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.

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.