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 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 |
· Moderately Restricts the volume of food that can be consumed.
· Moderate malabsorption of fat causing diarrhea 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
United States Average statistical loss at 10 years |
· 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 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 |
· 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
· ADEK vitamins
· 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
· 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 |
· 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. |