000-1200 thereafter
No dumping, no diarrhoea
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
ADEK vitamins
Calcium
Iron (menstruating women) |
Multivitamin
Calcium |
Multivitamin
Calcium |
| Potential Problems |
Dumping syndrome
Stricture
Ulcers
Bowel obstruction
Anaemia
Vitamin/mineral deficiencies (Iron, Vitamin B12, folate)
Leak |
Nausea and vomiting
Heartburn
Severe diarrhoea
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 |
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 |
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. |
